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Source at https://www.fhi.no/. Dette notatet har bakgrunn i det NFR-finansierte forskningsprosjektet «Stykkprisfinansiering i primærhelsetjenesten: Utilsiktede bivirkninger for pasienter og samfunn?» (1). Forskningsprosjektet ledes av professor Arnstein Mykletun, seniorforsker ved FHI, og involvert i dette notatet er ph.d. stipendiatene Kristian Kraft og Eivor Hovde Hoff, samt forsker og fastlege Kristian Amundsen Østby, alle ved FHI. Dette notatet er et oppdrag for ekspertutvalget for gjennomgang av allmennlegetjenesten som fikk sitt mandat 11.08.22 av Helse- og omsorgsdepartementet (2). Analysene for notatet er utført i tidsperioden januar og februar 2023. Helsedirektoratet har frikjøpt arbeidstid fra ovennevnte for leveranse av disse analysene. Ekspertgruppens behov for innsikt og resultater var sammenfallende med planlagte problemstillinger for det NFRfinansierte forskningsprosjektet, og kunne derfor gjennomføres på grunnlag av KUHR-data og Fastlegeregisteret. Tilleggsfinansieringen til dette notatet har muliggjort å fremskynde visse analyser og tilrettelegge resultatpresentasjonen for ekspertgruppen. Dette notatet inngår også som rapportering i det nevnte NFR-prosjektet. Det er gitt nødvendige godkjenninger (dispensasjon fra taushetsplikten) fra Regional etisk komite (REK-nummer 210548) og er tilrådt av personvernombudet ved FHI. Det har ikke vært utført fagfellevurdering, begrunnet i den korte tidsrammen for prosjektet. Analyser i denne rapporten vil i noen grad inngå i fagfellevurderte internasjonale og nasjonale publikasjoner i framtiden.

Supplemental material, sj-docx-3-sjp-10.1177_14034948221100685 for COVID-19 vaccination rates among healthcare workers by immigrant background: A nation-wide registry study from Norway by Kristian Bandlien Kraft, Ingeborg Elgersma, Trude Marie Lyngstad, Petter Elstrøm and Kjetil Telle in Scandinavian Journal of Public Health

Supplemental material, sj-docx-4-sjp-10.1177_14034948221100685 for COVID-19 vaccination rates among healthcare workers by immigrant background: A nation-wide registry study from Norway by Kristian Bandlien Kraft, Ingeborg Elgersma, Trude Marie Lyngstad, Petter Elstrøm and Kjetil Telle in Scandinavian Journal of Public Health

Supplemental material, sj-docx-2-sjp-10.1177_14034948221100685 for COVID-19 vaccination rates among healthcare workers by immigrant background: A nation-wide registry study from Norway by Kristian Bandlien Kraft, Ingeborg Elgersma, Trude Marie Lyngstad, Petter Elstrøm and Kjetil Telle in Scandinavian Journal of Public Health

BAKGRUNN Vaksinasjonsdekninga mot covid-19 varierer mellom innvandrargrupper i Noreg og mellom ulike land. Truleg formar oppvekst og vedvarande kontakt med fødelandet haldning til og ynske om vaksinasjon. Derfor samanlikna vi vaksinasjonsdekninga blant innvandrarar i Noreg fødde i Europa med vaksinasjonsdekninga i fødelanda. MATERIALE OG METODE Vaksinasjonsdekninga, prosentdelen av den vaksne befolkninga som hadde mottatt minst éin vaksinedose, for 22 europeiske land med universell vaksinetilgang innan 31.8.2021 vart 30.9.2021 henta frå European Centre for Disease Prevention and Control og frå Beredskapsregisteret for covid-19 for tilhøyrande innvandrargrupper i Noreg. Spreiingsdiagram med minste kvadraters regresjonslinje viste samanhengen mellom vaksinasjonsdekninga i fødelandet og dekninga i tilhøyrande innvandrargruppe i Noreg totalt og splitta etter butid i Noreg (< 6 år og ≥ 6 år). RESULTAT Modellen anslo ein auke i vaksinasjonsdekning i innvandrargruppene i Noreg med 0,64 prosentpoeng for kvart prosentpoengs auke i vaksinasjonsdekninga i dei europeiske fødelanda, og forklarte 63 % av variasjonen i vaksinasjonsdekninga i innvandrargruppene. Det var ingen statistisk signifikant skilnad i samvariasjon med fødelandet for innvandrarar med kort samanlikna med lang butid. TOLKING Det er samanheng mellom covid-19-vaksinasjonsdekninga blant innvandrarar i Noreg fødde i Europa og dekninga i fødelanda deira. Haldning til og ynske om vaksinasjon varierer mellom land og kan forklare noko av den observerte skilnaden mellom innvandrargrupper i Noreg.

Executive summary Introduction Reports from several countries indicate that people with low education and income are more likely to be affected by COVID-19. In this report we investigate how education level and household income are related to test activity, confirmed cases, hospitalizations, invasive ventilation, and death related to COVID-19 in Norway. Methods We have utilized the nation-wide emergency preparedness register, BeredtC19, which contains individual-level data covering the entire Norwegian population. The study population consists of individuals with a personal identification number, alive and registered as residents per 1st March 2020 and are aged 25 years or older. The study period was February 2020 to May 2021. The exposure variables, highest attained education and household income after tax (equivalent income), are operationalised, respectively, into five categories for education, and into deciles for household income. Outcomes studied were test activity (being tested and share of positive tests among those tested), laboratory confirmed cases, related hospitalizations, use of invasive ventilation and death. We have used both descriptive analyses and linear regressions. For the outcomes test activity, confirmed cases, and hospitalization, we adjust for age, sex, municipality of residence and country of birth. Results DiscussionThe sample comprised 3 882 249 persons, of which 1 864 860 were tested at least once, 75 698 were confirmed cases, 8 222 hospitalizations, 821 received invasive ventilation, and 710 died. In total, 20 % had attained below upper secondary education and 37 % university or college education. The median household income was 644 143 NOK. The lowest income decile and the undisclosed/no education group were on average younger compared to the other categories. Immigrants made up 93 % of those in the undisclosed/no education group and 40 % of the 1st (lowest) income decile. There was a positive correlation between increasing education from below upper secondary education to university/college education and test rate, which remained after adjustments. For household income, the relationship after 15th June 2020 was slightly S-shaped, with generally higher testing rates in the higher income deciles compared to the lower income deciles. After adjustment there was a clear positive relationship between household income and testing rate. Both lower education level and household income were associated with elevated risk of infection and with more severe disease (hospitalization, invasive ventilation, and death). Persons in the three lowest household income deciles and those with a below upper secondary education or undisclosed/no education have been hit hardest. The differences between the different education and income groups in confirmed cases and related hospitalizations decrease when we adjust for age, sex, municipality of residence and country of birth. For confirmed cases, the differences between household income deciles were fully attenuated. For other outcomes, differences were somewhat decreased, however there were still clear trends even after adjustment. Adjusting for immigrant status (country of birth) made the largest impact overall, especially for the category undisclosed/no education, which was predominantly immigrants. Discussion These findings correspond with other reports and studies on the relationship between COVID-19 (and health in general) and education and income. This report does not empirically examine why people with low education and low household income have been disproportionally affected, but factors such as working conditions, living conditions, health literacy, delayed access to health services or underlying diseases are suggested as possible mechanisms. Conclusion Individuals with lower education and household income have had higher rates of confirmed cases, hospitalization, invasive ventilation and deaths related to COVID-19. When we adjust for age, sex, municipality of residence and country of birth, differences between the groups are reduced, but rarely eliminated. Of the factors included, country of birth had the largest impact in accounting for the differences between the education and income groups. Going forward, it will be important to obtain more knowledge about the causes and mechanisms behind the observed overrepresentation.

It is a common claim that mutually exclusive social identities can explain political behavior. Recently, studies have instead examined how individuals themselves emphasize different overlapping social identities and its effect on political behavior. However, few of these studies have examined the importance of overlapping social identities in a homogenous country where there exist no mutually exclusive identity groups. Mutually exclusive identities are likely to affect individuals’ self-conception of identity. Consequently, a homogenous country would be a relevant case to examining the role of identity, without the influence of mutually exclusive identities. For this reason, this thesis examines the relationship between social identity and electoral behavior in a homogenous country, using Tunisia as a case. Drawing on regression models of survey data and ideational analysis, this thesis finds that the political importance of social identities is not dependent on the existence of a mutually exclusive out-group. The logistic regression model demonstrates that those who emphasize a Muslim identity are more likely to vote for the Islamist party, while those who emphasized a Tunisian identity are more likely to vote for the secular party. I develop two causal mechanisms that links identity and electoral behavior. First, individuals tend to vote for the party that are perceived as the protector and supporter of their identity because they want to maintain that identity. Second, identity affects attitudes which in turn affects electoral choice due to the role of ideology.