We examined the overall and site-specific cancer mortality disparities among first-generation - separately in adults (G1) and children (G1.5) at immigration - and second-generation (G2) immigrants and their countries of origin, using population-based registries in Sweden, encompassing more than 8.5 million individuals aged 20 years or older residing in Sweden since 1990, with follow-up until December 31, 2023. Cox proportional hazard models were fitted, stratified by sex, to estimate hazard ratios and 95% CIs compared with native Swedes. Mortality rates for most cancers transitioned from lower in G1 toward the rate of natives in G2. However, elevated mortality rates were sustained across generations for liver cancer in men and stomach cancer in women. Among G2, mortality rates associated with lymphohematopoietic cancers in men and lung and cervix uteri cancers in women were elevated y 10%, 9%, and 17%, respectively, compared to native Swedes. Country of origin analyses revealed substantial disparities. For instance, G2 women with Nordic parental origin had a 13% higher risk of death from lung cancer, whereas those with non-Western parental origin had a 54% lower risk, as compared to native Swedes. These findings suggest generational and arrival-age dynamics of cancer mortality and highlight target groups for cancer prevention and control among immigrants.

Objective This study explored the experience of stigma and access to healthcare by persons with long COVID from the majority Dutch and two ethnic minority populations (Turkish and Moroccan) living in the Netherlands.

Design This was a cross-sectional qualitative study that employed inductive and deductive thematic approaches to data analysis using MAXQDA.

Setting and participants Between October 2022 and January 2023, 23 semi-structured interviews were conducted with participants of Dutch, Moroccan and Turkish ethnic origins with long COVID living in the Netherlands. Participants were men and women aged 30 years and above.

Results Guided by the concepts of stigma and candidacy, the findings are structured according to the broader themes of stigma and access to care. The findings show that people with long COVID suffer self and public stigma resulting from the debilitating illness and symptoms. Especially among Turkish and Moroccan ethnic minority participants, strong filial obligations and gendered expectations of responsibility and support within their communities further worsen self-stigma. This experience of stigma persisted within healthcare where lack of information and appropriate care pathways led to feelings of frustration and abandonment, especially for participants with pre-existing health conditions which further complicate candidacy. Under the access to healthcare theme, the findings show multiple challenges in accessing healthcare for long COVID due to several multifaceted factors related to the various stages of candidacy which impacted access to care. Particularly for Turkish and Moroccan ethnic minority participants, additional challenges resulting from limited access to information, pre-existing structural challenges and experience of stereotyping based on ethnicity or assumed migrant identity by health professionals further complicate access to health information and long COVID care.

Conclusions The findings call for urgent attention and research to identify and coordinate healthcare for long COVID. There is also a need for accessible, informative and tailored support systems to facilitate patients’ access to information and care pathways for long COVID. Providing tailored information and support, addressing the various barriers that hinder optimal operating conditions in healthcare and leveraging on social networks is crucial for addressing stigma and facilitating candidacy for persons with long COVID towards improving access to care.

Introduction: Sweden, with its history of restrictive alcohol policies and a large and diverse migrant population, constitutes an interesting context for studies on alcohol consumption patterns in migrant groups. This study examines how hazardous drinking among migrants in Sweden varies by origin, duration of residence and age at migration.

Methods: Pooled cross-sectional survey data from the Västra Götaland region of Sweden, collected in 2011 and 2015, were linked to register data containing demo-graphic, socioeconomic and migration-related factors (i.e., country of birth, duration of residence, age at migration), for 7754 migrants and 68,493 Swedish-born individuals aged 18–84 years. Logistic regression analyses were applied to estimate odds ratios (OR) and 95% confidence intervals (CI) for hazardous drinking, identified by the validated Alcohol Use Disorders Identification Test.

Results: Relative to Swedish-born individuals, migrants from other Nordic countries had higher odds of hazardous drinking (OR 1.45, 95% CI 1.18–1.77), while migrants from other European (OR 0.55, 95% CI 0.44–0.69) and non-European (OR 0.25, 95% CI 0.20–0.31) countries showed lower likelihoods. Among non-Nordic migrants in particular, hazardous drinking was more common among those with a longer duration of residence and those who migrated at pre-school ages.

Discussion and Conclusions: Hazardous drinking among non-Nordic migrants increasingly resembled that of the Swedish-born population over time, aligning with findings in less restrictive alcohol policy contexts. Understanding how drinking patterns vary among migrant groups over time and across policy contexts is essential for developing effective public health strategies to reduce hazardous consumption and associated health and social harms.

Responses to increased alcohol availability may vary across the population as a function of differential vulnerability. This study therefore aimed to examine the effects of the implementation of Saturday opening at the Swedish alcohol retail monopoly in 2000 on risks of hospitalization due to external causes (HEC) among different population subgroups. Leveraging the experimental design of the reform, longitudinal difference-in-differences analyses were applied to a register-based cohort of individuals aged 20-40 at the time of implementation. The population was stratified into groups of Swedish, Finnish, and Middle Eastern origin, known to represent different levels of alcohol consumption and rates of alcohol-related morbidity. Results showed a 17.7% increase (P <. 029) in the risk of HEC among individuals of Finnish origin, as jointly caused by both increased prevalence in the experiment area and decreased prevalence in the control area. The increase was primarily driven by younger men with lower levels of education. Those of Swedish origin exhibited largely similar patterns (9.7% increase; P <. 001), while no measurable impact was observed among individuals of Middle Eastern origin (-21.4% decrease; P <. 076). The findings confirm that increasing alcohol availability contributes to the disease burden related to alcohol among population subgroups already susceptible to its effects.

In this issue of the Journal, Kim et al (Am J Epidemiol 2025;194(3):635-644) examine whether neighborhood disadvantage is associated with cardiovascular disease risk in Denmark. A potential contribution of their article is the study of mediators (cumulative income, unstable employment, and poor mental health) underlying the association using a quasi-experimental design based on a Danish refugee dispersal policy. In this commentary, I draw attention to some potential limitations involving use of refugee dispersal policies as natural experiments. I further discuss the extent to which the mediators studied by Kim et al contribute to our overall understanding of mechanisms linking neighborhood disadvantage and cardiovascular disease risk. However, because a similar dispersal policy was introduced during the same time period in a country neighboring Denmark-Sweden-I also take the opportunity to give an account of the background of dispersal policies in the two countries and offer some general reflections on their consequences for refugee integration and well-being there.

Background  Many studies have found more severe COVID-19 outcomes in migrants and ethnic minorities throughout the COVID-19 pandemic, while recent evidence also suggests higher risk of longer-term consequences. We studied the risk of a long COVID diagnosis among adult residents in Sweden, dependent on country of birth and accounting for known risk factors for long COVID.

Methods  We used linked Swedish administrative registers between March 1, 2020 and April 1, 2023, to estimate the risk of a long COVID diagnosis in the adult population that had a confirmed COVID-19 infection. Poisson regressions were used to calculate incidence rate ratios (IRR) of long COVID by country/region of birth. The contribution of sex, preexisting health status, disease severity, vaccination status, and socioeconomic factors to differences in long COVID diagnosis by country/region of birth were further investigated.

Results  Of the 1,869,188 persons diagnosed with COVID-19 that were included, 7539 had received a long COVID diagnosis. Compared with residents born in Sweden, we found higher risks of long COVID among migrants from East Europe (IRR: 1.44 CI: 1.29–1.60), Finland (IRR: 1.36 CI: 1.15–1.61), South Asia (IRR: 1.28 CI: 1.03–1.59), Other Asia (IRR: 1.35 CI: 1.13–1.62), Other Africa (IRR: 1.48 CI: 1.17–1.87), and the Middle East (IRR: 1.43 CI: 1.27–1.63) in models adjusted for age and sex. We discovered that disease severity, i.e., whether the person was hospitalized (IRR: 18.6 CI: 17.3–20.0) or treated in an intensive care unit (IRR: 120.5 CI: 111.7–129.8), primarily contributed to the higher risk of long COVID found in migrants while the contribution of vaccinations and social conditions were moderate. Preexisting health problems did not contribute to the increased risk of long COVID in migrants.

Conclusions  The greater exposure and impact of the COVID-19 virus among migrants also affected longer-term consequences. Disease severity was the most important risk factor for long COVID in migrants. The findings emphasize the need for targeted health interventions for migrant communities during an infectious disease pandemic, such as strategic vaccination campaigns and extending social insurance schemes, focusing on reducing disease severity to mitigate the longer-term health consequences of an infection.

Background: Low socioeconomic status has been demonstrated as a risk factor for COVID-19 severity and mortality. However, whether socioeconomic disparities also influence the risk of long COVID diagnosis among ethnic minorities compared to the native majority population remains unclear. Methods: We conducted a nationwide register-based cohort study in Denmark, including individuals with a first-time COVID-19 diagnosis between January 2020 and August 2022. The risk of long COVID diagnosis among ethnic groups (defined by country of birth) was compared according to socioeconomic status. Results: Among 2 287 175 COVID-19 cases, 4579 were diagnosed with long COVID. The risk of long COVID diagnosis did not significantly differ by income or educational attainment for most ethnic groups. However, among low-income individuals, migrants had a higher risk of long COVID than native Danes, particularly Eastern Europeans (HRadjusted 1.45, 95 % CI [1.25,1.70], p < 0.001), Southeast Asians (HRadjusted 2.08, 95 % CI [1.32,3.28], p = 0.002), Middle Easterners (HRadjusted 1.65, 95 % CI [1.31,2.07], p < 0.001), and North Africans (HRadjusted 1.68, 95 % CI [1.24,2.27], p < 0.001). Additionally, migrant workers (Eastern European, Middle Eastern, and South Asian) in occupational sectors such as “economy, business, and administration”, “operator, driver and transportation service”, “sales and customer service”, “general office and secretarial service” and “education” had a higher long COVID risk than native Danish workers in the same workplaces. Implications: These findings highlight the need to address ethnic disparities in long COVID, particularly among migrants with low income. Workplace interventions and policies targeting work-related vulnerabilities could help reduce the disproportionate burden of long COVID among migrant workers.

Awareness and utilization of health interventions can be influenced by sociodemographic factors. These factors play a role in information processing, particularly regarding health messaging. The aim of this study is to analyze how different sociodemographic factors and gambling behaviors are associated with awareness of a (Swedish) gambling self-exclusion register. The study used data from the Swedish longitudinal gambling study (Swelogs) and analyzed n = 6720 participants from a stratified random sample of the Swedish population aged 18–84 years. Logistic regressions were conducted to analyze associations between sociodemographic characteristics, gambling behavior and awareness. Males with middle (OR = 1.70, 95% CI = 1.32–2.19) and high income (OR = 1.58, 95% CI = 1.19–2.09) and females with high (OR = 1.35, 95% CI = 1.03–1.76) and middle-level education (OR = 1.35, CI = 1.04–1.76), had higher awareness of Spelpaus.se. Online gamblers with problematic gambling behavior were three times (OR = 3.69, 95% CI = 2.15–6.37) more likely to be aware than non-gamblers. Online gamblers born in Sweden were twice (OR = 1.95, 95% CI = 1.19–3.19) as likely to be aware compared to those born outside of Europe. Males with high level of awareness had higher PGSI scores compared to women. Education could increase awareness of potential health risks and opportunities for intervention, particularly among women. Future interventions should be tailored to cater to the specific needs of individuals with lower levels of awareness, to facilitate enhancing their awareness and ultimately promoting a more equitable utilization of self-exclusion measures.

While bereavement, particularly the loss of a child, is a well-known risk factor for mental health in the short term, its long-term consequences on depressive mood in old age and across different welfare regimes have been investigated less. This study focused on the combined role of child loss and divorce on depressive symptoms, measured using the EURO-D scale in Central, Nordic, Southern, and Eastern European countries. We used data from the European SHARE project, covering 22,959 participants aged 50+ over a 16-year period. Using OLS regressions, we found that, compared to no child loss and no divorce, the association between depressive symptoms and child loss was significant (β = 0.22, 95% C.I. = [0.13, 0.30]), among both women and men. The absolute increase was even stronger when the mutual effect of child loss and divorce was considered (β = 0.34, 95% C.I. = [0.18, 0.48]). Employing Generalized Estimating Equations, we found that depressive symptoms related to divorce did not increase over time, regardless of past bereavement. Compared with people in the Nordic countries, those living in Southern Europe experienced more depressive symptoms related to child loss and no divorce, but fewer depressive symptoms related to the combined effect of child loss and divorce. In sum, our findings indicate that bereavement due to child loss may lead to more depressive symptoms among both women and men in old age, especially in combination with divorce. In the latter case, we posit that participants living in Southern European countries may be protected by higher levels of social support through family ties or informal social networks.

Numerous studies have reported lower overall cancer mortality rates among immigrants compared to native populations. However, limited information exists regarding cancer mortality among immigrants based on specific birth countries and cancer types. We used population-based registries and followed 10 million individuals aged 20 years or older in Sweden between 1992 and 2016. The Cox proportional hazard model was used to explore the disparities in cancer mortality by country of birth and cancer type, stratified by gender. Age-standardized mortality rates were also computed using the world standard population. Hazard ratio (HR) of all-site cancer was slightly lower among immigrants (males: HRm = 0.97: 95% confidence interval: 0.95, 0.98; females: HRf = 0.93: 0.91, 0.94) than Swedish-born population. However, the immigrants showed higher mortality for infection-related cancers, including liver (HRf = 1.10: 1.01, 1.19; HRm = 1.10: 1.02, 1.17), stomach (HRf = 1.39: 1.31, 1.49; HRm = 1.33: 1.26, 1.41) cancers, and tobacco-related cancers, including lung (HRm = 1.44: 1.40, 1.49), and laryngeal cancers (HRm = 1.47: 1.24, 1.75). The HR of mesothelioma was also significantly higher in immigrants (HRf = 1.44: 1.10, 1.90). Mortality from lung cancer was specifically higher in men from Nordic (HRm = 1.41: 1.27, 1.55) and non-Nordic Europe (HRm = 1.49: 1.43, 1.55) countries and lower in Asian (HRm = 0.78: 0.66, 0.93) and South American men (HRm = 0.70: 0.57, 0.87). In conclusion, there are large variations in cancer mortality by country of birth, and cancer type and require regular surveillance. Our detailed analyses lead to some novel findings such as excess mortality rate of mesothelioma and laryngeal cancers in Immigrants in Sweden. A targeted cancer prevention program among immigrants in Sweden is needed.