Highlights
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Destinations, travel demographics, and travel plans were found to be similar among Nordic citizens responding to an online questionnaire [Au? rephrase].
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Overall, 37% of respondents had traveled to countries with a higher risk of acquiring travel-related diseases.
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Older individuals were found to travel almost as much as younger ones.
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One-third of the 60–74-year-olds had visited destinations outside Europe and North America.
KEYWORDS: Travel, Traveler, Nordic countries, Plans, Patterns, Elderly, VFR travel
Abstract
Background
Despite the high frequency of international travel from Nordic countries annually, data describing demographics, patterns, and plans of travel among Nordic inhabitants are scarce.
Methods
In 2018, an online questionnaire covering travel patterns, plans, and knowledge about travel-related diseases was sent to Nordic inhabitants 18–74 years of age. At-risk travelers were defined as those who had traveled outside Europe and North America during the previous 2 years.
Results
Of the 5407 respondents included, 4371 (80.8%) had traveled abroad within the past 2 years. Among the respondents, 37.0% (n = 1999) were at-risk travelers. The most frequent travel destinations were Europe (n = 3907, 89.4%) and Asia (n = 1019, 23.3%). Russia/Eurasia was a more common destination for Finnish travelers than the other travelers (10.6% vs 2.3–4.1%). Most at-risk travelers had traveled for leisure/tourism (n = 1329, 66.5%). Visiting friends and relatives was more frequent among Norwegian and Swedish travelers (n = 105, 22.0% and n = 98, 19.4%, respectively) than Finnish travelers (n = 74, 12.7%). The elderly traveled often and made up 21.4% of at-risk travelers.
Conclusions
Travel demographics, destinations, and future travel plans were similar across the Nordic countries. More than one third had traveled outside Europe/North America. One third were either elderly or visiting friends or relatives.
1. Introduction
A constant increase in international travel was observed up until March 2020, when the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic. There were 952 million arrivals at international destinations in 2010 and 1461 million in 2019, an increase of more than 50%. Of these, 437 million in 2010 and 685 million in 2019 were recorded in low- and middle-income countries (LMICs) [1]. A similar trend was also seen in Denmark, where 16.4 million individuals took an international flight from a Danish airport in 2019, an increase of 33.2% compared to 2010 [2]. In 2019, Norwegians reported 8.89 million trips abroad [3]. The respective figure for Finns was 9.4 million, of which 7.3 million trips were for leisure and 2.1 million were work-related [4,5]. During 2019, a total of 15.4 million passengers traveled internationally from Swedish airports [6].
International travel plays an important role in the spread of certain infectious agents. During the West African Ebola outbreak in 2014–2016, the virus was transported between countries by individuals crossing the borders [7]. More recently, we have witnessed the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During the first weeks of the COVID-19 pandemic, most of the cases in Denmark were related to international travel [8]. In the second year of the pandemic, international travel still stood out as a major player in the spread of new variants of concern. A previous study showed that one out of six inpatients in a Danish infectious disease department had been hospitalized due to travel-related diseases [9]. The high frequency of travel among Nordic citizens increases the risk of importing travel-related diseases; thus, in-depth knowledge about travel habits and destinations is of particular value for health planners, health care providers, and travel clinics.
The aim of this study was to describe the demographics, travel patterns, and future travel plans among Nordic travelers. Such data could be used as a tool to improve pre-travel medical advice and post-travel health care.
2. Materials and methods
2.1. Data source
The study data were obtained from a cross-sectional survey targeting inhabitants in each of the four Nordic countries (Denmark, Finland, Norway, and Sweden) that gathered information on travel habits and knowledge on travel-related diseases. The survey was conducted at the beginning of 2018 by Sanofi Pasteur, with the assistance of Mindshare Media UK Limited, using an online panel consisting of approximately 150 000 Swedish, 100 000 Danish, 110 000 Finnish, and 90 000 Norwegian inhabitants. Mindshape Media is a market research agency complying with the standards and best practice formulated by the European Society for Opinion and Marketing Research (ESOMAR). The survey was conducted as an online questionnaire. The questionnaire comprised 23 questions about travel patterns (e.g., frequency, destinations, main purpose), risk behavior abroad, vaccination status, knowledge about travel-related diseases, and future travel plans.
2.2. Participants
The questionnaire was sent to Nordic inhabitants aged 18–74 years, and respondents were stratified to the general population by gender, age, and geographic region. In the analyses, all respondents who did not remember whether they had traveled or not during the past 2 years and those who had left that specific question unanswered were excluded. A separate analysis was conducted for at-risk travelers due to the higher risk of acquiring travel-related diseases. At-risk travelers were defined as those with a history of travel outside Europe and North America at least once during the previous 2 years. This was covered by the second part of the questionnaire, which focused only on the respondent's last trip outside of Europe and North America.
2.3. Variables
The respondents were divided into groups based on their country of residence (Finland, Sweden, Norway, and Denmark), gender, age group (18–35 years, 36–59 years, and 60–74 years), and occupation (leading position, managerial employee, white-collar worker, employee, retired, student, unemployed, and other). The following categories to describe travel frequency were used: at least twice every year, once a year, every second year, once every 3–4 years, once every 5 years or less often, and ‘I do not know/do not remember’. The main purpose of travel was categorized as education/study, leisure/tourism, visiting friends or relatives (VFR), volunteering, work/business, and other. The duration of the trip was recorded as <1 week, 1–2 weeks, 3–4 weeks, 4 weeks–6 months, or >6 months. Accommodation was grouped according to the type of accommodation used most of the time: 4–5-star hotel, 2–3-star hotel, guesthouse/bungalow, youth hostel/hostel, camping, staying with friends/family/relatives, Airbnb/rental apartment, or other. Travel partner categories included travelling alone, with partner/wife/husband, with children, with friends, with colleagues, or other. Destinations were grouped into those in Europe, North America, Latin America, Africa, Russia/Eurasia, Middle East, Asia, and Oceania.
2.4. Statistical methods
Data from the questionnaires were analyzed using Stata statistical software (v16.1; Stata Corp., College Station, TX, USA). Continuous variables were presented as the mean value with standard deviation if the data were normally distributed, and as the median with interquartile range if not. The Chi-square test or Fisher's exact test was used to compare the distribution of categorical variables among the countries. The t-test was used for continuous variables when a normal distribution could be assumed. For all tests, a P-value below 0.05 was considered statistically significant.
3. Results
3.1. Baseline characteristics
A total of 5559 individuals filled in the questionnaire. Fifty-two individuals who did not remember whether they had travelled or not during the past 2 years and 100 who did not answer that specific question were excluded. The final study population comprised 5407 individuals: 1350 from Finland, 1364 from Sweden, 1326 from Norway, and 1367 from Denmark (Table 1). Half of the respondents were women (n = 2714, 50.2%). Almost half were in the age group of 36–59 years (n = 2416, 44.7%) and more than one in five were older than 60 years (n = 1209, 22.4%) (Table 1).
Table 1.
Baseline characteristics of 5407 Nordic travelers answering an online travel questionnaire.
| Finland | Sweden | Norway | Denmark | Total | P-valuea | |
|---|---|---|---|---|---|---|
| All travelers | ||||||
| Number of respondents, n (%) | 1350 (25.0) | 1364 (25.2) | 1326 (24.5) | 1367 (25.3) | 5407 (100) | |
| Gender, n (%) | ||||||
| Women | 681 (50.4) | 692 (50.7) | 669 (50.5) | 672 (49.2) | 2714 (50.2) | 0.85 |
| Age (years), n (%) | ||||||
| 18–35 | 420 (31.1) | 462 (33.9) | 486 (36.7) | 414 (30.3) | 1782 (33.0) | <0.01 |
| 36–59 | 628 (46.5) | 569 (41.7) | 602 (45.4) | 617 (45.1) | 2416 (44.7) | |
| 60–74 | 302 (22.4) | 333 (24.4) | 238 (17.9) | 336 (24.6) | 1209 (22.4) | |
| Frequency of travel, n (%) | ||||||
| ≥2 times per year | 563 (41.7) | 546 (40.0) | 757 (57.1) | 655 (47.9) | 2521 (46.6) | <0.01 |
| Once a year | 333 (24.7) | 377 (27.6) | 357 (26.9) | 369 (27.0) | 1436 (26.6) | |
| Every second year | 116 (8.6) | 132 (9.7) | 81 (6.1) | 107 (7.8) | 436 (8.1) | |
| Once every 3–4 years | 120 (8.9) | 90 (6.6) | 51 (3.8) | 87 (6.4) | 348 (6.4) | |
| Once every 5 years or less often | 174 (12.9) | 157 (11.5) | 54 (4.1) | 122 (8.9) | 507 (9.4) | |
| Do not know/remember | 44 (3.3) | 62 (4.5) | 26 (2.0) | 27 (2.0) | 159 (2.9) | |
| Occupation | ||||||
| Leading position | 34 (2.5) | 65 (4.8) | 79 (6.0) | 107 (7.8) | 285 (5.3) | <0.01 |
| Managerial employee | 54 (4.0) | 210 (15.4) | 96 (7.2) | 95 (6.9) | 455 (8.4) | |
| White-collar worker | 227 (16.8) | 344 (25.2) | 94 (7.1) | 285 (20.8) | 950 (17.6) | |
| Employee | 390 (28.9) | 73 (5.4) | 440 (33.2) | 189 (13.8) | 1092 (20.2) | |
| Retired | 284 (21.0) | 278 (20.4) | 194 (14.6) | 285 (20.8) | 1041 (19.3) | |
| Student | 125 (9.3) | 123 (9.0) | 152 (11.5) | 160 (11.7) | 560 (10.4) | |
| Unemployed | 113 (8.4) | 96 (7.0) | 69 (5.2) | 77 (5.6) | 355 (6.6) | |
| Other | 123 (9.1) | 175 (12.8) | 202 (15.2) | 169 (12.4) | 669 (12.4) | |
| Traveled in the last 2 years | ||||||
| Number of travelers, n (%) | 1066 (79.0) | 1073 (78.7) | 1107 (83.5) | 1125 (82.3) | 4371 (80.8) | <0.01 |
| At-risk travelersb | ||||||
| Number of travelers, n (%) | 505 (47.4) | 505 (47.1) | 478 (43.2) | 511 (45.4) | 1999 (45.7) | 0.18 |
| Gender, n (%) | ||||||
| Women | 253 (50.1) | 259 (51.3) | 231 (48.3) | 245 (47.9) | 988 (49.4) | 0.69 |
| Age (years), n (%) | ||||||
| 18–35 | 157 (31.9) | 190 (37.6) | 213 (44.6) | 167 (32.7) | 727 (36.4) | <0.01 |
| 36–59 | 236 (46.7) | 200 (39.6) | 196 (41.0) | 212 (41.5) | 844 (42.2) | |
| 60–74 | 112 (22.2) | 115 (22.8) | 69 (14.4) | 132 (25.8) | 428 (21.4) | |
When the expected value of incidence was below 5, Fisher's exact test was used. For all other variables, the Chi-square test was used.
At-risk travelers were defined as those who had traveled outside Europe and North America at least once during the previous 2 years.
Most respondents (73.2%) traveled abroad either once a year (n = 1436, 26.6%) or at least twice a year (n = 2521, 46.6%). One in 10 reported travelling every 5 years or less often (n = 507, 9.4%). The Norwegian respondents were more likely to travel at least twice every year than the respondents from the other Nordic countries (57.1% vs 40.0–47.9%) (Table 1). The proportion reporting travel abroad at least twice a year was higher among 60–74-year-olds than among the younger age groups (62.9% vs 52.2–54.6%) (Table 2).
Table 2.
Travel demographics compared between age groups.
| Age groups |
Total | P-valuea | |||
|---|---|---|---|---|---|
| 18–35 years | 36–59 years | 60–74 years | |||
| Number of travelers, n (%) | 1468 (33.6) | 1955 (44.7) | 948 (21.7) | 4371 | |
| Gender, n (%) | |||||
| Women | 916 (62.4) | 929 (47.5) | 334 (35.2) | 2179 (49.9) | <0.01 |
| Frequency of travel, n (%) | |||||
| ≥2 times per year | 767 (52.2) | 1068 (54.6) | 596 (62.9) | 2431 (55.6) | <0.01 |
| Once a year | 496 (33.8) | 586 (30.0) | 236 (24.9) | 1318 (30.2) | |
| Every second year | 112 (7.6) | 167 (8.5) | 59 (6.2) | 338 (7.7) | |
| Once every 3–4 years | 52 (3.5) | 85 (4.3) | 35 (3.7) | 172 (3.9) | |
| Once every 5 years or less often | 24 (1.6) | 38 (1.9) | 15 (1.6) | 77 (1.8) | |
| Do not know/remember | 17 (1.2) | 11 (0.6) | 7 (0.7) | 35 (0.8) | |
When the expected value of incidence was below 5, Fisher's exact test was used. For all other variables, the Chi-square test was used.
3.2. Travel destinations
Four out of five respondents had traveled within the past 2 years (n = 4371, 80.8%) (Table 1), and almost nine out of 10 within Europe (n = 3907, 89.4%). Other common destinations were Asia (n = 1019, 23.3%), the Middle East (n = 658, 15.1%), and North America (n = 646, 14.8%). The destinations were generally very similar across the countries, except Finnish respondents were more likely to travel to Russia/Eurasia (10.6% vs 2.3–4.1%) and less likely to visit North America (10.1% vs 15.5–16.9%) than travelers from the other Nordic countries. Moreover, travel to Africa was reported more frequently by Swedish respondents than the other participants (11.9% vs 8.3–9.2%) (Figure 1). North America and the Middle East were more common destinations among the 18–35-year-olds than among the other age groups (18.8% vs 11.4–13.4% and 18% vs 12.2–14.2%, respectively) (Figure 1).
Figure 1.
Travel destinations and future travel plans.
3.3. At-risk travelers
There were 1999 at-risk travelers (37.0% of all respondents) (Table 1). The last travel outside of Europe/North America was most often for leisure/tourism (n = 1329, 66.5%) (Table 3). VFR as a reason for travelling was reported more frequently by Norwegian and Swedish at-risk travelers (n = 105, 22.0% and n = 98, 19.4%, respectively), than by Finnish at-risk travelers (n = 74, 12.7%). The Norwegians were also more likely to travel as volunteers and for educational reasons compared to the other Nordic travelers, while the Danes traveled more for business reasons.
Table 3.
Travel characteristics among at-risk travelers, during their last travel outside of Europe and North America.
| Country of residence, n (%) |
Total | P-valuea | ||||
|---|---|---|---|---|---|---|
| Finland | Sweden | Norway | Denmark | |||
| Purpose | ||||||
| Education/study | 13 (2.6) | 10 (2.0) | 18 (3.8) | 13 (2.5) | 54 (2.7) | <0.01 |
| Leisure/tourism | 369 (73.1) | 332 (65.7) | 290 (60.7) | 338 (66.1) | 1329 (66.5) | |
| Visiting friends or relatives | 64 (12.7) | 98 (19.4) | 105 (22.0) | 88 (17.2) | 355 (17.8) | |
| Volunteering | 11 (2.2) | 14 (2.8) | 14 (2.9) | 9 (1.8) | 48 (2.4) | |
| Work/business | 40 (7.9) | 46 (9.1) | 49 (10.3) | 63 (12.3) | 198 (9.9) | |
| Other | 8 (1.6) | 5 (1.0) | 2 (0.4) | 0 (0.0) | 15 (0.8) | |
| Duration | ||||||
| <1 week | 62 (12.3) | 32 (6.3) | 26 (5.4) | 38 (7.4) | 158 (7.9) | <0.01 |
| 1–2 weeks | 321 (63.6) | 318 (63.0) | 259 (54.2) | 303 (59.3) | 1201 (60.1) | |
| 3–4 weeks | 76 (15.0) | 105 (20.8) | 133 (27.8) | 127 (24.9) | 441 (22.1) | |
| 4 weeks–6 months | 38 (7.5) | 41 (8.1) | 47 (9.8) | 38 (7.4) | 164 (8.2) | |
| >6 months | 8 (1.6) | 9 (1.8) | 13 (2.7) | 5 (1.0) | 35 (1.8) | |
| Accommodation | ||||||
| 4–5-star hotel | 196 (38.8) | 241 (47.7) | 197 (41.2) | 242 (47.4) | 876 (43.8) | <0.01 |
| 2–3-star hotel | 149 (29.5) | 119 (23.6) | 85 (17.8) | 119 (23.3) | 472 (23.6) | |
| Guesthouse/bungalow | 17 (3.4) | 30 (5.9) | 36 (7.5) | 27 (5.3) | 110 (5.5) | |
| Youth hostel/hostel | 19 (3.8) | 17 (3.4) | 13 (2.7) | 22 (4.3) | 71 (3.6) | |
| Camping | 3 (0.6) | 3 (0.6) | 8 (1.7) | 6 (1.2) | 20 (1.0) | |
| Friends/family/relatives | 64 (12.7) | 58 (11.5) | 76 (15.9) | 61 (11.9) | 259 (13.0) | |
| Airbnb/rental apartment | 16 (3.2) | 19 (3.8) | 44 (9.2) | 13 (2.5) | 92 (4.6) | |
| Other | 41 (8.1) | 18 (3.6) | 19 (3.9) | 21 (4.1) | 99 (5.0) | |
| Travel companion | ||||||
| Alone | 95 (18.8) | 73 (14.5) | 92 (19.2) | 76 (14.9) | 336 (16.8) | 0.08 |
| Partner/wife/husband | 253 (50.1) | 249 (49.3) | 213 (44.6) | 276 (54.0) | 991 (49.6) | 0.03 |
| Children | 67 (13.3) | 99 (19.6) | 75 (15.7) | 85 (16.6) | 326 (16.3) | 0.06 |
| Friends | 98 (19.4) | 103 (20.4) | 104 (21.7) | 88 (17.2) | 393 (19.7) | 0.33 |
| Colleagues | 24 (4.8) | 32 (6.4) | 38 (7.9) | 28 (5.5) | 122 (6.1) | 0.18 |
| Other | 31 (6.1) | 39 (7.7) | 35 (7.3) | 52 (10.2) | 157 (7.9) | 0.11 |
When the expected number of incidence was below 5, Fisher's exact test was used. For all other variables, the Chi-square test was used.
The duration of the trip was in most cases 1–2 weeks (n = 1201, 60.1%), followed by 3–4 weeks (n = 441, 22.1%). Only 158 (7.9%) of the travelers reported that their last trip outside of Europe and North America had lasted less than 1 week.
Most of the at-risk travelers preferred 4–5-star hotels (n = 876, 43.8%), 2–3-star hotels (n = 472, 23.6%), or staying with friends and family (n = 259, 13%). Only 20 individuals (1.0%) preferred camping. As compared to the other Nordic travelers, the Finns tended to choose a 2–3-star hotel more often, and a 4–5-star hotel less often. The Norwegian travelers were more likely than travelers from the other Nordic countries to stay at an Airbnb or rental apartment (n = 44, 9.2% vs n = 13–19, 2.5–3.8%).
One-sixth of the participants traveled alone (n = 336, 16.8%). The most common travel companion was a partner (n = 991, 49.6%) (Table 3).
People working in a leading position traveled more for work/business (31.9% vs 2.5–11.7%), more frequently made trips shorter than 1 week (11.0% vs 5.3–9.9%), and were most likely to stay at 4–5-star hotels (61.3% vs 28.8–53.2%) during their last travel outside of Europe and North America. Employees, unemployed, and students were less likely to stay at 4–5-star hotels (28.8–37.8%), but more likely to stay at youth hostels/hostels (4.3–9.6%) than the others. Retired participants were most likely to travel for leisure/tourism. Unemployed people were more likely to visit friends and family than the others (28.8% vs 12.9–20.9%) (Table 4). In this study, fewer of the Finns worked in leading positions (3.8% vs 7.9–11.2%), while fewer of the Norwegians were retired (10.5% vs 17.5–19.6%). The Swedes were more commonly white-collar workers (27.1% vs 8.8–20.6%) and managerial employees (17.6% vs 5.3–9.8%). Almost one-third of Finns (27.7%) and Norwegians (32.2%) were employees, compared to 6.1% of Swedes and 13.1% of Danes.
Table 4.
Travel habits during the last trip outside of Europe/North America compared between different occupations.
| Occupation |
Total | P-valuea | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Leading position | Managerial employee | White-collar worker | Employee | Retired | Student | Unemployed | Other | |||
| Number of travelers, n (%) | 163 (8.2) | 205 (10.3) | 380 (19.0) | 394 (19.7) | 331 (16.6) | 240 (12.0) | 80 (4.0) | 206 (10.3) | 1999 | |
| Country of origin, n (%) | ||||||||||
| Finland | 19 (3.8) | 27 (5.3) | 104 (20.6) | 140 (27.7) | 99 (19.6) | 50 (9.9) | 22 (4.4) | 44 (8.7) | 505 | |
| Sweden | 40 (7.9) | 89 (17.6) | 137 (27.1) | 31 (6.1) | 88 (17.4) | 52 (10.3) | 24 (4.8) | 44 (8.7) | 505 | |
| Norway | 47 (9.8) | 39 (8.2) | 42 (8.8) | 156 (32.6) | 50 (10.5) | 76 (15.9) | 12 (2.5) | 56 (11.7) | 478 | |
| Denmark | 57 (11.2) | 50 (9.8) | 97 (18.9) | 67 (13.1) | 94 (18.4) | 62 (12.1) | 22 (4.3) | 62 (12.1) | 511 | |
| Purpose, n (%) | ||||||||||
| Education/study | 3 (1.8) | 2 (1.0) | 7 (1.8) | 7 (1.8) | 1 (0.3) | 25 (10.4) | 3 (3.8) | 6 (2.9) | 54 (2.7) | <0.01 |
| Leisure/tourism | 82 (50.3) | 144 (70.2) | 256 (67.4) | 265 (67.3) | 260 (78.6) | 147 (61.3) | 49 (61.3) | 126 (61.2) | 1329 (66.5) | |
| Visiting friends or relatives | 21 (12.9) | 31 (15.1) | 68 (17.9) | 71 (18.0) | 49 (14.8) | 49 (20.4) | 23 (28.8) | 43 (20.9) | 355 (17.8) | |
| Volunteering | 5 (3.1) | 3 (1.5) | 6 (1.6) | 11 (2.8) | 10 (3.0) | 7 (2.9) | 0 (0.0) | 6 (2.9) | 48 (2.4) | |
| Work/business | 52 (31.9) | 24 (11.7) | 40 (10.5) | 38 (9.6) | 9 (2.7) | 11 (4.6) | 2 (2.5) | 22 (10.7) | 198 (9.9) | |
| Other | 0 (0.0) | 1 (0.5) | 3 (0.8) | 2 (0.5) | 2 (0.6) | 1 (0.4) | 3 (3.8) | 3 (1.5) | 15 (0.8) | |
| Duration, n (%) | ||||||||||
| <1 week | 18 (11.0) | 13 (6.3) | 31 (8.2) | 39 (9.9) | 21 (6.3) | 19 (7.9) | 6 (7.5) | 11 (5.3) | 158 (7.9) | <0.01 |
| 1–2 weeks | 86 (52.8) | 129 (62.9) | 244 (64.2) | 237 (60.2) | 197 (59.5) | 134 (55.8) | 52 (65.0) | 122 (59.2) | 1201 (60.1) | |
| 3–4 weeks | 42 (25.8) | 44 (21.5) | 85 (22.4) | 88 (22.3) | 75 (22.7) | 53 (22.1) | 10 (12.5) | 44 (21.4) | 441 (22.1) | |
| 4 weeks–6 months | 12 (7.4) | 19 (9.3) | 15 (3.9) | 25 (6.3) | 37 (11.2) | 23 (9.6) | 10 (12.5) | 23 (11.2) | 164 (8.2) | |
| >6 months | 5 (3.1) | 0 (0.0) | 5 (1.3) | 5 (1.3) | 1 (0.3) | 11 (4.6) | 2 (2.5) | 6 (2.9) | 35 (1.8) | |
| Accommodation | ||||||||||
| 4–5-star hotel | 100 (61.3) | 109 (53.2) | 183 (48.2) | 149 (37.8) | 145 (43.8) | 80 (33.3) | 23 (28.8) | 87 (42.2) | 876 (43.8) | <0.01 |
| 2–3-star hotel | 20 (12.3) | 51 (24.9) | 99 (26.1) | 104 (26.4) | 93 (28.1) | 51 (21.3) | 20 (25.0) | 34 (16.5) | 472 (23.6) | |
| Guesthouse/bungalow | 9 (5.5) | 7 (3.4) | 19 (5.0) | 21 (5.3) | 20 (6.0) | 13 (5.4) | 4 (5.0) | 17 (8.3) | 110 (5.5) | |
| Youth hostel/ hostel | 1 (0.6) | 3 (1.5) | 10 (2.6) | 17 (4.3) | 2 (0.6) | 23 (9.6) | 6 (7.5) | 9 (4.4) | 71 (3.6) | |
| Camping | 2 (1.2) | 4 (2.0) | 2 (0.5) | 4 (1.0) | 0 (0.0) | 6 (2.5) | 0 (0.0) | 2 (1.0) | 20 (1.0) | |
| Friends/family/relatives | 15 (9.2) | 16 (7.8) | 39 (10.3) | 57 (14.5) | 40 (12.1) | 41 (17.1) | 21 (26.3) | 30 (14.6) | 259 (13.0) | |
| Airbnb/rental apartment | 8 (4.9) | 7 (3.4) | 14 (3.7) | 27 (6.9) | 9 (2.7) | 16 (6.7) | 2 (2.5) | 9 (4.4) | 92 (4.6) | |
| Other | 8 (4.9) | 8 (3.9) | 14 (3.7) | 15 (3.8) | 22 (6.7) | 10 (4.2) | 4 (5.0) | 18 (8.7) | 99 (5.0) | |
When the expected value of incidence was below 5, Fisher's exact test was used. For all other variables, the Chi-square test was used.
3.4. Future travel plans
Plans for visiting various regions in the future were similar among the respondents from the four countries. More than two thirds of the participants planned to travel to another European country during the next 2 years, the rates being highest among Norwegians (73.5%) and lowest among Swedes (66.7%). Compared to the others, the Finnish travelers were more likely to plan travel to Russia or Eurasia (10.3% vs 3.4–4.4%) and less likely to North America (12.7% vs 18.1–18.7%). A similar trend was seen in their plans for visiting Latin America (7.4% vs 8.6–9.7%). Among the Danish travelers, plans to visit the Middle East appeared slightly more common (11.5% vs 8.3–9.9%). Only a small proportion of respondents (5.5–8.7%) had no plans for traveling abroad during the following 2 years (Figure 1). One in 10 of those aged 60–74 years and one in 20 of those aged 18–35 years had no travel plans for the next 2 years. In general, the elderly were less likely to plan travel to destinations outside Europe compared with the younger participants (Figure 1).
4. Discussion
The main finding of this study was the similarity in travel destinations and habits between the respondents from the various Nordic countries. Almost three out of four participants reported travelling abroad at least every year, with Europe being the most common destination, followed by Asia. Older individuals reported travelling almost as much as younger ones. One-third of the 60–74-year-olds reported visiting destinations outside Europe and North America. These data are valuable for pre-travel practitioners, since the elderly are a group with special needs: they often have one or more chronic diseases (such as cardiovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, chronic kidney disease, and osteoporosis) [10] and, due to immunosenescence, there may be concern related to an inadequate response to travel vaccines [11]. These factors increase their susceptibility to different pathogens. Therefore, the risk of acquiring a travel-related disease and how to prevent it should be a focus point for medical practitioners when advising elderly travelers prior to trips abroad. Furthermore, elderly participants over 60 years of age or with comorbidities are rarely included in travel vaccine trials and thus there is a general lack of knowledge on vaccine efficacy in this population group.
Almost half of the respondents (45.7%) who had traveled internationally within the last 2 years had been outside of Europe and North America. This proportion is comparable to that reported by the World Tourism Organization (UNWTO), with 46.9% of all trips in 2019 being to LMICs [1]. Most of the respondents traveled for leisure. This concurs with studies describing travel both nationally and internationally [12], involving airport surveys [13], and those describing patterns of travel-related diseases, where most of the hospitalized travelers are tourists [9,14]. One-sixth of the participants (17.8%) traveled to visit friends and relatives. In international studies and reports, this proportion has been somewhat higher (27%) [12]. In a European airport survey, 25.4% of participants traveled to visit friends and relatives, while among travelers from Stockholm, the rate was only 8.5% [13]. VFR travel is of special concern, since these travelers have a higher risk of acquiring many travel-related diseases and are less likely to seek pre-travel medical advice. Indeed, they are over-represented among those with imported infectious diseases such as malaria, hepatitis A, and typhoid fever [9,14,15]. In the current study data, VFR travel was more common among the Norwegian and Swedish respondents, than among the Finns. This is presumably explained by differences in rates of immigrants between these three countries: in 2017, 22% of the residents in Sweden and 17% of those in Norway were immigrants or descendants of immigrants, whereas in Finland this was only 6% [16].
In this study, the Swedes and Finns traveled less often than the Norwegians and Danes. In contrast, a previous study reported that Finns travel the most in the world [17]. According to Eurostat, Swedes spent an average of 15.3 nights abroad in 2019, compared to 14.1 for Finns, 13.8 for Norwegians, and 9.9 for Danes [18]. Therefore, one explanation may be that Swedes travel less often but stay abroad longer during each trip. Another explanation for why Norwegians travel more often may be that the Norwegian GDP is higher. In 2020, the Norwegian GDP per capita was $67 294.50 USD, while the numbers were $60 908.80 USD in Denmark, $51 925.70 USD in Sweden, and $49 041.30 USD in Finland [19]. The present study also found that there were more Danish and Norwegian participants who worked in leading positions compared to Finnish participants (Table 4). These may be contributing factors to why Finnish citizens stay less often at 4–5-star hotels.
Since at-risk travelers were defined as individuals traveling outside of Europe and North America during the past 2 years, it was not surprising that only 7.9% of the travel lasted less than a week. Trips with a short duration were more common among Finnish residents, which is partly explained by their higher rate of travel to Russia and Eurasia, located geographically closer to Finland than to the other Nordic countries. Furthermore, 1.3% of the Finnish population speak Russian as their mother language and approximately 30 000 people have Russian citizenship [20,21].
Apart from the Finns traveling to Russia and Eurasia, only minor differences were seen in the travel destinations. No change was expected in planned travel destinations, as the participants’ travel plans often included the same destinations they had visited during the past 2 years. Europe appeared to be the only exception: compared with the proportion visiting Europe within the past 2 years, fewer were planning a trip to this region in the following 2 years. One possible reason for this may be that travel to Europe is often cheaper, easier to plan, and less time-consuming and, therefore, decisions to visit European destinations tend to be more impulsive than those to other regions, for which planning is often required several months in advance.
4.1. Strengths and limitations
This study included data from four different countries. This allowed a comparison of travel habits and knowledge about travel-related diseases across the Nordic countries. The respondents were stratified to the general population by age, gender, and geographic region. A major limitation is that information on the number of people who received the questionnaire and decided not to answer was not available, resulting in a potential selection bias. However, since the respondents were stratified to the general population, this potential bias will have been minimized. It is plausible though, that people who tend to travel more often are more interested in completing a questionnaire about travel. Thus, the proportion of travelers might be overestimated. The responses from the different countries were, however, mostly similar and comparable, and the few differences were likely to be explained by populations and their travel habits. Thus, it is believed that the respondents represented the general population fairly well.
The analysis of at-risk travelers focused only on the last travel. Therefore, the number may be biased and may not fully reflect the types of trip these participants normally go on. The study data on travel patterns comply well with those of other studies, and thus it is believed that they closely represent the general travel habits.
4.2. Perspectives
This is the first of three articles on travel and travel-related diseases among Nordic citizens. The subsequent articles will focus on travel vaccination and knowledge about travel-related disease. Knowledge about the demographics of travelers, travel patterns, and travel plans are important in order to improve and target pre-travel advice in the future to special risk groups. Further, it may guide the need for manufacturing of vaccines and possibly the development of new travel vaccines.
4.3. Conclusions
International travel is frequent among Nordic residents. Overall, the destinations, travel demographics, and future travel plans were remarkably similar among the Nordic countries. Almost half of the respondents had visited destinations with a higher risk of acquiring travel-related diseases, and are thus presumed to need medical pre-travel advice and vaccinations. Together with further knowledge on risk behavior during travel, this information may be used to predict the risk of Nordic citizens acquiring a travel-related disease, as well as to enhance cooperation on pre-travel medical advice across the countries. The similarities may also show the possibility for cooperation on pre-travel advice and medical guidelines regarding travel-related disease across the countries.
Declarations
Funding source: This study was funded by Sanofi Pasteur, with payment to Mindshare Media UK Limited.
Ethical approval: Not applicable.
Conflict of interest
None.
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