This study aimed to investigate the impact of socioeconomic status and country of origin on COVID-19 outcomes in Swedish intensive care units (ICUs), hypothesising that these factors are independently associated with 90-day mortality.

Registry-based cohort study.

Swedish ICUs, from 6 March 2020 to 31 December 2022.

Adults (≥18 years) with confirmed SARS-CoV-2 infection and acute hypoxaemic respiratory failure. A total of 5833 patients were included in the multivariable model.

Not applicable.

The primary outcome was 90-day mortality. Secondary outcomes included 1-year mortality and ventilator and renal replacement therapy-free days within 60 days post-ICU admission.

Non-European country of origin was independently associated with higher 90-day and 1-year mortality adjusted OR (aOR) 1.34 [95% CI 1.13 to 1.61], p=0.001, aOR 1.26 [95% CI 1.01 to 1.5], p=0.01, respectively. Socioeconomic variables did not significantly impact mortality or organ support-free days. Other predictors of 90-day mortality included age, sex, chronic heart and lung disease, Simplified Acute Physiology Score 3 score, immunosuppression, time in hospital prior to ICU admission, pandemic wave and admission Partial pressure of oxygen in arterial blood/Fraction of inspired oxygen-ratio.

The study identified significant disparities in COVID-19 outcomes based on country of origin, with non-European patients facing higher mortality risks. These findings could challenge the notion of equitable healthcare in Sweden and underscore the need for further research into systemic inequalities.