This research examines the impact of population over-coverage on socio-demographic indicators for international migrants in Sweden. Over-coverage occurs when emigrants or deceased individuals remain in population registers, leading to overestimation of the resident population. This particularly affects migrants due to the increasing prevalence of return, onward, and circular migration. As register-based data collection becomes prevalent, addressing over-coverage bias is critical. Using multiple systems estimation models, we adjust for over-coverage in Swedish population registers and calculate accurate demographic and socio-economic rates. We use administrative data for 2003-16 to compute age-specific fertility rates, mortality rates, employment/unemployment rates, Total Fertility Rates, and life expectancy for migrants. Results demonstrate that over-coverage substantially affects demographic and economic indicators, particularly at typical migration ages, with mortality rates showing the largest bias at older ages. Findings highlight the importance of addressing over-coverage to improve the reliability of socio-demographic insights from register-based population systems.

Research has shown that married individuals live longer lives than unmarried women and men. A smaller number of studies have included non-marital cohabitation and have found that their mortality falls between the married and other unmarried groups. There are indications that the cohabiting population is diverse in terms of mortality risk, yet very little is known about how the association is related to age and stages of the life course. Sweden is a forerunner in family trends, and this is the first study that examines cohabitation and mortality in a Swedish context. Using Swedish register data for the years 2012–2017, we investigated how different partnership statuses are related to mortality for men and women at different ages (N = 5,572,011). We also examine whether the association between cohabitation and mortality is similar after accounting for family-of-origin effects through the use of a sibling comparison design. Our findings confirmed the notion of cohabiters as a diverse group whose relative mortality risk differs depending on the timing of cohabitation. Never-married cohabiters had a mortality risk similar to married couples at younger ages and a gradually increased risk with age. Divorced and widowed cohabiters exhibited an age gradient in the opposite direction. Future research should consider how the context of cohabitation changes across the life course.

This study examines COVID-19 mortality across long-term care settings comparing migrants and Swedish-born during the first 2 years of the pandemic. Previous research shows that migrants faced higher risks of severe COVID-19 outcomes, contrasting with the observed Migrant Mortality Advantage. Using Swedish total population data (2019-22), we stratified participants aged 70+ by care setting and migration status. We analysed the first pandemic year (March 2020-February 2021) and the second year (March 2021-February 2022), alongside pre-pandemic mortality data for context. Outcome measures included all deaths from COVID-19 and other causes. Cox proportional hazards models were employed adjusting for sociodemographic and health variables. Our findings highlight the significant impact of care settings on COVID-19 mortality in the first pandemic year, exceeding that for other causes of death. Migrants born in low- or middle-income countries in institutional care had higher mortality rates (HR = 42.88, 95% CI = 36.69-50.13) than Swedish-born individuals in institutional care (HR = 25.83, 95% CI = 24.12-27.65) relative to Swedish-born with no care. This contrasts with mortality patterns for non-COVID causes before and during the pandemic, indicating a specific migrant disadvantage during the first year. In the second year, the excess COVID-19 mortality in care settings decreased yet continued to be higher for migrants than for Swedish-born, likely influenced by the equalizing effect of vaccinations. Despite mitigation efforts, a clear migrant mortality disadvantage persisted among those receiving home care or living in care homes.

Children of immigrants born in the host country-the second generation (G2)-face higher risks of unemployment and overqualification compared to the majority native population in Western Europe. While the health effects of unemployment and overqualification are well documented, it remains unclear whether these factors impact the mental health of the G2 in the same way as in the majority population. This study uses Swedish register data to examine the association between different labor market disadvantages, i.e., unemployment and overqualification, and mental health outcomes among the G2 and the majority population. The outcome was measured as time to the first prescription of psychotropic medications (anxiolytics, sedatives, hypnotics, and antidepressants). Descriptive findings showed that psychotropic prescription rates are higher among G2 groups compared to the majority population. Cox proportional hazards models, adjusted for demographic and socioeconomic factors, indicated that unemployment similarly impacts mental health across origin groups, suggesting that being unemployed does not contribute to the mental health inequality between the G2 and the majority population. G2 individuals, especially G2 European individuals, showed higher risks of psychotropic prescriptions across all employment types. These findings imply that improving the labor market position is not sufficient to address mental health inequalities between the G2 and the majority population.

Background: Explanations for the disproportional COVID-19 burden among immigrants relative to host-country natives include differential exposure to the virus and susceptibility due to poor health conditions. Prior to the pandemic, immigrants displayed deteriorating health with duration of residence that may be associated with increased susceptibility over time. The aim of this study was to compare immigrant–native COVID-19 mortality by immigrants’ duration of residence to examine the role of differential susceptibility. Methods: A population-based cohort study was conducted with individuals between 18 and 100 years old registered in Sweden between 1 January 2015 and 15 June 2022. Cox regression models were run to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Inequalities in COVID-19 mortality between immigrants and the Swedish-born population in the working-age group were concentrated among those of non-Western origins and from Finland with more than 15 years in Sweden, while for those of retirement age, these groups showed higher COVID-19 mortality HRs regardless of duration of residence. Both age groups of immigrants from Africa and the Middle East showed consistently higher COVID-19 mortality HRs. For the working-age population: Africa: HR<15: 2.46, 95%CI: 1.78, 3.38; HR≥15: 1.49, 95%CI: 1.01, 2.19; and from the Middle East: HR<15: 1.20, 95%CI: 0.90, 1.60; HR≥15: 1.65, 95%CI: 1.32, 2.05. For the retirement-age population: Africa: HR<15: 3.94, 95%CI: 2.85, 5.44; HR≥15: 1.66, 95%CI: 1.32, 2.09; Middle East: HR<15: 3.27, 95%CI: 2.70, 3.97; HR≥15: 2.12, 95%CI: 1.91, 2.34. Conclusions: Differential exposure, as opposed to differential susceptibility, likely accounted for the higher COVID-19 mortality observed among those origins who were disproportionately affected by the pandemic in Sweden.

BACKGROUND The number of confirmed COVID-19 deaths differed across countries and across waves of the pandemic. Patterns also differed between groups within a country. OBJECTIVE We combine data on excess mortality with data on cause-of-death-specific mortality in the case of Sweden to identify which groups had excess mortality beyond what can be captured by analyses of COVID-19-specific deaths. We also explore the possibility that some groups may have benefited in terms of reduced all-cause mortality, potentially due to home-centered living conditions during the pandemic. METHODS We produced and compared three sets of group-specific incidence rates: deaths from (1) any cause in 2020, (2) any cause in 2019, (3) any cause excluding COVID-19 in 2020. We compared rates across different socioeconomic profiles based on combinations of sex, age, marital status, education, and country of birth. CONTRIBUTION We show that many of those who died during 2020 would not have done so in the absence of the pandemic. We find some evidence of COVID-19 mortality underestimation, mainly among individuals with a migration background. We also found groups for which mortality decreased during the pandemic, even when including COVID-19 mortality. Progression across the first and second waves of the pandemic shows that more groups appeared to become protected over time and that there was less underestimation of COVID-19 mortality in the second part of 2020.

Over-coverage occurs when individuals who reside in a country leave or pass away, and this demographic event is not recorded in population registers, leading to population size overestimation. This problem can have important policy and decision-making consequences. With the increased reliance on incomplete but overlapping official registers for documenting whole populations or subgroups of populations, there is a need for more sophisticated modelling techniques that reliably estimate population size, and hence over-coverage, from such registers. Previous approaches have considered multiple systems estimation (MSE) for monitoring over-coverage, but MSE does not naturally extend to cases where individuals are followed over time. In this paper, motivated by the case study of Sweden, we develop a capture-recapture (CR) modelling framework for population registers that allows us to estimate the population size each year, the probability of presence for each individual in the population, conditional on their records, each year and to quantify the effect of demographic characteristics on the probability of emigration and re-immigration, amongst other parameters. Our results suggest that the CR approach, which accounts for the whole time series for each individual, gives a more realistic estimate of the population size compared to existing, deterministic approaches, especially when considering the subgroup of newly arrived individuals, and that it provides new insights on individual behaviour in terms of migration patterns than existing MSE approaches.

In Denmark and Sweden, statutory retirement age is indexed to life expectancy to account for mortality improvements in their populations. However, mortality improvements have not been uniform across different sub-populations. Notably, in both countries, individuals of lower socioeconomic status (SES) have experienced slower mortality improvements. As a result, a uniform rise in the statutory retirement age could disproportionally affect these low-SES groups and may unintentionally lead to a reverse redistribution effect, shifting benefits from short-lived low-SES individuals to long-lived high-SES individuals. The aim of this study is twofold: to quantify and contextualise mortality inequalities by SES in Denmark and Sweden, and to assess how indexing retirement age will affect future survival to retirement age by SES in these countries. We used Danish and Swedish registry data (1988–2019), to aggregate individuals aged 50 + based on their demographic characteristics and SES. We computed period life tables by year, sex, and SES to estimate the difference in survival across different SES groups. We then forecast mortality across SES groups to assess how indexing retirement age will affect survival inequalities to retirement age, using two forecasting models—the Mode model and the Li-Lee model. Mortality inequalities are comparable in Denmark and Sweden, even though the latter generally has higher survival. We also find that indexing retirement age to life expectancy will have two main consequences: it will reduce the probability of reaching retirement for all SES groups, particularly those of low SES, and time spent in retirement will be reduced, particularly for those of high SES.

BACKGROUND Denmark and Sweden index their statutory retirement ages to life expectancy. When lifespan increases, so does retirement age. This policy does not consider demographic heterogeneity in life expectancy, e.g., between migrants and non-migrants, posing possible issues for pension policies that index retirement age to life expectancy. OBJECTIVE To understand how mortality inequalities between migrants and non-migrants interact with the indexation of statutory retirement age in Denmark and Sweden. METHODS We used Danish and Swedish registry data from 1988-2018, and included individuals aged 50+. Migrants were classified as European-born or non-European-born. We calculated the probability of dying before retirement age, remaining life expectancy at retirement age, lifespan inequalities after retirement age, and the likelihood that a nonmigrant would outlive a migrant. We also classified the Danish-born population into four income levels and compared them to migrant groups. RESULTS Non-European-born migrants had the survival advantage in both countries, but equal or higher lifespan inequality at retirement. Sweden had a proportionally larger migrant population, but Denmark's was more diverse. The probability that a non-migrant would outsurvive a migrant was 40%-50% in both countries. CONCLUSIONS The healthy migrant effect was observed in both Denmark and Sweden. Despite mortality advantages, migrants do not contribute to increasing life expectancy in Denmark or Sweden. CONTRIBUTION This study contributes to the literature on mortality differences between migrants and non-migrants in Scandinavia. The novel contributions of this paper are the consideration of the socioeconomic status of non-migrants in Denmark, and the calculation of probabilities that migrants will outsurvive non-migrants, all within the context of pension policy.

International migrants and their children represent increasing shares of the populations of major host countries and have growing potential to affect estimates of national mortality. Yet, while many studies have observed mortality differences between migrants, their children, and the majority population, few have progressed beyond this point to quantify the actual impact of these differences upon national life expectancy levels. Studies that have, reveal that migrants increasingly enhance national life expectancy, but do not progress beyond a single average generational effect. Here, using established demographic methods, we aim to quantify and unpack the impact of migrants and the children of migrants on national life expectancy in Sweden, with emphasis on potential differences by age, generations, and migration background. Going “against the grain” relative to other countries, we reveal an initial negative effect of first-generation migrants on national life expectancy levels in Sweden, followed by a gradual waning and disappearance of this effect over time. This change is attributable to the transformation in origin composition of Sweden's migrant population from migrants born in Nordic countries (that have higher mortality than the majority population) to migrants born in non-Western countries (that have lower mortality than the majority population), particularly at working ages. For children of migrants, nearly all ages and migrant backgrounds contribute to an increasingly negative effect on national life expectancy over time. The unique and disparate mortality risks of migrants, the children of migrants, and the majority population suggest a need to monitor their mortality separately so as to maximise potential future gains in national life expectancy in Sweden.

Marriage is protective against suicide across most populations, including for persons of different ethnicities and immigrant backgrounds. However, the well-being benefits of marriage are contingent upon marital characteristics—such as conflict and quality—that may vary across spousal dyads with different immigration backgrounds. Leveraging Swedish register data, we compare suicide mortality among married persons on the basis of their and their spouse’s immigration backgrounds. We find that relative to those in a native Swede-Swede union, Swedish men married to female immigrants and immigrant women married to native men are at higher risk of death by suicide, while immigrants of both genders who are married to someone from their birth country have a lower risk of suicide mortality. The findings support hypotheses about the strains that may be encountered by those who intermarry, as well as the potential selection of individuals into inter- and intra-ethnic marriages.

Given that surprisingly little is known about the demography of human kinship, we provide a demographic account of the kinship networks of individuals in Sweden in 2017 across sex and cohort between ages 0 and 102. We used administrative register data of the full population of Sweden to provide the first kinship enumeration for a complete population based on empirical data. We created ego-focused kinship networks of children, parents, siblings, grandchildren, grandparents, aunts and uncles, nieces and nephews, and cousins. We show the average number of kin of different types, the distribution of the number of kin, and changes in dispersion over time. A large share of all kin of an individual are horizontal kin, such as cousins. We observe the highest number of kin-on average, roughly 20-around age 35. We show differences between matrilineal and patrilineal kin and differences in the kinship structure arising from fertility with more than one childbearing partner, such as half-siblings. The results demonstrate substantial variability in kinship within a population. We discuss our findings in the context of other methods to estimate kinship.

Previous research has investigated several different aspects of the relationship between having a child and parental mortality. One aspect of research that has been neglected until now is the age of the child. If children have an effect on parental mortality, this is likely to change as they grow up. We apply hazard regression models to longitudinal Swedish register data of the total population for men and women separately. Adjusting for a variety of control variables, we find that parents with younger children experience a substantive mortality advantage compared to parents—of the same age—who have older children. The mortality advantage decreases gradually as the age of the youngest child increases. Robustness checks confirm that this result cannot be explained by differences in the parent’s age and parental age at first birth. Childless women and men of the same age experience the highest mortality. Additional models for different causes of death suggest that selection, behavioral changes, and unobserved protective effects contribute to this pattern.

The growing necessity for evidence-based policy built on rigorous research has never been greater. However, the ability of researchers to provide such evidence is invariably tied to the availability of high-quality data. Bias stemming from over-coverage in official population registers, i.e. resident individuals whose death or emigration is not registered, can lead to serious implications for policymaking and research. Using Swedish Population registers and the statistical framework of multiple systems estimation, we estimate the extent of over-coverage among foreign-born individuals’ resident in Sweden for the period 2003–2016. Our study reveals that, although over-coverage is low during this period in Sweden, we observed a distinct heterogeneity in over-coverage across various sub-populations, suggesting significant variations among them. We also evaluated the implications of omitting each of the considered registers on real data and simulated data, and highlight the potential bias introduced when the omitted register interacts with the included registers. Our paper underscores the broad applicability of multiple systems estimation in addressing and mitigating bias from over-coverage in scenarios involving incomplete but overlapping population registers.

In this study, we examined the impact of hip fractures on trajectories of home care, nursing home residence, and mortality among individuals aged 65 years or more and explored the impacts of living arrangements, cohabitation, frailty, and socioeconomic position on these trajectories. Based on a linkage of nationwide Swedish population registers, our study included 20,573 individuals with first hip fracture in 2014-2015. Care trajectories during the 2 years following the fracture were visualized and compared with those of 2 hip-fracture-free control groups drawn from the general population: age- and sex-matched controls and health-matched controls identified through propensity score matching. Multistate modeling was employed to identify sociodemographic and health-related factors associated with care trajectories among hip fracture patients. We found that hip fracture patients already had worse health than the general population before their fracture. However, when controlling for prefracture health, hip fractures still had a considerable impact on use of elder-care services and mortality. Comparisons with the health-matched controls suggest that hip fractures have an immediate, yet short-term, impact on care trajectories. Long-term care needs are largely attributable to poorer health profiles independent of the fracture itself. This emphasizes the importance of adequate comparison groups when examining the consequences of diseases which are often accompanied by other underlying health problems.

• Immigrants have higher life expectancy at age 1 than the native-born in Denmark, Finland and Norway do from 1990 to 2019. • Immigrants in Denmark, Finland and Norway increasingly enhance national life expectancy at age 1 over time. • Immigrants in Sweden have lower life expectancy at age 1 than native-born in Sweden do in 1990, but similar levels by 2019. • The effect of immigrants on national life expectancy at age 1 in Sweden transforms from negative to positive over time. • The unique mortality of immigrants affects rankings of life expectancy at age 1 in the Nordic region in recent years.

Background: Certain migration contexts that may help clarify immigrants' health needs are understudied, including the order in which married individuals migrate. Research shows that men, who are healthier than women across most populations, often migrate to a host country before women. Using Danish register data, we investigate descriptive patterns in the order that married men and women arrive in Denmark, as well as whether migration order is related to overnight hospitalizations. Methods: The study base includes married immigrants who lived in Denmark between January 1, 1980 and December 31, 2014 (N = 13,680). We use event history models to examine the influence of spousal migration order on hospitalizations. Results: The order that married individuals arrive in Denmark is indeed highly gendered, with men tending to arrive first, and varies by country of origin. Risk of hospitalization after age 50 does not depend on whether an individual migrated before, after, or at the same time as their spouse among either men or women. However, among those aged 18+, men migrating before their wives are more likely to experience hospitalizations within the first 5 years of arrival. Conclusions: These findings provide the first key insights about gendered migration patterns in Denmark. Although spousal order of migration is not related to overnight hospitalization among women, our findings provide preliminary evidence that men age 18+ who are first to arrive experience more hospitalization events in the following 5 years. Future research should explore additional outcomes and whether other gendered migration contexts are related to immigrants' health.

Supplementary File Mortality by sex, age and county 2017-2020 In this study, we provide an account of mortality levels in Sweden in 2020, focusing on both excess mortality and mortality due to COVID-19 deaths.We present various measures of life expectancy for women and men based on age-specific death rates in 2020. Our measures of excess mortality are based on comparisons with benchmarks derived from a previous mortality forecast for 2020 by Statistics Sweden and observed average mortality rates during 2017–2019. We present data on regional and seasonal variation in excess mortality, as well as estimates of Years of Potential Life Lost due to COVID-19. We decompose excess mortality in 2020 into excess mortality due to COVID-19 and excess mortality attributable to other causes. We also provide some estimates on the impact of excess mortality in 2020 on the remaining life expectancy for different cohorts of women and men in Sweden. We demonstrate that the impact of COVID-19 mortality was concentrated at higher ages, and among men in particular. Conversely, some younger age groups experienced negative excess mortality. The mortality changes during 2020 caused life expectancy levels to revert back to those observed in 2018 for women and in 2017 for men.

Period life expectancy at birth (PLE0) is defined as how long – on average – a newborn baby could expect to live if current mortality rates do not change. It is one of the most widely used population health indicators in the world by academics, governments, statistical agencies, and international organisations. Yet, while estimates of PLE0 routinely factor immigrations and emigrations into population denominators and migrant residents form part of these population denominators, the effect of the unique mortality of international migrants on national PLE0 has almost never been studied. Here, our aim is to understand whether estimates and comparisons of national PLE0 in four Nordic nations – Denmark, Finland, Norway, and Sweden – are being affected by the mortality of their international migrant populations. We use register data for over three decades, from 1990 to 2019. We calculate PLE0 by sex for entire resident, native-born, and migrant populations, as well as the differences between them. Our analysis reveals a dynamic and increasing impact of the mortality of international migrants on national PLE0 that is already beginning to affect inter-country comparisons and rankings of mortality. Our unique findings should resonate strongly in all nations with substantial shares of international migrants and all of the aforementioned stakeholders that use PLE0 to drive and inform public health policy.

Objectives This is the first population-level study to examine inequalities in COVID-19 mortality according to working-age individuals’ occupations and the indirect occupational effects on COVID-19 mortality of older individuals who live with them. Methods We used early-release data for the entire population of Sweden of all recorded COVID-19 deaths from 12 March 2020 to 23 February 2021, which we linked to administrative registers and occupational measures. Cox proportional hazard models assessed relative risks of COVID-19 mortality for the working-aged population registered in an occupation in December 2018 and the older population who lived with them. Results Among working aged-adults, taxi/bus drivers had the highest relative risk of COVID-19 mortality: over four times that of skilled workers in IT, economics, or administration when adjusted only for basic demographic characteristics. After adjusting for socioeconomic factors (education, income and country of birth), there are no occupational groups with clearly elevated (statistically significant) COVID-19 mortality. Neither a measure of exposure within occupations nor the share that generally can work from home were related to working-aged adults’ risk of COVID-19 mortality. Instead of occupational factors, traditional socioeconomic risk factors best explained variation in COVID-19 mortality. Elderly individuals, however, faced higher COVID-19 mortality risk both when living with a delivery or postal worker or worker(s) in occupations that generally work from home less, even when their socioeconomic factors are taken into account. Conclusions Inequalities in COVID-19 mortality of working-aged adults were mostly based on traditional risk factors and not on occupational divisions or characteristics in Sweden. However, older individuals living with those who likely cannot work from home or work in delivery or postal services were a vulnerable group.