Ethnic differences in COVID-19 hospitalization and hospital outcomes in a multi-ethnic population in the Netherlands

Abstract Background Evidence from the US and UK suggests that ethnic minority populations are at an increased risk for developing severe COVID-19, however data from other West-European countries are scarce. Methods We analysed data from 1439 patients admitted between February 2020 and January 2021 to four main hospitals in Amsterdam and Almere, the Netherlands. Differences in the risk for hospitalization were assessed by comparing demographics to the general population. Using a population-based cohort as reference, we determined differences in the association between comorbidities and COVID-19 hospitalization. Outcomes following hospitalization were analysed using Cox-regression. Results The hospitalization risk was higher in all ethnic minority groups than in those of Dutch origin, with age-adjusted odds ratios ranging from 2.2(95%CI, 1.7-2.6) in Moroccans to 4.5(95%CI 3.2-6.0) in Ghanaians. Hypertension and diabetes were similarly associated with COVID-19 hospitalization. For all other comorbidities, we found differential associations. ICU-admission and mortality during 21-day follow-up following hospitalization was comparable between ethnicities. Conclusions The risk of COVID-19 hospitalization was higher in all ethnic minority groups compared to the Dutch, but the risk of adverse outcomes following hospitalization was similar. Our results suggest that these inequalities may in part be attributable to comorbidities that can be prevented by targeted public health prevention measures. More work is needed to gain insight into the role of other potential factors such social determinants of health, which might have contributed to the ethnic inequalities in COVID-19 hospitalization.