Elke Wynberg

COVID-19 burden differed by city district and ethnicity during the pre-vaccination era in Amsterdam, the Netherlands 3 71 either PCR or antigen test performed in an authorized testing facility), COVID-19 related hospital admission and death. Henceforth, we refer to individuals with a notified SARSCoV-2 infection as confirmed COVID-19 cases. Definitions City district was determined based on the postal code of the current residence(12) and categorized into Centre, New-West, North, East, West, South, and South-East. Based on recent socio-economic data, residents of the Central, West, South and East districts have higher average incomes, while South-East, North and New-West are districts have lower average incomes(13). Migration background and generation were based on the country of birth of individuals and their parents according to national definitions(14). First, we distinguished individuals with and without migration background. Individuals were considered not to have a migration background (i.e., ethnic-Dutch) if both their parents were born in the Netherlands. Individuals were considered to have a migration background if they were born abroad with at least one parent born abroad (first generation) or if they were born in the Netherlands with both parents born abroad (second generation)(15). In the case of a second generation migrant whom both parents were born abroad, the mother´s country of birth was leading in determining the migration background. Second, we then subdivided individuals with a migration background into those originating from a European or non-European country, according to the classification of the Dutch Central Bureau of Statistics (CBS)(16). Exceptions to this rule included migrants originating from North America, Australia, Indonesia or Japan, who were classified under European due to their country´s high socio-economic status. Although the second wave started from August 2020 onward, we defined the second wave of infections as the period from June 2020 to January 2021 in order to perform a consecutive study on our former data. Statistical analysis We calculated crude and directly standardised rates (DSR) of confirmed COVID-19 cases, hospitalisations and deaths per 100,000 population, overall and by city district and migration background. For the group of non-European migration background, we additionally calculated these outcomes separately for the largest non-European groups in the Netherlands (i.e., Netherlands Antilles, Morocco, Surinam, Turkey and Ghana). Rates were standardised for age (≤14, 15-29, 29-44, 45-59, 60-74, ≥75 years) and sex (female,

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