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

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

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1166193

DOI=10.3389/fpubh.2023.1166193

ISSN=2296-2565

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 individuals living in city districts with a lower socio-economic status (SES). In this study, we assessed whether these disparities continued throughout the second wave, when COVID-19 testing was available to anyone with symptoms but prior to availability of COVID-19 vaccination. 
Methods: Surveillance data on all PCR-confirmed SARS-CoV-2 infections in Amsterdam between 15 June 2020 and 20 January 2021 were matched to municipal registration data to obtain confirmed 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 district and migration background. Rate differences (RD) and rate ratios (RR) were calculated to compare DSR between city district and migration backgrounds. We used multivariable Poisson regression to assess the association of city district, migration background, age and sex with rates of hospitalization. 
Results: A total of 53,584 COVID-19 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 the lower-SES peripheral city districts (South-East/North/New-West) than higher-SES central districts (Central/West/South/East), with almost a two-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). In a multivariable Poisson regression model, city district, migration background, male 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 have the highest COVID-19 burden in the second wave of COVID-19 in Amsterdam, the Netherlands.