Pandemic inequity in a megacity: a multilevel analysis of individual, community and healthcare vulnerability risks for COVID-19 mortality in Jakarta, Indonesia

Abstract

IntroductionWorldwide, the 33 recognised megacities comprise approximately 7% of the global population, yet account for 20% COVID-19 deaths. The specific inequities and other factors within megacities that affect vulnerability to COVID-19 mortality remain poorly defined. We assessed individual, community-level and healthcare factors associated with COVID-19-related mortality in a megacity of Jakarta, Indonesia, during two epidemic waves spanning 2 March 2020 to 31 August 2021.MethodsThis retrospective cohort included residents of Jakarta, Indonesia, with PCR-confirmed COVID-19. We extracted demographic, clinical, outcome (recovered or died), vaccine coverage data and disease prevalence from Jakarta Health Office surveillance records, and collected subdistrict level sociodemographics data from various official sources. We used multilevel logistic regression to examine individual, community and subdistrict-level healthcare factors and their associations with COVID-19 mortality.ResultsOf 705 503 cases with a definitive outcome by 31 August 2021, 694 706 (98.5%) recovered and 10 797 (1.5%) died. The median age was 36 years (IQR 24–50), 13.2% (93 459) were <18 years and 51.6% were female. The subdistrict level accounted for 1.5% of variance in mortality (p<0.0001). Mortality ranged from 0.9 to 1.8% by subdistrict. Individual-level factors associated with death were older age, male sex, comorbidities and age <5 years during the first wave (adjusted OR (aOR)) 1.56, 95% CI 1.04 to 2.35; reference: age 20–29 years). Community-level factors associated with death were poverty (aOR for the poorer quarter 1.35, 95% CI 1.17 to 1.55; reference: wealthiest quarter) and high population density (aOR for the highest density 1.34, 95% CI 1.14 to 2.58; reference: the lowest). Healthcare factor associated with death was low vaccine coverage (aOR for the lowest coverage 1.25, 95% CI 1.13 to 1.38; reference: the highest).ConclusionIn addition to individual risk factors, living in areas with high poverty and density, and low healthcare performance further increase the vulnerability of communities to COVID-19-associated death in urban low-resource settings.

Joint Effect of Diabetes Mellitus and Hypertension on COVID-19 in-Hospital Mortality Stratified by Age Group and Other Comorbidities: A Cohort Retrospective Study Using Hospital-Based Data in Sleman, Yogyakarta

“…This study reported similar results with previous studies, that COVID-19 patients with diabetes mellitus had higher risk of in-hospital mortality than those without diabetes mellitus [ 5 , 6 , 7 , 8 , 23 , 25 , 26 , 27 , 28 , 29 ]. This result could be explained by chronic inflammatory conditions occurring among COVID-19 patients with DM.…”

Antibody Responses and Reactogenicity of a Heterologous, Full-Dose Messenger RNA-1273 Booster in Heavily SARS-CoV-2–Exposed CoronaVac-Vaccinated Health-Care Workers in Indonesia: A Real-World Observational Study

“…[33][34][35] Our observations confirm intense SARS-CoV-2 exposure among frontline health workers in Jakarta during the Delta wave in July 2021. 36 Our findings concur with the notion that Delta breakthrough infections postvaccination are associated with subsequent more potent and durable immune responses than those seen in individuals who were infected only or received only two doses of the COVID-19 vaccine. 37 From an immunological perspective, we noted a lower pre-mRNA-1273 booster correlation between Bab and Nab titers in the vaccinated-infected group, wherein the most recent exposure to the spike protein was from natural infection rather than vaccination.…”

“… 33 – 35 Our observations confirm intense SARS-CoV-2 exposure among frontline health workers in Jakarta during the Delta wave in July 2021. 36 Our findings concur with the notion that Delta breakthrough infections postvaccination are associated with subsequent more potent and durable immune responses than those seen in individuals who were infected only or received only two doses of the COVID-19 vaccine. 37 …”

Geographical variations and district-level factors associated with COVID-19 mortality in Indonesia: a nationwide ecological study

“…The majority of cases and deaths in Indonesia were reported in Java Island, a more developed setting populated by 152 million individuals (56% of the total Indonesia’s population). Recent studies from Indonesia’s capital city of Jakarta suggested that COVID-19 disproportionately affected individuals with older age and pre-existing chronic comorbidities, as well as those areas within Jakarta with lower vaccine coverage, and higher poverty and population density [ 25 , 26 ]. However, data on the impact of COVID-19 across 514 districts of Indonesia that have different pre-existing burdens of major infectious diseases such as malaria, tuberculosis, HIV and other tropical infections [ 27 ], as well as non-communicable diseases like cardiovascular diseases, cancers, chronic pulmonary diseases, diabetes, and others [ 28 ], are scarce.…”