Risk of Dying From COVID-19 is Greater for Men, Unmarried and Born in Low- and Middle-Income Countries

Sven Drefahl. Courtesy of Leila Zoubir/Stockholm University

Being a man, having a lower income, having a lower level of education, not being married, and being born abroad in low- or middle-income countries - these are factors that, independent of one another, are related to an elevated risk of dying from COVID-19 in Sweden. These are the findings of a new study in the journal Nature Communications from Stockholm University.

"We can show that there are independent effects of various separate risk factors that have been brought up in debates and news about COVID-19. All of these factors are accordingly individually associated with a strongly elevated risk of dying from COVID-19," said Sven Drefahl, associate professor of demography at Stockholm University Demography Unit in the Department of Sociology, and main-author of the study.

When it comes to the elevated risk for people from low- and middle-income countries in, for example, the Middle East and North Africa of dying from COVID-19, it does not agree with the general patterns of mortality for that group.  Drefahl explains that those born abroad generally have a lower mortality than people born in Sweden. This also applies when the research took income and level of education into account. The elevated risk of dying from COVID-19 for this group remains after the researchers controlled for circumstances, such as income and level of education. The study also shows that the risk of dying from COVID-19 was much higher in the Stockholm area than outside, both for those born in Sweden and those born abroad, which can be explained by the spread of disease being greater in that area.

The study shows that being a man, having a lower income and lower level of education also result in a strongly elevated risk of dying from COVID-19. As to these aspects, this also agrees with the patterns for mortality from other diseases.

"Men generally have a higher mortality at comparable ages, which is considered to be due to a combination of biology and lifestyle. The fact that people with little education or a low income have a higher mortality may largely be due to lifestyle factors including finances -- how much one can afford to prioritize one's health. Similarly, we can explain the elevated mortality from COVID-19 for these groups," said co-author Gunnar Andersson.

A number of earlier studies have also shown that single and unmarried people have a higher mortality from various diseases. This is usually to some part explained by selection, meaning that people who have worse health from the beginning are less attractive on the partner market and therefore get married to a lesser degree. "The explanation is also considered to be in singles having a less protected environment than those who live in a couple relationship. Accordingly, marriage can lead to a healthier life with a lower risk of disease than for the unmarried. This can also explain the elevated risk of dying from COVID-19 for unmarried individuals shown by our study," said Drefahl.

Source: Stockholm University

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