Older migrants from low- and middle-income countries living in Swedish care settings, who typically enjoy a mortality advantage and higher life expectancy compared to the native-born population, faced a higher risk of death from Covid-19 during the first year of the pandemic. This reversal of the established migrant mortality advantage is documented in a new study from Stockholm University, published in the European Journal of Public Health.
Before the pandemic, data from 2019 confirmed that older migrants in institutional care had lower mortality rates than Swedish-born older individuals in similar settings. This pattern has been consistently observed across various high-income countries: despite socioeconomic disadvantages, migrants—particularly those from non-Western countries—tend to experience lower mortality than natives.
The Covid-19 pandemic disrupted this pattern. During its first year, older migrants in care settings were significantly more likely to die than their Swedish-born counterparts. Even after controlling for prior diseases and other background factors, the disadvantage persisted.
This finding is striking because care settings are highly regulated environments where residents share similar routines, exposure levels, and standards of care. Researchers had expected that institutional living would equalise risks between migrant and native populations, especially since previous studies tended to attributed higher Covid-19 mortality among immigrants in Sweden to differences in mobility and socialising patterns outside such controlled environments.
The study found that migrants were more likely to die from the virus mainly because they were more exposed to it, not because they were more vulnerable to its effects. Even after taking into account differences in health and socio-demographic characteristics, migrants still showed higher death rates. This suggests that the main problem was unequal exposure to infection. However, it is still unclear what caused this greater exposure. Future research should look at whether these patterns are driven by inequalities between institutions or within individual institutions.
Overall, the research indicates that while care institutions are designed to provide uniform protection and support, they may also reproduce broader social inequalities in ways that become visible only in times of crisis. Understanding why the migrant mortality advantage reversed under pandemic conditions requires further interdisciplinary investigation into the intersection of health systems, care practices, and inequality.
Such insights are essential for developing future public health strategies that ensure not only consistent institutional standards but also genuine equity within them.