Ethnic disparities in incident SARS-CoV-2 infections became wider during the second wave of SARS-CoV-2 in Amsterdam, the Netherlands: a population-based longitudinal study

ABSTRACT

BackgroundSurveillance data in high-income countries have reported more frequent SARS-CoV-2 diagnoses in ethnic minority groups. We examined the cumulative incidence of SARS-CoV-2 and its determinants in six ethnic groups in Amsterdam, the Netherlands. MethodsWe analyzed participants enrolled in the population-based HELIUS cohort, who were tested for SARS-CoV-2-specific antibodies and answered COVID-19-related questions between June 24-October 9, 2020 (after the first wave) and November 23, 2020-March 31, 2021 (during the second wave). We modeled SARS-CoV-2 incidence from January 1, 2020-March 31, 2021 using Markov models adjusted for age and sex. We compared incidence between ethnic groups over time and identified determinants of incident infection within ethnic groups. Findings2,497 participants were tested after the first wave; 2,083 (83{middle dot}4%) were tested during the second wave. Median age at first visit was 54 years (interquartile range=44-61); 56{middle dot}6% were female. Compared to Dutch-origin participants (15{middle dot}9%), cumulative SARS-CoV-2 incidence was higher in participants of South-Asian Surinamese (25{middle dot}0%; adjusted hazard ratio [aHR]=1{middle dot}66;95%CI=1{middle dot}16-2{middle dot}40), African Surinamese (28{middle dot}9%;aHR=1{middle dot}97;95%CI=1{middle dot}37-2{middle dot}83), Turkish (37{middle dot}0%;aHR=2{middle dot}67;95%CI=1{middle dot}89-3{middle dot}78), Moroccan (41{middle dot}9%;aHR=3{middle dot}13;95%CI=2{middle dot}22-4{middle dot}42), and Ghanaian (64{middle dot}6%;aHR=6{middle dot}00;95%CI=4{middle dot}33-8{middle dot}30) origin. Compared to those of Dutch origin, differences in incidence became wider during the second versus first wave for all ethnic minority groups (all p for interaction<0.05), except Ghanaians. Having household members with suspected SARS-CoV-2 infection, larger household size, and low health literacy were common determinants of SARS-CoV-2 incidence across groups. InterpretationSARS-CoV-2 incidence was higher in the largest ethnic minority groups of Amsterdam, particularly during the second wave. Prevention measures, including vaccination, should be encouraged in these groups. FundingZonMw, Public Health Service of Amsterdam, Dutch Heart Foundation, European Union, European Fund for the Integration of non-EU immigrants.