Hospitalisation rates differed by city district and ethnicity during the first wave of COVID-19 in Amsterdam, The Netherlands

Abstract

Background It is important to gain insight into the burden of COVID-19 at city district level to develop targeted prevention strategies. We examined COVID-19 related hospitalisations by city district and migration background in the municipality of Amsterdam, the Netherlands. Methods We used surveillance data on all PCR-confirmed SARS-CoV-2 hospitalisations in Amsterdam until 31 May 2020, matched to municipal registration data on migration background. We calculated directly standardised (age, sex) rates (DSR) of hospitalisations, as a proxy of COVID-19 burden, per 100,000 population by city district and migration background. We calculated standardised rate differences (RD) and rate ratios (RR) to compare hospitalisations between city districts of varying socio-economic and health status and between migration backgrounds. We evaluated the effects of city district and migration background on hospitalisation after adjusting for age and sex using Poisson regression. Results Between 29 February and 31 May 2020, 2326 cases (median age 57 years [IQR = 37–74]) were notified in Amsterdam, of which 596 (25.6%) hospitalisations and 287 (12.3%) deaths. 526/596 (88.2%) hospitalisations could be matched to the registration database. DSR were higher in individuals living in peripheral (South-East/New-West/North) city districts with lower economic and health status, compared to central districts (Centre/West/South/East) (RD = 36.87,95%CI = 25.79–47.96;RR = 1.82,95%CI = 1.65–1.99), and among individuals with a non-Western migration background compared to ethnic-Dutch individuals (RD = 57.05,95%CI = 43.34–70.75; RR = 2.36,95%CI = 2.17–2.54). City district and migration background were independently associated with hospitalisation. Conclusion City districts with lower economic and health status and those with a non-Western migration background had the highest burden of COVID-19 during the first wave of COVID-19 in Amsterdam.

Differences in SARS-CoV-2 infections during the first and second wave of SARS-CoV-2 between six ethnic groups in Amsterdam, the Netherlands: A population-based longitudinal serological study

“…Given the higher rates per population observed in SARS-CoV-2 incidence, as well as hospitalization and mortality in ethnic minority groups, 1 , 2 , 23 which were also apparent in Amsterdam, 4 sustained and targeted actions to reduce these disparities are warranted. With the wide availability of safe and effective vaccines against SARS-CoV-2, it is imperative to achieve high vaccination uptake, particularly in populations at high risk of SARS-CoV-2 infection and unfavorable outcomes.…”

“…Higher rates of SARS-CoV-2 diagnoses were observed in ethnic minority groups, in particular people of African and Asian descent, during the first wave of the SARS-CoV-2 epidemic in the United Kingdom, United States, and much of Europe. 1 , 2 , 3 , 4 SARS-CoV-2 seroprevalence estimates in England and the United States continued to increase in individuals of African and Asian descent during late 2020 and early 2021. 5 , 6 These disparities have been related to ethnic differences in household composition, occupations with higher risk of infection (e.g.…”

SARS-CoV-2 antibody prevalence and correlates of six ethnic groups living in Amsterdam, the Netherlands: a population-based cross-sectional study, June–October 2020

“…It should be mentioned that our results also stem from a setting where economic inequalities are not prohibitive to healthcare access. 33 In comparison to the seroprevalence estimates, people from large ethnic groups (Netherlands Antilles, Morocco, Surinam, Turkey, Ghana) had increased hospitalisation rates compared with ethnic Dutch individuals living in Amsterdam between February and May 2020, 9 as shown in other settings. 2 3 In addition, individuals with a migration background living in the Netherlands had a higher excess mortality during the first 6 weeks of the COVID-19 pandemic.…”

“…8 During the first wave of COVID-19, COVID-19-related hospitalisation rates were higher in individuals who have migrated from lower and middleincome countries compared with ethnic Dutch individuals in Amsterdam, with the highest rates observed in individuals of Ghanaian or Turkish ethnic origin. 9 However, it was unclear if these differences resulted from differences in acquiring infection, differences in disease severity after infection, or both. If SARS-CoV-2 infection prevalence is increased in specific ethnic groups, targeted prevention measures could be instated or improved to help minimise the risk of further transmission.…”

“…10 However, since the testing policy in the Netherlands has changed several times and until 1 June 2020, testing was largely restricted to symptomatic healthcare workers or those living or working in long-term care facilities, these data are prone to differential testing uptake. 9 Ethnic differences in testing uptake could be further exacerbated by testing access, willingness to test and disease perceptions. 4 11-13 Another limitation of registries is that migration background is often missing.…”