Cancer is a leading cause of death among individuals with type 2 diabetes (T2D), and immigrants in Europe face a higher T2D risk than native populations. We investigated mortality disparities in overall and eight specific T2D-related cancers among immigrants and native Swedes diagnosed with T2D between 2006 and 2021. An open cohort of 478,607 individuals aged ≥ 35 years at the time of T2D diagnosis (28% first-generation [G1] and 6% second-generation [G2] immigrants) was followed until December 31, 2023. Flexible parametric survival models were used to estimate hazard ratios (HRs), stratified by age at arrival and duration of residence for G1 immigrants. G1 immigrants, except those from Nordic countries, generally had lower overall cancer mortality than natives. However, mortality risks for specific cancers converged toward those of natives with longer residence in Sweden, and notably liver and endometrial cancer mortality were higher among those who arrived early in life compared with natives. In G2 immigrants, kidney and endometrial cancer mortality rates were elevated, particularly for those with Western (HR = 1.63) and Nordic (HR = 1.82) parental origins, respectively. Mortality rates from colorectal and liver cancers also appeared to increase among those more recently diagnosed with T2D. These findings underscore the need for strengthening integrated diabetes and cancer care and tailored support services for high-risk immigrant populations.

Death anniversaries may trigger stress responses that negatively affect health in bereaved individuals. Little is known about such reactions after adult sibling loss. This study examined whether mortality risk increases around the anniversary of a sibling's death. Using Swedish national register data (1990-2016), we conducted a time-stratified case-crossover study including 12 789 adults who experienced sibling loss and later died. Conditional logistic regression estimated associations between mortality and death anniversaries (including pre-anniversary and post-anniversary periods), adjusting for time-invariant confounders. Analyses were stratified by the bereaved's sex and age, the sibling's sex, sibling order, and whether ≥1 parent was alive at the bereaved's death. Among women, mortality risk was lower on the anniversary date (OR, 0.44; 95% CI, 0.21-0.93), and in the period from 1 day before and up to the anniversary date for women who lost a younger or same-age sibling (OR, 0.45; 95% CI, 0.20-1.00). In contrast, men bereaved before age 50 years had a heightened risk in the period ranging from 12 days before and up to the anniversary (OR, 1.40; 95 % CI, 1.05-1.86). Overall, sibling-death anniversaries were not associated with elevated mortality, though observed sex- and age-specific patterns merits further investigation.

Importance Bereavement is a known risk factor for cardiovascular disease (CVD), but it remains unclear whether the COVID-19 pandemic—which disrupted health care and increased social isolation—altered this association. Objective To compare the association between bereavement and incident CVD before and during the pandemic. Design, Setting, and Participants This cohort study of Swedish national health registries included individuals aged 30 years or older in Sweden during the pre–COVID-19 (2018-2019) and COVID-19 (2020-2021) periods. Analyses were performed between September 2024 and August 2025. Exposures Bereavement exposure was defined as the loss of a partner, child, parent, or sibling. Main Outcomes and Measures The first diagnosis of any CVD event, identified from an outpatient hospital visit or hospitalization via the Swedish Patient Register or death via the Swedish Cause of Death Register. Cox regression was used to estimate hazard ratios (HRs) of incident CVD after bereavement by study period, type of loss, and age. Results Analysis included a total of 5 365 829 study participants (51.4% female; median [IQR] age, 51.6 [40.4-64.6] years) during the pre–COVID-19 period and 5 522 898 study participants (51.4% female; median [IQR] age, 49.8 [38.2-62.8] years) during the COVID-19 period. Overall, 372 477 (6.94%) and 368 902 (6.68%) incident CVD cases were identified during the pre–COVID-19 and COVID-19 periods, respectively. Bereavement was associated with increased CVD risk regardless of period or type of loss. However, the risk increment was greater during the COVID-19 period compared with the pre–COVID-19 period for loss of a partner (HR, 1.46 [95% CI, 1.41-1.51] vs 1.30 [95% CI, 1.26-1.35]; P for difference <.001) and sibling (HR, 1.23 [95% CI, 1.20-1.27] vs 1.16 [95% CI, 1.13-1.19]; P for difference =.003). No period difference was noted for the loss of a child or parent. The risk increment after loss of a partner or parent increased with age, while the risk after loss of a child or sibling decreased with age. Conclusions and Relevance In this cohort study, bereavement was associated with increased CVD risk both before and during the COVID-19 pandemic; however, a stronger association for partner or sibling loss was noted during the pandemic. These findings suggest that bereavement may be a period of heightened cardiovascular vulnerability, underscoring the importance of targeted clinical monitoring and preventive care for bereaved individuals.

Background: Ethnic minorities appear to be at higher risk of long COVID. Our objective was to estimate ethnic differences in the burden of long COVID symptoms and their impact on daily life and occupational status.

Methods: Retrospective cohort study of adults (≥ 18 years) admitted to a Long COVID Clinic, Copenhagen University Hospital – Amager and Hvidovre, Copenhagen, Denmark, from February 2021 through November 2022. Data from symptom questionnaires were linked to clinical data from patient records and national register data. Using regression models, we calculated the burden and number of long COVID symptoms as well as the risk of certain symptom categories, of being on sick leave, of loss of independence, and of having returned to usual leisure activities.

Results: A total of 864 patients from the long COVID clinic were included; hereof 31.2% were ethnic minorities. Compared to patients of Danish origin, ethnic minorities had an 18.32% higher mean burden of long COVID symptoms (adjusted mean difference (MD_adj) 3.23, 95% confidence interval (CI): 1.67;4.78) and experienced 18.56% more long COVID symptoms on average (MD_adj 1.56, 95% CI: 0.86;2.26). Ethnic minorities were more likely to experience cardio-pulmonary, psychological, and gastrointestinal symptoms. However, compared to patients of Danish origin, ethnic minorities had lower odds of being on sick leave (adjusted odds ratio (OR_adj) 0.61, 95% CI: 0.40;0.94) and of having returned to usual leisure activities (OR_adj 0.68, 95% CI: 0.48;0.94).

Conclusions: Ethnic minorities experienced a higher number and symptom burden of long COVID symptoms along with a higher risk of certain symptom categories, notably psychological symptoms. However, ethnic minorities had lower odds of being on sick leave. Additional research is needed into the explanations of the disparities identified in this study.

Background: Ethnic inequalities in COVID-19 outcomes are extensively documented, yet underlying causes remain unclear. We investigated ethnic disparities in clinical severity at admission with COVID-19 and their relation to mechanical ventilation (MV), 60-day mortality, and long COVID.

Methods: Retrospective cohort study of adults (≥18 years) admitted with COVID-19 (March 2020–March 2022). Clinical and sociodemographic data extracted from patient records were linked to national register data. Using logistical regression, competing risk, and Cox proportional hazards models, we estimated risk of high-flow oxygen upon admission, MV, 60-day mortality, and long COVID comparing ethnic minority patients with patients of Danish origin.

Results: Of 1610 patients, 39.1% were ethnic minority patients. Ethnic minorities were younger, had longer symptom duration (7 vs 6 days, p < 0.001), and a higher risk of requiring high-flow oxygen upon admission (OR 1.41, 95% CI: 1.12;1.79) than patients of Danish origin until adjusted for age. However, ethnic minorities were not at higher risk of MV (HR 1.00, 95% CI: 0.69;1.44), 60-day mortality (HR 0.81, 95% CI: 0.61;1.09), long COVID (HR 0.82, 95% CI: 0.56;1.19) or related symptom diagnosis (HR 1.32, 95% CI: 0.85;2.05).

Conclusion: While ethnic minorities presented later and more severely ill at admission with a higher risk of receiving high-flow oxygen, their risk of MV, 60-day mortality, and long COVID were comparable to patients of Danish origin. This was largely explained by a substantial difference in age. Our findings emphasise the need for public health interventions to ensure equitable and timely healthcare access for all populations.

Aims: Several studies suggest that ethnic minorities are at higher risk of experiencing long COVID compared to majority populations. This study aimed to qualitatively explore the experiences of accessing care, diagnosis and rehabilitation among patients with long COVID in a multiethnic population in Denmark. Methods: We carried out 18 semi-structured interviews with individuals of Danish, Turkish and Moroccan background who were diagnosed with long COVID. Informants were sampled purposively to secure variation in sex, age, country of origin and immigration status. Our interview guide was developed using the theoretical framework of candidacy. Interviews were transcribed verbatim, member checked and subsequently analyzed using thematic framework analysis and NVivo software. Results: Our findings show that accessing care and rehabilitation for long COVID was difficult regardless of ethnic background. Following the novelty of COVID-19 and thus uncertainty of long COVID, informants had to self-advocate and navigate established and alternative healthcare services by themselves. Additionally, patients with Moroccan and Turkish minority background had to contend with experiences of differential treatment and of having their motives for seeking help questioned, while also finding it harder to benefit from the rehabilitation measures offered. Conclusions: Our study demonstrates how the emergence of a new viral disease with unknown long-term sequelae resulted in a group of patients who largely carried the burden of getting better by themselves. Yet patients with an ethnic minority background experienced additional, worrying barriers. More research into relevant diagnosis, care and support for all long COVID patients is needed, especially among ethnic minorities.

Bereavement is associated with an increased risk of mental illness. The COVID-19 pandemic caused excess mortality, and may have exacerbated the mental health impact of bereavement due to social restrictions and reduced healthcare access. Using Swedish national register data, this study aimed to compare the risk of mental illness following bereavement before (2018–2019) and during (2020–2021) the pandemic, exploring how the pandemic might have modified the psychological impact of bereavement and identifying high-risk groups.We conducted a nationwide matched cohort study including (1) 3,840,845 individuals (349,168 bereaved) before the pandemic, and (2) 5,132,988 individuals (466,636 bereaved) during the pandemic. Mental illness was defined as the first occurrence of any psychiatric diagnosis or suicidal behavior during each period. Multivariable Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). We found that bereaved individuals had a significantly higher risk of mental illness compared to non-bereaved individuals in both periods (before pandemic: HR 1.42, 95%CI 1.34-1.49; during pandemic: HR 1.34, 95%CI 1.28-1.39). Bereaved individuals younger than 30 years had markedly higher risks of psychiatric disorders in the pre-pandemic period compared to the pandemic period. Higher risks of incident psychiatric disorders were observed for loss of a child or spouse, compared to loss of a sibling or parent, as well as for loss due to accident or suicide as compared to other causes. Furthermore, bereavement due to COVID-19 was associated with an increased risk of mental illness during the pandemic period (HR 1.38, 95% CI 1.21-1.59). In conclusion, bereavement was consistently associated with an increased risk of mental illness, before and during COVID-19 pandemic, although young individuals (<30 years) seemed more affected before the pandemic. However, further research in settings with a different pandemic burden and/or mitigation strategies is needed to assess the generalizability of our findings beyond Sweden.

Objectives Employment status is a key health determinant that impacts mental health through multiple mechanisms. Individuals who migrate in midlife may face particular labor market integration challenges, yet research on the mental health impacts of unemployment among midlife migrants, and how this varies by origin and gender, remains limited. This study investigates associations between employment status and psychiatric disorders among individuals who migrated after age 40, compared with Swedish-born individuals. Study design Using Swedish administrative register data from 1997 to 2016, a retrospective cohort study was conducted among individuals who migrated after age 40 (n = 21,154) and an age-matched Swedish-born cohort (n = 1,403,098). Methods Gender-stratified Cox proportional hazard models estimated hazard ratios (HR) for outpatient and inpatient psychiatric care. Employed, Swedish-born individuals served as the primary reference group. Results Unemployment was associated with increased risks of psychiatric care across all origin groups (HRs from 1.35 to 3.74). For most migrant groups, risks were comparable to those of the unemployed Swedish-born. Nonetheless, indications of mental health inequalities between unemployed migrants and Swedish-born individuals were evident, most notably by the greater magnitudes of increased risk observed among European women and Nordic men. Conclusions Among midlife migrants, unemployment was consistently associated with poorer mental health, yet its contribution to migrant-native mental health inequalities was only seen in specific groups. Findings highlight the importance of examining how migration background, together with gender and other social factors, shapes health risks, and promoting the socio-economic integration of midlife migrants to support health in later life.

Objectives Neighbourhood migrant density is increasingly recognised as a social determinant of health. However, its association with hospitalised patients with cancer outcomes, such as mortality and readmission rates, remains understudied. This study examined whether neighbourhood migrant density influenced these outcomes and whether these associations varied before and during the COVID-19 pandemic.

Design Retrospective cohort study.

Setting Swedish national registers.

Participants Hospitalised patients with cancer (ICD code C00–C97) from 2014 to 2019 (before the pandemic) and 2020–2021 (during the pandemic).

Outcomes 90-day mortality and readmission rates. Independent variables were neighbourhood migrant density—categorised as total, Western and non-Western migrants (as a proportion of the total area population).

Results We identified 243 357 hospitalised patients with cancer before the pandemic and 112 935 during the pandemic. Swedish-born individuals and Western migrants residing in high migrant density neighbourhoods had higher rates of 90-day mortality (incidence rate ratio, IRR: 1.15, 95% CI 95% CI 1.12 to 1.19 and IRR: 1.09, 95% CI 1.00 to 1.18) and readmission (IRR: 1.16, 95% CI 1.13 to 1.19 and IRR: 1.14, 95% CI 1.07 to 1.22). During the pandemic, 90-day mortality rates significantly increased among Western migrants and 90-day readmission rates increased for all patients from high migrant density neighbourhoods.

Conclusions High neighbourhoods migrant density was associated with increased 90-day mortality and readmission among Swedish-born individuals and Western migrants before the pandemic. These outcomes were exacerbated during the pandemic, particularly among migrants. Cancer care for residents in neighbourhoods with high migrant density needs to be improved, especially during public health crises.

Aim/Background: Grounded in the Minority Stress Model, which conceptualizes discrimination as a chronic social stressor affecting health among minority populations, this study examines the association between perceived ethnic discrimination and leisure-time physical activity (LTPA) among adults in Sweden. Methods: Using representative cross-sectional data from the Health on Equal Terms survey, we analysed a sample of 64,273 individuals aged 16 to 84 years living in Sweden. Perceived discrimination was measured as offensive treatment and LTPA was measured through a question about physical movement during free time. Logistic regressions were performed to examine the association between perceived discrimination and LTPA. The relative excess risk due to interaction (RERI) was estimated to assess the contribution of the region of birth to the relationship between discrimination and LTPA. Results: Findings show a low prevalence of perceived discrimination (1.3%) and a high prevalence of LTPA in the population (86.6%). However, a significant negative association was observed between perceived ethnic discrimination and engagement in LTPA (odds ratio: 0.73, 95% confidence interval: 0.56–0.96). Migrants born in Asia who reported discrimination were more likely to engage in LTPA (RERI: 0.11 (0.03–0.19)) compared with those born in Nordic countries. No significant interactions were found for other birth regions (i.e. South America, Africa, North America, and Oceania). Conclusion: These results suggest that perceived discrimination might shape health-related behaviours in the Swedish context. Future research should further investigate the mechanisms linking discrimination and health behaviours using longitudinal designs and multidimensional measures of social integration and stress processes.