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

Coyer, Liza; Wynberg, Elke; Buster, Marcel; Wijffels, Camiel; Prins, Maria; Schreijer, Anja; Duijnhoven, Yvonne T. H. P. van; Dam, Alje P. van; Lubben, Mariken van der; Leenstra, Tjalling

doi:10.1101/2021.03.15.21253597

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…Survival bias among the retrospectively-enrolled hospitalised participants may have caused an underestimation of time to complete recovery in those with severe/critical disease, although results were comparable when restricting our analyses to prospectively identified participants. Questionnaires in languages other than Dutch and English were not offered, therefore individuals with a migration background, who have been disproportionally affected by COVID-19, also in Amsterdam[25, 26], were underrepresented in this cohort. Furthermore, misclassification bias may have resulted from using ICU admission as a proxy for critical disease; suitability for ICU admission is also judged by the patient’s chance of survival; indeed, those with critical disease tended to be younger and have a lower BMI than those in the severe group.…”

Section: Discussionmentioning

confidence: 99%

Evolution of COVID-19 symptoms during the first 9 months after illness onset

Wynberg

Willigen

Dijkstra

et al. 2021

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Background: Few longitudinal data on COVID-19 symptoms across the full spectrum of disease severity are available. We evaluated symptom onset, severity and recovery up to nine months after illness onset. Methods: The RECoVERED Study is a prospective cohort study based in Amsterdam, the Netherlands. Participants aged>18 years were recruited following SARS-CoV-2 diagnosis via the local Public Health Service and from hospitals. Standardised symptom questionnaires were completed at recruitment, at one week and month after recruitment, and monthly thereafter. Clinical severity was defined according to WHO criteria. Kaplan-Meier methods were used to compare time from illness onset to symptom recovery, by clinical severity. We examined determinants of time to recovery using multivariable Cox proportional hazards models. Results: Between 11 May 2020 and 31 January 2021, 301 COVID-19 patients (167[55%] male) were recruited, of whom 99/301(32.9%) had mild, 140/301(46.5%) moderate, 30/301(10.0%) severe and 32/301(10.6%) critical disease. The proportion of participants reporting at least one persistent symptom at 12 weeks after illness onset was greater in those with severe/critical disease (81.7%[95%CI=68.7-89.7%]) compared to those with mild or moderate disease (33.0%[95%CI=23.0-43.3%] and 63.8%[95%CI=54.8-71.5%]). At nine months after illness onset, almost half of all participants (42.1%[95%CI=35.6-48.5]) continued to report ≥1 symptom. Recovery was slower in participants with BMI≥30kg/m2 (HR 0.51[95%CI=0.30-0.87]) compared to those with BMI<25kg/m2, after adjusting for age, sex and number of comorbidities. Conclusions: COVID-19 symptoms persisted for nine months after illness onset, even in those with mild disease. Obesity was the most important determinant of time to recovery from symptoms.

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Section: Discussionmentioning

confidence: 99%

Evolution of COVID-19 symptoms during the first 9 months after illness onset

Wynberg

Willigen

Dijkstra

et al. 2021

Preprint

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“…Furthermore, data from ongoing studies of the general population spread of the virus [ 4 ] suggest that a higher risk of exposure is associated with socio-economic vulnerabilities, such as limited educational and employment opportunities and/or belonging to an ethnic minority, and that people in poorer general health are more likely to develop severe and fatal illness [ 5 – 8 ]. It has also been observed that immigrants are at greater risk of exposure and infection than native populations, probably because they often work in high-risk occupations, live in overcrowded accommodation, and face barriers to healthcare and prevention initiatives [ 9 , 10 ]. Some studies have found that immigrants with COVID-19 are also at increased risk of hospitalisation [ 9 , 10 ], but it is unclear whether this means that they are also at increased risk of COVID-19-related death [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…It has also been observed that immigrants are at greater risk of exposure and infection than native populations, probably because they often work in high-risk occupations, live in overcrowded accommodation, and face barriers to healthcare and prevention initiatives [ 9 , 10 ]. Some studies have found that immigrants with COVID-19 are also at increased risk of hospitalisation [ 9 , 10 ], but it is unclear whether this means that they are also at increased risk of COVID-19-related death [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Mortality among Italians and immigrants with COVID-19 hospitalised in Milan, Italy: data from the Luigi Sacco Hospital registry

et al. 2022

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Background To compare differences in the probability of COVID-19-related death between native Italians and immigrants hospitalised with COVID-19. Methods This retrospective study of prospectively collected data was conducted at the ASST Fatebenefratelli-Sacco Hospital in Milan, Italy, between 21 February and 31 November 2020. Uni- and multivariable Cox proportional hazard models were used to assess the impact of the patients' origin on the probability of COVID-19-related death. Results The study population consisted of 1,179 COVID-19 patients: 921 Italians (78.1%) and 258 immigrants (21.9%) who came from Latin America (99, 38%), Asia (72, 28%), Africa (50, 19%) and central/eastern Europe (37, 14%). The Italians were significantly older than the immigrants (median age 70 years, interquartile range (IQR) 58–79 vs 51 years, IQR 41–60; p < 0.001), and more frequently had one or more co-morbidities (79.1% vs 53.9%; p < 0.001). Mortality was significantly greater among the Italians than the immigrants as a whole (26.6% vs 12.8%; p < 0.001), and significantly greater among the immigrants from Latin America than among those from Asia, Africa or central/eastern Europe (21% vs 8%, 6% and 8%; p = 0.016). Univariable analysis showed that the risk of COVID-19-related death was lower among the immigrants (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.30–0.63; p < 0.0001], but the risk of Latin American immigrants did not significantly differ from that of the Italians (HR 0.74, 95% CI 0.47–1.15; p = 0.183). However, after adjusting for potential confounders, multivariable analysis showed that there was no difference in the risk of death between the immigrants and the Italians (adjusted HR [aHR] 1.04, 95% CI 0.70–1.55; p = 0.831), but being of Latin American origin was independently associated with an increased risk of death (aHR 1.95, 95% CI 1.17–3.23; p = 0.010). Conclusions Mortality was lower among the immigrants hospitalised with COVID-19 than among their Italian counterparts, but this difference disappeared after adjusting for confounders. However, the increased risk of death among immigrants of Latin American origin suggests that COVID-19 information and prevention initiatives need to be strengthened in this sub-population.

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“…The increased preventive measures during church services could have offered reduced SARS-CoV-2 transmission. Given the higher rates per population observed in SARS-CoV-2 incidence, as well as hospitalization and mortality in ethnic minority groups, 1,2,22 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.…”

Section: Discussionmentioning

confidence: 99%

“…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 requiring use of public transportation, and increased exposure to crowded conditions.…”

Section: Introductionmentioning

confidence: 99%

Ethnic disparities in incident SARS-CoV-2 infections became wider during the second wave of SARS-CoV-2 in Amsterdam, the Netherlands: a population-based longitudinal study

Coyer

Boyd

Schinkel

et al. 2021

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Background Surveillance data in high-income countries have reported more frequent SARS-CoV-2 diagnoses in ethnic minority groups. We examined the cumulative incidence of SARS-CoV-2 and its determinants in six ethnic groups in Amsterdam, the Netherlands. Methods We analyzed participants enrolled in the population-based HELIUS cohort, who were tested for SARS-CoV-2-specific antibodies and answered COVID-19-related questions between June 24-October 9, 2020 (after the first wave) and November 23, 2020-March 31, 2021 (during the second wave). We modeled SARS-CoV-2 incidence from January 1, 2020-March 31, 2021 using Markov models adjusted for age and sex. We compared incidence between ethnic groups over time and identified determinants of incident infection within ethnic groups. Findings 2,497 participants were tested after the first wave; 2,083 (83.4%) were tested during the second wave. Median age at first visit was 54 years (interquartile range=44-61); 56.6% were female. Compared to Dutch-origin participants (15.9%), cumulative SARS-CoV-2 incidence was higher in participants of South-Asian Surinamese (25.0%; adjusted hazard ratio [aHR]=1.66;95%CI=1.16-2.40), African Surinamese (28.9%;aHR=1.97;95%CI=1.37-2.83), Turkish (37.0%;aHR=2.67;95%CI=1.89-3.78), Moroccan (41.9%;aHR=3.13;95%CI=2.22-4.42), and Ghanaian (64.6%;aHR=6.00;95%CI=4.33-8.30) origin. Compared to those of Dutch origin, differences in incidence became wider during the second versus first wave for all ethnic minority groups (all p for interaction<0.05), except Ghanaians. Having household members with suspected SARS-CoV-2 infection, larger household size, and low health literacy were common determinants of SARS-CoV-2 incidence across groups. Interpretation SARS-CoV-2 incidence was higher in the largest ethnic minority groups of Amsterdam, particularly during the second wave. Prevention measures, including vaccination, should be encouraged in these groups.

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

Cited by 9 publications

References 17 publications

Evolution of COVID-19 symptoms during the first 9 months after illness onset

Evolution of COVID-19 symptoms during the first 9 months after illness onset

Mortality among Italians and immigrants with COVID-19 hospitalised in Milan, Italy: data from the Luigi Sacco Hospital registry

Ethnic disparities in incident SARS-CoV-2 infections became wider during the second wave of SARS-CoV-2 in Amsterdam, the Netherlands: a population-based longitudinal study

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