Chapter 2 48 Table 3. Characteristics associated with COVID-19 related hospitalisation Characteristic aRR (95% CI) P-value Migration background None (ethnic-Dutch) 1 Western 0.97 (0.71-1.29) 0.83 Non-Western 2.20 (1.82-2.67) <0.001 City district Central (C/W/S/E) 1 Peripheral (SE/N/NW) 1.53 (1.28-1.82) <0.001 Sex Male 1 Female 0.59 (0.49-0.70) <0.001 Age <45 years 1 45-59 years 4.95 (3.73-6.6) <0.001 60-74 years 13.52 (10.47-17.63) <0.001 ≥75 years 23.84 (17.92-31.88) <0.001 Abbreviations: aRR adjusted rate ratio, C Centre, CI confidence interval, E East, N North, NW NorthWest, SE South-East, W West. Estimates were obtained from a multivariable Poisson regression model. DISCUSSION We identified geographical and ethnic disparities in the burden of COVID-19 in Amsterdam during the first wave of COVID-19. Specifically, people living in peripheral, lower-income city districts (New-West, North or South-East) with a non-Western migration background had three-fold higher hospitalisation rates compared to ethnic-Dutch individuals living central, higher-income city districts (Centre, West, South or East). Previous research has demonstrated similar health disparities between city districts in Amsterdam(13). A quadrennially repeating comprehensive health survey has consistently shown that residents of peripheral city districts are more likely to suffer from comorbidities and be overweight or obese than residents of central districts(13). As chronic lifestyle conditions such as type 2 diabetes mellitus and cardio-vascular disease have been shown to increase the risk of developing severe COVID-19 symptoms(21), this suggests that the higher rate of COVID-19 hospitalisations seen in these city districts might be partially explained by a higher prevalence of chronic comorbidities. In addition, the peripheral districts have been shown to have a higher percentage of vulnerable residents(13), based on a vulnerability score that encompasses income, job security and healthcare expenditure. The interplay between SES and risk of both SARS-CoV-2 infection and severe disease has been previously documented(22). For example, individuals
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