Background  Immigrants in Sweden, particularly those from low- and middle-income countries, had higher risks of COVID-19 mortality and morbidity compared to the Swedish-born. However, prior studies have not quantified the contribution of the differential distribution of health and social determinants to the increased risks.

Methods  We used total population registers from Sweden to investigate disparities in COVID-19 hospitalization between five groups of immigrants and Swedish-born, using a cohort 577911 working-age adults (18–65 years) living in Stockholm during the first two waves of the COVID-19 pandemic. Applying a decomposition analysis, we quantified the relative contribution of age, sex, income, education, occupation type, residential area, and pre-existing medical conditions to these disparities.

Results  Our study shows that immigrants have higher risks of hospitalization compared to Swedish-born, and that the investigated factors accounted for these disparities to varying degrees across immigrant groups. For the most affected immigrant groups (from Africa and Middle East), the examined factors together account for only a minor part of the disparities (21% and 18% for Wave 1; 16% and 11% for Wave 2), with occupation type and residential area contributing substantially.

Conclusions  Common observable social determinants of health account for a moderate share of the overall disparities in COVID-19 hospitalizations between Swedish-born individuals and immigrant from the most affected regions of origin.