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Abstract
Introduction In Sweden, thousands of hospitalisations and deaths due to COVID-19 were reported since the pandemic started. Considering the uneven spatial distribution of those severe outcomes at the municipality level, the objective of this study was, first, to identify high-risk areas for COVID-19 hospitalisations and deaths, and second, to determine the associated contextual factors with the uneven spatial distribution of both study outcomes in Sweden.
Methods The existences of spatial autocorrelation of the standardised incidence (hospitalisations) ratio and standardised mortality ratio were investigated using Global Moran’s I test. Furthermore, we applied the retrospective Poisson spatial scan statistics to identify high-risk spatial clusters. The association between the contextual demographic and socioeconomic factors and the number of hospitalisations and deaths was estimated using a quasi-Poisson generalised additive regression model.
Results Ten high-risk spatial clusters of hospitalisations and six high-risk clusters of mortality were identified in Sweden from February 2020 to October 2020. The hospitalisations and deaths were associated with three contextual variables in a multivariate model: population density (inhabitants/km2) and the proportion of immigrants (%) showed a positive association with both outcomes, while the proportion of the population aged 65+ years (%) showed a negative association.
Conclusions Our study identified high-risk spatial clusters for hospitalisations and deaths due to COVID-19 and the association of population density, the proportion of immigrants and the proportion of people aged 65+ years with those severe outcomes. Results indicate where public health measures must be reinforced to improve sustained and future disease control and optimise the distribution of resources.
- COVID-19
- epidemiology
- public health
- other study design
Data availability statement
No data are available. The study used secondary registry data which are regulated by the Public Access to Information and Secrecy Act (2009:400) and are protected by strict confidentiality. For the purpose of research though, after formal application to access personal data, the responsible authority can grant access to data, though this is contingent on vetting by the Ethical Review Authority of Sweden, according to the Act (2003:460) concerning the Ethical Review of Research Involving Humans.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
No data are available. The study used secondary registry data which are regulated by the Public Access to Information and Secrecy Act (2009:400) and are protected by strict confidentiality. For the purpose of research though, after formal application to access personal data, the responsible authority can grant access to data, though this is contingent on vetting by the Ethical Review Authority of Sweden, according to the Act (2003:460) concerning the Ethical Review of Research Involving Humans.
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Footnotes
Handling editor Seye Abimbola
Twitter @Fonseca_Osvaldo
Contributors OFR: Conceptualisation, study design, data curation, formal analysis, software, visualisation, data interpretation and writing—original draft. PEG and MSS: Methodology, data interpretation, supervision and writing—review and editing. A-MFC: Investigation, funding acquisition, supervision, project administration, resources, data interpretation and writing—review and editing.
Funding Strategic funding during 2020 from the Department of Clinical Microbiology, Umeå University (A-MFC); Central ALF funding from Region Västerbotten (RV-836351) (A-MFC) and Base Unit ALF funding Clinical Microbiology (RV-939769) (A-MFC), Laboratory of Molecular Infection Medicine Sweden.
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Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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