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COVID-19 vaccination coverage and the effect on regional disparities in morbidity and mortality among older people in Sweden, 2021-2023

Nilsson, Anton LU ; Dietler, Dominik LU orcid ; Bonander, Carl ; Inghammar, Malin LU and Björk, Jonas LU orcid (2026) In Scandinavian Journal of Public Health p.1-9
Abstract

AIMS: The COVID-19 pandemic had substantial impacts on mortality and morbidity, even after the rollout of vaccinations. These impacts however, varied considerably across regions. We examined regional disparities in COVID-19 mortality and hospitalizations among older people in Sweden from January 2021 to August 2023 and assessed the role of vaccination coverage in shaping these disparities.

METHODS: Using full-population data on people in Sweden born in 1955 or earlier, we created a nested case-control study. Conditional logistic regressions with county fixed effects were estimated across three periods of vaccination rollout (Doses 1-2, 3-4, and 5-6). County fixed effects were compared across models with and without vaccination... (More)

AIMS: The COVID-19 pandemic had substantial impacts on mortality and morbidity, even after the rollout of vaccinations. These impacts however, varied considerably across regions. We examined regional disparities in COVID-19 mortality and hospitalizations among older people in Sweden from January 2021 to August 2023 and assessed the role of vaccination coverage in shaping these disparities.

METHODS: Using full-population data on people in Sweden born in 1955 or earlier, we created a nested case-control study. Conditional logistic regressions with county fixed effects were estimated across three periods of vaccination rollout (Doses 1-2, 3-4, and 5-6). County fixed effects were compared across models with and without vaccination adjustment. Further, the benefits of vaccination coverage corresponding to the most successful regions were evaluated with potential impact fractions (PIFs).

RESULTS: Across counties, the final shares of vaccinated individuals ranged from 94% to 98% for Doses 1 and 2, 90% to 96% for Dose 3, 80% to 91% for Dose 4, 65% to 83% for Dose 5, and 13% to 47% for Dose 6. In models without vaccination adjustments, COVID-19 mortality ranged from -56% to +75% relative to an average county, and hospitalizations from -45% to +51%. Vaccination adjustment had little impact on the disparities. Overall PIFs were 8% to 11% for mortality and 7% to 8% for hospitalizations, with greater PIFs in urban counties.

CONCLUSIONS:
While higher vaccination coverage, especially in urban areas, could have prevented COVID-19 deaths and hospitalizations among older adults in Sweden, the vaccinations were not a major driver of regional disparities in these outcomes.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Scandinavian Journal of Public Health
pages
1 - 9
publisher
SAGE Publications
external identifiers
  • pmid:41731352
ISSN
1651-1905
DOI
10.1177/14034948261420643
language
English
LU publication?
yes
id
85d88923-7dfc-40e3-b939-dd6b1a037e74
date added to LUP
2026-03-05 07:37:12
date last changed
2026-03-05 08:03:19
@article{85d88923-7dfc-40e3-b939-dd6b1a037e74,
  abstract     = {{<p>AIMS: The COVID-19 pandemic had substantial impacts on mortality and morbidity, even after the rollout of vaccinations. These impacts however, varied considerably across regions. We examined regional disparities in COVID-19 mortality and hospitalizations among older people in Sweden from January 2021 to August 2023 and assessed the role of vaccination coverage in shaping these disparities.</p><p>METHODS: Using full-population data on people in Sweden born in 1955 or earlier, we created a nested case-control study. Conditional logistic regressions with county fixed effects were estimated across three periods of vaccination rollout (Doses 1-2, 3-4, and 5-6). County fixed effects were compared across models with and without vaccination adjustment. Further, the benefits of vaccination coverage corresponding to the most successful regions were evaluated with potential impact fractions (PIFs).</p><p>RESULTS: Across counties, the final shares of vaccinated individuals ranged from 94% to 98% for Doses 1 and 2, 90% to 96% for Dose 3, 80% to 91% for Dose 4, 65% to 83% for Dose 5, and 13% to 47% for Dose 6. In models without vaccination adjustments, COVID-19 mortality ranged from -56% to +75% relative to an average county, and hospitalizations from -45% to +51%. Vaccination adjustment had little impact on the disparities. Overall PIFs were 8% to 11% for mortality and 7% to 8% for hospitalizations, with greater PIFs in urban counties.</p><p>CONCLUSIONS: <br>
 While higher vaccination coverage, especially in urban areas, could have prevented COVID-19 deaths and hospitalizations among older adults in Sweden, the vaccinations were not a major driver of regional disparities in these outcomes.<br>
 </p>}},
  author       = {{Nilsson, Anton and Dietler, Dominik and Bonander, Carl and Inghammar, Malin and Björk, Jonas}},
  issn         = {{1651-1905}},
  language     = {{eng}},
  month        = {{02}},
  pages        = {{1--9}},
  publisher    = {{SAGE Publications}},
  series       = {{Scandinavian Journal of Public Health}},
  title        = {{COVID-19 vaccination coverage and the effect on regional disparities in morbidity and mortality among older people in Sweden, 2021-2023}},
  url          = {{http://dx.doi.org/10.1177/14034948261420643}},
  doi          = {{10.1177/14034948261420643}},
  year         = {{2026}},
}