The effects of COVID-19 vaccination on cardiovascular outcomes: an analysis exploiting temporal variation in vaccination eligibility

Anton Nilsson, Carl Bonander, Jonas Björk, Dominik Dietler, and Tove Fall

This project will investigate the short-term effects of COVID-19 vaccinations on cardiovascular (CV) outcomes. Previous evidence has shown that vaccination against COVID-19 may lead to short-term adverse CV events, particularly myocarditis and pericarditis. At the same time, several adverse CV consequences of COVID-19 have also been documented, meaning that COVID-19 vaccination may be protective against certain CV outcomes via its protection against COVID-19. For more credible conclusions on these issues, more evidence is needed, however.

The Lockdown Cohort -effect: The COVID-19 pandemic’s effect on the socioeconomic composition of parents and social inequalities in perinatal health

Olof Östergren, and Moritz Oberndorfer

The COVID-19 pandemic placed a heavy social and health burden on populations. Yet, because of potential social inequalities in the pandemic’s impact on fertility behaviour, babies conceived during the pandemic may be the most socially advantaged and healthiest birth cohort of the last decades. In this project, we will use register-based data to analyse changes in the socioeconomic composition of parents during the COVID-19 pandemic and estimate to what extent potential differences in perinatal outcomes between children born and conceived during the pandemic and earlier cohorts are caused by changes in parental composition.

Vaccine effectiveness identified from age cutoffs

Adam Altmejd, Dominik Dietler, Tove Fall, Torsten Persson, and Olof Östergren

The purpose of this project is to estimate how effectively COVID-19 vaccines prevent severe illness and death. Effectiveness, measured from real-world data, can differ from the efficacy numbers produced by clinical trials for several reasons. Mainly, people change their behavior once they are vaccinated, perhaps taking more risks of infecting themselves or passing on an infection onto others. The general population may also differ from trial participants in terms of age, comorbidities and simultaneous use of other pharmaceuticals that may moderate the effects of the vaccine.

COVID-19 and type 2 diabetes incidence and severity across migration status

Louise Bennet, Dominik Dietler, and Annelie Carlsson

Type 2 diabetes (T2D) is a severe chronic disease affecting 6% in the general population and approximately 12% in people originating from non-western regions. Today every fifth person in Sweden is born abroad and non-western immigrants represents the largest immigrant groups. T2D contributes to increased risk of morbidity and complications affecting the cardiovascular (macro- and microvascular system) and nervous system and is one of the main contributors to cardiovascular morbidity and mortality.

Surveillance of disease outbreaks using health counselling data linked with registers

Jonas Björk, Dominik Dietler, Tove Fall, Mattias Ohlsson, Atiye Sadat Hashemi, Thomas Eriksson, and Mirfarid Musavian Ghazani

The overall aim is to develop a generic syndromic surveillance system, based on deep and standard machine learning methods within applied artificial intelligence, to detect unusual symptom reporting to the 1177 health counselling service. The project will use data from the recent COVID-19 pandemic as an empirical example and will have the following specific objectives: To detect clusters of unusual health counselling contacts, defined by for example age, gender, country of origin, disease history, socioeconomic adversity or geographic location, that may signal the emergence of new health crises, locally or more broadly in society.

Incidence of Type-1-Diabetes before and during the COVID-19 pandemic

Annelie Carlsson, Dominik Dietler, Elsa Palmqvist, Louise Bennet, and Magnus Jöud

Type 1 diabetes is one of the most common chronic diseases in children. Sweden has the second-highest incidence in the world, after Finland. The etiology of the disease is mostly unknown, but type 1 diabetes is considered an autoimmune disease. Triggers for developing the disease include viral infections, increased growth, inactivity and obesity. A series of epidemiological studies have reported that the number of people with newly diagnosed type 1 diabetes increased during the COVID-19 epidemic.

Social inequalities in use of mental health care services among young persons during the different phases of the pandemic

Olof Östergren, Peter Larm, Stefanie Möllborn, Fabrizia Giannotta, Jonas Vlachos, and Helena Svaleryd

The pandemic had profound consequences on nearly all aspects of social life, health and health care access. Policy makers and scholars have expressed concern about the consequences of the pandemic on mental health of young persons. International evidence has found modest increases in poor mental health outcomes. Evidence from register-based studies in Sweden have suggested that the trends may differ depending on the specific indicator of mental health, population sub-group and stage of the pandemic.

Utility of real-world mobility data for surveillance of SARS-CoV-2 transmission during the first wave of the pandemic in Sweden

Dominik Dietler, Thomas Eriksson, Jonas Björk, Joacim Rocklöv, and Henrik Sjödin

Disease transmission models can provide valuable information for decision makers on the likely future spread of SARS-CoV-2 under different policy scenarios. We aim to integrate real-world mobility data - a key factor affecting social contact patterns – into surveillance models. The results will provide insights into the strengths and weaknesses of real-world data from mobile phone operators for predicting infectious disease transmission over time and space. Furthermore, they generate valuable experiences for real-time disease modelling using mobility data for managing potential future health crises.

Effect of the SARS-CoV-2 pandemic on population frailty

Dominik Dietler, Jonas Björk, and Anton Nilsson

Sweden experienced high numbers of COVID-19 deaths in the early phases of the SARS-CoV-2 pandemic. This can be at least partly due to a “dry tinder effect” – a high proportion of frail individuals that were alive at the onset of the pandemic due to a mild pre-pandemic influenza season. We aim at quantifying such changes in population frailty in relation to mortality trends triggered by the recurrent influenza season and the SARS-CoV-2 pandemic using individual-level data on comorbidities from health records.

How did the COVID-19 pandemic affect learning disparities between immigrants and natives?

Adam Altmejd, Carina Mood, Jan Jonsson, and Andreas Gustafsson

International data show overall a negative impact of the COVID-19 period on learning, although the only published Swedish study shows no effect. The newly published PISA results, however, suggest that Swedish school children suffered to the same extent as those in other countries, with tougher restrictions on schooling. We focus on the test score gap between pupils with foreign-born parents and others, and ask whether the gap grew or contracted over the COVID period.

Do migrants have a mortality disadvantage in the care setting? Living arrangement and mortality among elderly migrants in Sweden before and during the COVID-19 pandemic

Eleonora Mussino, Sol Juarez, Anna Meyer, Gunnar Andersson, Karin Modig, and Sven Drefahl

This study examines the relationship between migration status and COVID-19 mortality in Sweden, focusing on the elderly in different care settings and living arrangements. Previous research consistently demonstrates that migrants have faced a higher risk of severe COVID-19 outcomes, a finding that stands in stark contrast to the otherwise observed migrant mortality advantage. Utilizing Swedish register data for the years from 1990 to 2021/22, the study stratifies participants aged 70 and above based on their care status and country of origin, adjusting for other sociodemographic and health characteristics.

Remote Instruction and Student Mental Health. Swedish Evidence from the Pandemic

Evelina Björkegren, Helena Svaleryd , and Jonas Vlachos

In their efforts to mitigate the spread of COVID-19, most countries implemented school closures and transitioned to remote instruction. This raised concerns about a potential negative impact on student mental health. Sweden took a different approach by only closing upper-secondary schools. In March, students aged 17-19 in upper-secondary schools shifted to remote learning, while their lower-secondary counterparts, aged 14-16, continued with in-person classes. This unique situation in Sweden provided us with a natural experiment to study the effects of different instructional modes on student mental health.

Civic Capital, Crisis, and Health Behaviours during the Covid-19 Pandemic in Sweden

Olof Östergren, and Bartholomew Konechni

In the recent pandemic, international evidence has found that higher levels of civic capital, the values, institutions, and practices that are conducive to cooperation within a community, were associated with reduced spatial mobility and a greater uptake in preventative behaviours such as wearing a mask as well as lower excess mortality. However, the previous literature exploring civic capital’s role during the pandemic has overwhelmingly done so in countries which adopted stringently enforced non-pharmaceutical interventions (NPIs).

COVID-19 Mortality and the Structural Characteristics of Long-Term Care Facilities: Evidence from Sweden

Rasmus Broms, Carl Dahlström, Jenna Najar, and Marina Nistotskaya

As in many countries around the globe, older citizens in long-term care facilities (LTCFs) in Sweden were hit hard by the Coronavirus pandemic, but mortality varied greatly between different facilities. Current knowledge about the causes of this variation is limited. This article closes this gap by focusing on the link between the structural characteristics of LTCFs—ownership, size, and staffing—and the risk of dying from COVID-19 in Sweden during 2020. Having utilized both individual- and facility-level data, our results suggest that lower staff turnover, having a nurse employed at the facility, and smaller facility size are associated with an decreased risk of dying from COVID-19.

Earnings Losses and the Role of the Welfare State During the COVID-19 Pandemic: Evidence from Sweden

Adrian Adermon, Lisa Laun, Patrik Lind, Martin Olsson, Jan Sauermann, and Anna Sjögren

Many governments introduced temporary adjustments to counter the economic and health consequences of the COVID-19 pandemic. We study the importance of already-existing government transfers and new pandemic measures to mitigate individual income losses during the onset of the pandemic in Sweden using a difference-in-differences approach and population-wide data on monthly earnings and government transfer payments. We find that labor earnings dropped by 2.7 percent in 2020. Existing transfers and new pandemic measures reduced earnings losses to 1.

The impact of private and public providers of vaccination

Helena Svaleryd, Jonas Vlachos, and Jaroslav Yakymovych

This project analyzes whether private and public healthcare providers differ in how they facilitate access to vaccination, particulary how they prioritize between groups and whether personal network connections matter for early vaccination. The results will be informative regarding the costs and benefits of private and public healthcare provision in a crisis situation when the contracting environment is inherently weak. Since the crisis organization builds on the organization during normal times, the results will also have implications for healthcare organization more generally.

Exploring Health System Resilience of Essential Health Services During COVID-19 in Sweden: A Cross-Regional Analysis within Socioeconomic Context

Helena Nordenstedt, Emily Maresch, My Fridell, and Anna Mia Ekström

The outbreak of the COVID-19 pandemic had a profound global impact, putting significant strain on health systems worldwide. Resources were redirected to combat the pandemic, leading to disruptions in non-COVID-19 related healthcare services. These disruptions could potentially have long-term health consequences for patients such as delayed and decreased prevention, diagnosis, and treatment of diseases which could possibly lead to a higher mortality and morbidity. During COVID-19, there was an abundance of regular health services that were out-crowded, resulting in interrupted or postponed services, which highlighted the importance of health systems’ ability to withstand such crises – this is also known as health system resilience.

Inequality and COVID-19 in Sweden: Relative risks of nine bad life events, by four social gradients, in pandemic vs. prepandemic years

Adam Altmejd, Evelina Björkegren, Torsten Persson, and Olof Östergren

The COVID-19 pandemic struck societies directly and indirectly, not just challenging population health but disrupting many aspects of life. Different effects of the spreading virus—and the measures to fight it—are reported and discussed in different scientific fora, with hard-to-compare methods and metrics from different traditions. While the pandemic struck some groups more than others, it is difficult to assess the comprehensive impact on social inequalities. This paper gauges social inequalities using individual-level administrative data for Sweden’s entire population.

Heterogeneous impacts of COVID-19 on incomes

Adrian Adermon, Lisa Laun, Costanza Naguib, Martin Olsson, Jan Sauermann, and Anna Sjögren

An important question for policymakers is which groups experienced the largest income losses in the pandemic, and how well they were protected by the welfare system. Understanding this will allow potential holes in the safety net to be patched before another crisis. It is also useful to know which policies protected different groups, to better understand the distributional effects of changing these policies. In this project, we study the heterogeneous impacts of the COVID-19 pandemic on individual incomes for the full Swedish population.

The Impact of the COVID-19 Pandemic on the Surgical Treatment of Colorectal Cancer Patients in Sweden

Anders Hansson Elliot, AnnaMia Ekström, and Ulf Gustafsson

In March 2020, during the initial phase of the COVID-19 pandemic, a significant portion of healthcare resources in Sweden and worldwide were redirected towards pandemic control. This also impacted surgical procedures, including those for imperative cases such as cancer and acute/subacute conditions. Some newly operated patients became infected with SARS-CoV-2, leading to perioperative deaths. This situation triggered a national and international debate on the criteria for performing surgeries during a pandemic.

Did COVID-19 have lasting effects on the spatial allocation of local services?

Oskar Nordström Skans, Adam Gill, and Lena Hensvik

The COVID-19 pandemic had a massive temporary effect on people’s mobility patterns. Recent evidence suggests that part of this adjustment is here to stay – the pandemic appears to have had lasting effects on the incidence of working-from-home n many countries. Data from the US indicates that this may change the spatial economic structure of cities – the rise of the “donut” city. In this paper, we focus on the allocation of services as an indicator of real spatial effects of increased WFH induced by the pandemic.

Age at migration and COVID-19

Oskar Nordström Skans, Olof Åslund, Erik Grönqvist, and Tram Pham

This project analyzes how age at migration affected outcomes and behavior during the most severe phases of the COVID-19 pandemic. The project focuses primarily on outcomes in adulthood among people who immigrated to Sweden as children (or who were born just after their parents arrived). We quantify how COVID-19 disparities differ between individuals as a function of how much of their childhood was spent in Sweden. Previous research has shown that host-country exposure during childhood have large causal effects on adulthood outcomes in such diverse dimensions such as Height, Education, Earnings and Social Integration at the Housing, Marriage and Labor markets.

Inequalities in mortality going in and out of the pandmic: The contribution of age and cause of death to changes in life expectancy by education during 2015-2022.

Olle Lundberg, Olof Östergren, Adam Altmejd, Marcus Ebeling, and Karin Modig

Life expectancy in Sweden decreased between 2019 and 2020 from 84.7 to 84.3 years for women and from 81.3 to 80.6 for men. Between 2020 and 2021, life expectancy increased to 84.8 years among women and 81.2 years among men. The loss of life expectancy in 2020 was largely recovered in 2021 and among women, life expectancy in 2021 was higher than before the pandemic. However, both the decrease in life expectancy and the recovery in 2021 differed by educational attainment.

Medical scandals and vaccine hesitancy

Svenja Miltner, and Jonatan Riberth

In this project we consider the effects on vaccine hesitancy and health care utilization from an unusual medical scandal. Following the 2009–2010 swine flu pandemic, Sweden adopted a mass vaccination campaign where 60% of the Swedish population was vaccinated against the Swine flu. A number of individuals developed narcolepsy, a severe, incurable neurological disease, from the swine flu vaccine. We use individual level data on Covid and swine flu vaccinations to measure vaccine hesitancy during the Covid-19 pandemic among the affected individuals.

Individual and aggregate consequences of post-covid conditions

Adam Altmejd, Torsten Persson, Olof Östergren, Anna Mia Ekström, Oskar Nordström Skans, Maxim Kan, and Nicola Orsini

The purpose of the project is to describe how long-COVID, or post-COVID-19, conditions (PCC), have affected Swedish society. The project will start by describing (i) those who suffer from PCC, (ii) whether the burden of disease is unequally distributed across social groups, and (iii) some of the implications for those diagnosed. Next, we will evaluate if vaccines provide some protection from PCC. We will also estimate the labor-market effects of PCC.

Pre-Booked Appointment Letters for Increasing Vaccination Coverage in Target Populations

Tove Fall, Georgios Varotsis, Carl Bonander, Anna Sarkadi, Helena Svaleryd, and Ulf Hammar

Prevention is a key task for the healthcare system, as is provision of equitable healthcare for the whole population. Vulnerable groups for adverse outcomes of respiratory infections include the elderly, groups with low socioeconomic status (SES), and those living with certain chronic diseases, groups that traditionally have lower vaccination uptake rates. There is therefore a need to find tools that increase vaccination coverage among these groups. In Sweden, regional strategies have included vaccination buses and drop-in vaccinations.

Symptoms reported through the Swedish Healthcare Guide 1177 for disease surveillance and hospital predictions

Tove Fall, Jonas Björk, Ulf Hammar, Per Lundmark, and Georgios Varotsis

Disease surveillance is crucial during a pandemic because it allows informed decisions and evaluation of the effectiveness of implemented policies. Our study aims to develop new methods for real-time surveillance of respiratory virus spread and to predict surges in hospital admissions based on >4 million yearly calls to the Swedish Healthcare Guide 1177 phone-line, a largely untapped resource for syndromic surveillance. We have two main aims: Development of methods to estimate the daily infection prevalence at a local level 2020-2022 based on national health inquiry calls to Swedish Healthcare Guide 1177 phone-line linked to subsequent PCR and antibody test results using COVID-19 as a model.

Understanding social inequalities in Covid-19 testing behavior

Olof Östergren, Arizo Karimi, Emelie Counil, Jonas Björk, Tove Fall, and Karl Gauffin

Groups with lower socioeconomic status have suffered disproportionately from severe Covid-19. However, more cases were detected among individuals in higher socioeconomic positions. These seemingly conflicting observations are in part attributed to differences in testing behavior; individuals in lower socioeconomic positions in Sweden had lower testing rates and higher positivity rates compared to those in higher positions. The propensity to get tested can depend on several things. Some factors may motivate the individual to get tested while others can make the individual more likely to avoid taking a test.

Predictors of COVID-19 outcomes among residents of Swedish long-term care facilities—a nationwide study of the year 2020

Jenna Najar, Rasmus Broms, Marina Nistotskaya, and Carl Dahlström

What is the primary question addressed by this study? This study examines predictors for SARS-CoV-2 infection and COVID-19 death among residents of long-term care facilities (LTCFs), using Swedish nation-wide data for the whole pandemic year of 2020. What is the main finding of this study? We found that several factors were associated with SARS-CoV-2 infection and COVID-19 death. All-cause dementia was a particularly strong predictor of COVID-19 death, especially among those aged 65-75 years.

Sweden's COVID-19 Recession: How Foreign and Domestic Infections Struck against Firms and Workers

Anders Akerman, Karolina Ekholm, Torsten Persson, and Oskar N. Skans

The COVID-19 pandemic had massive contractionary effects on most economies across the globe. However, the economic effects varied tremendously both within and across countries. We use highly granular Swedish micro-data to document the economic effects of the COVID-19 pandemic on Swedish private-sector firms and their workers. The study shows that trading firms suffered larger output losses if they exported to, or imported from, countries with high COVID-rates and/or disruptive COVID restrictions.