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Funding Information: VH has received a grant from Finska L?kares?llskapet. AJ has received a grant from Wilhelm och Else Stockmanns stiftelse and speaker honoraria from Astellas, GlaxoSmithKline, Sanofi, Thermo Fisher, MSD, OrionPharma and UnimedicPharma. JH has recieved grants from NordForsk, Government research funding and Kirsti och Tor Johansson's hj?rt och cancerstiftelse. The authors declare that they have no other conflicts of interest in relation to this work. This work was supported by a research grant from Finska L?kares?llskapet. Funding Information: VH has received a grant from Finska Läkaresällskapet . AJ has received a grant from Wilhelm och Else Stockmanns stiftelse and speaker honoraria from Astellas , GlaxoSmithKline , Sanofi , Thermo Fisher , MSD , OrionPharma and UnimedicPharma . JH has recieved grants from NordForsk , Government research funding and Kirsti och Tor Johansson's hjärt och cancerstiftelse . The authors declare that they have no other conflicts of interest in relation to this work. This work was supported by a research grant from Finska Läkaresällskapet . Publisher Copyright: © 2021 The Authors ; Objectives: Motivated by reports of increased risk of coronavirus disease 2019 (COVID-19) in ethnic minorities of high-income countries, we explored whether patients with a foreign first language are at an increased risk of COVID-19 infections, more serious presentations, or worse outcomes. Methods: In a retrospective observational population-based quality registry study covering a population of 1.7 million, we studied the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), admissions to specialist healthcare and the intensive care unit (ICU), and all-cause case fatality in different language groups between 27th February and 3rd August 2020 in Southern Finland. A first language other than Finnish, Swedish or Sami served as a surrogate marker for a foreign ethnic background. Results: In total, 124 240 individuals were tested, and among the 118 300 (95%) whose first language could be determined, 4005 (3.4%) were COVID-19-positive, 623 (0.5%) were admitted to specialized hospitals, and 147 (0.1%) were admitted to the ICU; 254 (0.2%) died. Those with a foreign first language had lower testing rates (348, 95%CI 340-355 versus 758, 95%CI 753-762 per 10 000, p < 0.0001), higher incidence (36, 95%CI 33-38 versus 22, 95%CI 21-23 per 10 000, p < 0.0001), and higher positivity rates (103, 95%CI 96-109 versus 29, 95%CI 28-30 per 1000, p < 0.0001). There was no significant difference in ICU admissions, disease severity at ICU admission, or ICU outcomes. Case fatality by 90 days was 7.7% in domestic cases and 1.2% in those with a foreign first language, explained by demographics (age-and sex adjusted HR 0.49, 95%CI 0.21-1.15). Conclusions: The population with a foreign first language was at an increased risk for testing positive for SARS-CoV-2, but when hospitalized they had outcomes similar to those in the native, domestic language population. This suggests that special attention should be paid to the prevention and control of infectious diseases among language minorities. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. ; Peer reviewed