COVID-19 burden differed by city district and ethnicity during the pre-vaccination era in Amsterdam, the Netherlands 3 81 DISCUSSION This study reveals ethnic and geographical differences in COVID-19 burden in Amsterdam during the second wave of COVID-19, prior to the roll-out of vaccination. Age- and sex standardised rates of confirmed COVID-19 cases, hospitalisations and deaths were higher in peripheral, lower-SES city districts than central, higher-SES districts. Additionally, COVID-19 burden was significantly higher among individuals with a non-European migration background compared to Dutch ethnic origin. The current results corroborate our earlier findings of higher rates of hospitalisations for people living in peripheral city districts and with a non-European migration background(8). However, whilst differences in hospitalisation between city districts seemed constant, differences between migration backgrounds amplified during the second wave. While individuals with a non-European migration background were twice as likely to be hospitalised compared to individuals without migration background during the first wave(8), this has increased to 4.5 times during the second wave. Specifically, we observed greatest increases in relative risk for individuals of Moroccan and Turkish ethnic origin. Differences in hospitalisation rates between the first and second wave could be explained in multiple ways. First, Dutch non-pharmaceutical interventions during the first wave were more restrictive than during the second wave. We speculate that fewer general restrictions and increased exposure may consequently have augmented differences in exposure risk between populations with a non-European migration background compared to ethnic-Dutch individuals, accentuating existing differences in COVID-19 hospitalisation rates between ethnic groups(21). In addition, early intervention in the community in order to prevent COVID-19 hospital admission was inaccessible to all during the first wave of COVID-19, but became more prevalent during the second wave due to increase expertise among general practitioners on the clinical management of COVID-19 in the community(22). This may have served to prevent more hospitalisations among ethnic-Dutch confirmed COVID-19 cases than those with a non-European migration background, thus strengthening the differences in hospitalisation risk between these groups as the pandemic progressed. Differences in SARS-CoV-2 infections and related hospitalisation and deaths, among people with a migration background and lower SES have been observed in the Netherlands as well as globally(23). Similar to our results Chilunga et al. observed a higher death rate among patients with a migration background compared to patients with Dutch origin, mainly among those with Turkish, Moroccan and Surinamese background(24). This was
RkJQdWJsaXNoZXIy MTk4NDMw