Chapter 3 68 ABSTRACT Background During the first wave of COVID-19 in Amsterdam, the Netherlands, a disproportional number of COVID-19 hospitalisations 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 SARS-CoV-2 testing was available to anyone with symptoms but prior to 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 migration background of cases. Crude and directly age- and sex-standardised rates (DSR) of confirmed cases, hospitalisations 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 hospitalisation. 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 hospitalised and 297 (0.6%) deceased. DSR of notified infections, hospitalisation 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 two-fold higher hospitalisation 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 hospitalisation 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 district, migration background, male sex and older age were independently associated with COVID-19 hospitalisation 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.
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