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Article History

Received: 11 February 2026

Accepted: 14 April 2026

First Online: 6 June 2026

Acknowledgements

: This paper is built on the degree thesis work of medical student Oscar Wikstrand, from Sahlgrenska Academy, University of Gothenburg. We thank him for his great work providing the fundamental basics of this article.

: This study used pseudonymised individual-level data from Swedish healthcare registers that are not publicly available according to Swedish legislation. The data can be obtained from the respective Swedish data holders on the basis of ethics approval for the research in question, subject to relevant legislation, processes and data protection.

: This study was made possible by funding from the SciLifeLab National COVID-19 Research Program, financed by the Knut and Alice Wallenberg Foundation (grants KAW 2021-0010/VC2021.0018 and KAW 2020.0299/VC 2022.0008), the Swedish Research Council (grants 2021-05045, 2021-05450, 2022-06395, 2025-06643), and the Swedish Heart-Lung Foundation (20210030, 20210581, 20240726). The SCIFI-PEARL study also has basic funding based on grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (grants ALFGBG-938453, ALFGBG-971130, ALFGBG-978954, ALFGBG-1006729, ALFGBG-997083), grants from Forte (Swedish Research Council for Health, Working Life and Welfare), (grant 2022-00444, 2024-01711), and previously from a joint grant from Forte (Swedish Research Council for Health, Working Life and Welfare) and FORMAS (Research Council for Environment, Agricultural Sciences and Spatial Planning), (grant 2020-02828). The study sponsor/funder was not involved in the design of the study; the collection, analysis, and interpretation of data; writing the report; and did not impose any restrictions regarding the publication of the report.

: FN owns some AstraZeneca shares. FN, HL and AS report participation in research projects funded by Bayer and AstraZeneca (regulator-mandated phase IV study; investigator-initiated study), with funds paid to the University of Gothenburg where they are employed (no personal fees) and with no relation to the work reported here. KE-O has been a consultant for Novo Nordisk, Sanofi, Eli Lilly and Abbott Diabetes Care and a lecturer at Sanofi and Abbott Diabetes Care. The remaining authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.

: HL, FN and YX were involved in the conception and design of the study. HL and YX were involved in the analysis, and all authors were involved in interpretation of the results. HL and YX wrote the first draft and all authors edited, reviewed and approved the final version of the manuscript. HL, FN and YX have full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.