Abstract
BackgroundIt is important to gain insight into the burden of COVID-19 at city district level to develop targeted prevention strategies. We examined COVID-19 related hospitalisations by city district and migration background in the municipality of Amsterdam, the Netherlands.MethodsWe used surveillance data on all PCR-confirmed SARS-CoV-2 hospitalisations in Amsterdam until 31 May 2020, matched to municipal registration data on migration background. We calculated directly standardised (age, sex) rates (DSR) of hospitalisations, as a proxy of COVID-19 burden, per 100,000 population by city district and migration background. We calculated standardised rate differences (RD) and rate ratios (RR) to compare hospitalisations between city districts of varying socio-economic and health status and between migration backgrounds. We evaluated the effects of city district and migration background on hospitalisation after adjusting for age and sex using Poisson regression.ResultsBetween 29 February and 31 May 2020, 2326 cases (median age 57 years [IQR = 37–74]) were notified in Amsterdam, of which 596 (25.6%) hospitalisations and 287 (12.3%) deaths. 526/596 (88.2%) hospitalisations could be matched to the registration database. DSR were higher in individuals living in peripheral (South-East/New-West/North) city districts with lower economic and health status, compared to central districts (Centre/West/South/East) (RD = 36.87,95%CI = 25.79–47.96;RR = 1.82,95%CI = 1.65–1.99), and among individuals with a non-Western migration background compared to ethnic-Dutch individuals (RD = 57.05,95%CI = 43.34–70.75; RR = 2.36,95%CI = 2.17–2.54). City district and migration background were independently associated with hospitalisation.ConclusionCity districts with lower economic and health status and those with a non-Western migration background had the highest burden of COVID-19 during the first wave of COVID-19 in Amsterdam.
Highlights
The first cases of coronavirus disease 2019 (COVID-19) were reported at the end of 2019 in Wuhan, China
Between 29 February 2020 and 31 May 2020, 2326 COVID-19 cases were notified in Amsterdam, of which 596 (25.6%) hospitalisations and 287 (12.3%) deaths
Hospitalisation DSR were almost two-fold higher in individuals living in peripheral city districts compared to central districts (RR = 1.82, 95%confidence intervals (CI) = 1.65–1.99), with 36.87 additional hospitalisations per 100.000 population (RD = 36.87, 95%CI = 25.79–47.96)
Summary
COVID-19 case definition and test strategy Up to and including 11th March 2020, SARS-CoV-2 testing in the Netherlands was conducted only in individuals who fulfilled a strict case definition: (i) having an epidemiological link to a confirmed case and/or returning from a high-risk region with widespread transmission within 14 days prior to the onset of symptoms, and (ii) the presence of fever with at least one of the following symptoms: coughing, shortness of breath (dyspnoea). From 11 May 2020, testing at the PHS site was made available to teachers and those working in other contact professions with COVID-like symptoms but remained inaccessible for the general public until 1 June 2020 Because of this restrictive test policy during the period analysed, we used hospitalisations as a marker of epidemic progression. We retrieved secondary data collected between 29 February (date of first confirmed case) and 31 May 2020 from the AmsterdamAmstelland COVID-19 notification database, the surveillance database by the PHS of Amsterdam on all notified cases, hospitalisations and deaths residing in the municipality of Amsterdam These data included information on age and sex of the case, and whether the case had worked as a health care worker or was a resident in a long-term care facility.
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