Chapter 3 82 almost 30% higher in the second wave than in the first wave. The authors postulate that the latter might be due elevated SARS-CoV-2 infections among migration groups. Globally, similar results were seen. A recent meta-analysis showed that ethnic inequalities in COVID-19 health outcomes are seen. This review revealed an increased risk for COVID-19 infections among people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59–1.99), South Asian (aRR:3.00, 95% CI:1.59–5.66), Mixed (aRR:1.64, 95% CI:1.02–1.67) and Other ethnic groups (aRR:1.36, 95% CI:1.01–1.82) compared with White majority populations. Almost all minority ethnic groups were at increased risk of hospital admission and ICU admission and higher death rates were mostly seen among patients with Hispanic, Mixed, and Indigenous groups. The authors suggest that these differences might be due to several factors such as socioeconomic inequalities, cultural factors and barriers to adequate healthcare. Nonetheless, it is important to discuss the multitude of complex factors that may contribute to increased COVID-19 burden in peripheral city districts as well as among key non-European ethnic groups, in order to help design tailored interventions. Indeed, whilst belonging to an ethnic minority group is associated with having a lower socioeconomic status, migration background has consistently been shown to be an additional, independent determinant of COVID-19 hospitalisation(25) – also in the current analysis. Socioeconomic deprivation is likely to facilitate viral spread due to working in professions with a higher likelihood of exposure to infection, more frequently using public transportation and living in small houses with larger families(26-28). It has also been well-documented that lower socioeconomic status is strongly correlated with an increased burden of non-communicable disease, which in turn amplify severe outcomes during SARS-CoV-2 infection(29, 30). The added, increased risk of migration background for COVID-19 hospitalisation is likely attributable to various factors that could influence both exposure to SARS-CoV-2 and subsequent severe disease. For instance, living in intergenerational familial units or frequent gatherings of extended families or religious communities may lead to more rapid viral spread(31, 32). Barriers to early intervention by community healthcare services due to language or cultural differences(33, 34) can increase risk of hospitalisation, as well as higher prevalence of comorbidities. Cultural differences might also underpin the likelihood for ethnic-Dutch older adults to reside in nursing homes where supportive care can be provided for COVID-19 complications, compared to older adults in non-European communities who may be more often cared for at home, with an increased chance for hospital admission when experiencing severe COVID-19 symptoms(35). Interestingly, a recent study in the
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