COVID-19 burden differed by city districts and ethnicities during the pre-vaccination era in Amsterdam, the Netherlands

Yara Bachour; Elke Wynberg; Liza Coyer; Marcel Buster; Anja Schreijer; Yvonne T H P van Duijnhoven; Alje P van Dam; Maria Prins; Tjalling Leenstra

doi:10.3389/fpubh.2023.1166193

COVID-19 burden differed by city districts and ethnicities during the pre-vaccination era in Amsterdam, the Netherlands

Front Public Health. 2023 Jun 23:11:1166193. doi: 10.3389/fpubh.2023.1166193. eCollection 2023.

Authors

Affiliations

¹ Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands.
² Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
³ Department of Epidemiology, Health Promotion and Care Innovation, Public Health Service of Amsterdam, Amsterdam, Netherlands.

Abstract

Background: During the first wave of COVID-19 in Amsterdam, the Netherlands, a disproportional number of COVID-19 hospitalizations occurred in individuals with an ethnic minority background and in individuals living in city districts with a lower socioeconomic status (SES). In this study, we assessed whether these disparities continued throughout the second wave, when SARS-CoV-2 testing was available to anyone with symptoms but prior to the availability of COVID-19 vaccination.

Methods: Surveillance data on all notified SARS-CoV-2 cases in Amsterdam between 15 June 2020 and 20 January 2021 were matched to municipal registration data to obtain the migration background of cases. Crude and directly age- and sex-standardized rates (DSR) of confirmed cases, hospitalizations, and deaths per 100,000 population were calculated overall, and by city districts, and migration backgrounds. Rate differences (RD) and rate ratios (RR) were calculated to compare DSR between city districts and migration backgrounds. We used multivariable Poisson regression to assess the association of city districts, migration backgrounds, age, and sex with rates of hospitalization.

Results: A total of 53,584 SARS-CoV-2 cases (median age 35 years [IQR = 25-74]) were notified, of whom 1,113 (2.1%) were hospitalized and 297 (0.6%) deceased. DSR of notified infections, hospitalization, and deaths per 100,000 population were higher in lower SES peripheral city districts (South-East/North/New-West) than higher SES central districts (Central/West/South/East), with almost a 2-fold higher hospitalization DSR in peripheral compared to central districts (RR = 1.86, 95%CI = 1.74-1.97). Individuals with a non-European migration background also had a higher COVID-19 burden, particularly with respect to hospitalization rates, with a 4.5-fold higher DSR for individuals with a non-European background compared to ethnic-Dutch (RR 4.51, 95%CI = 4.37-4.65). City districts, migration backgrounds, male gender, and older age were independently associated with COVID-19 hospitalization rates.

Discussion: Individuals with a non-European background and individuals living in city districts with lower SES continued to independently have the highest COVID-19 burden in the second wave of COVID-19 in Amsterdam, the Netherlands.

Keywords: COVID-19; SARS-CoV-2; city district; ethnicity; hospitalization; infection; living area.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19 Testing
COVID-19 Vaccines
COVID-19* / epidemiology
Ethnicity
Humans
Male
Minority Groups
Netherlands / epidemiology
SARS-CoV-2
Vaccination

Substances

COVID-19 Vaccines

Grants and funding

LC was funded by a grant from ZonMw (No. 10430022010002) for conducting data analysis. ZonMw did not have any involvement in the study design, data collection, data analysis, or interpretation of the data, in the writing of the manuscript, or in the decision to submit the work for publication.