Ethnic inequalities in incidence, nature, determinants, and duration of long COVID among hospitalised adults in the Netherlands: A retrospective cohort study (preprint)

ABSTRACT

Background In-depth data on long-term health effects of COVID-19 across ethnic groups are lacking. We investigated incidence, nature, determinants, and duration of long COVID across ethnic groups admitted for COVID-19 (Dutch, Turkish, Moroccan, African Surinamese, Asian Surinamese, Others) in the Netherlands.Methods We used COVID-19 admissions and follow up data (January 2021- July 2022) from Amsterdam University Medical Centers. We calculated incidence proportions of long COVID according to NICE guidelines by ethnic group (at twelve weeks post-discharge) and assessed its determinants in the total population via backward stepwise Poisson regressions. We then examined associations between ethnicity and long COVID using Poisson regression models and adjusted for derived determinants. We also assessed persistence (proportions) of long COVID symptoms at one-year post-discharge.Results 1886 participants were included. Long COVID incidence proportion was 26%, 95% CI 24–28%. Age and sex adjusted long COVID incidence proportions were highest in Surinamese, Turkish and Moroccan origin populations. Symptoms such as dizziness, joint and muscle pain, palpitations, insomnia, and headache varied by ethnicity. Determinants of long COVID were female sex, intensive care unit (ICU) admission, receiving oxygen, or corticosteroid therapy during admission. African Surinamese (IRR = 1.47, 95% CI1.15–1.89), South-Asian Surinamese (IRR = 1.59, 1.11–2.26), Moroccan (IRR = 1.39, 1.05–1.83) and Turkish (IRR = 1.56, 1.12–2.18) had a higher risk of long COVID than Dutch origin after adjustments for sex, admission to intensive care unit ICU, and receiving oxygen and corticosteroid therapy during admission. Only 14% of any long COVID symptoms resolved by one-year post-discharge mainly among the South Asian Surinamese origin participants.Conclusion Our findings show that one fourth of participants report ongoing symptoms 12 weeks after a COVID-19 admission, with Surinamese, Moroccan and Turkish origin participants having higher long COVID risk than Dutch origin participants. Long COVID risk in the total population is related to female sex, ICU admission, and receiving oxygen and steroid therapies during hospitalisation. Majority of long COVID symptoms disappear within a year of hospital discharge. There is an urgent need for preventive and treatment efforts that consider ethnic inequalities in long COVID among hospitalised individuals.