# Determinants of COVID-19-related hospital and ICU admissions in the region Haaglanden, The Netherlands: a cross-sectional study

## TL;DR

This study explores factors influencing hospital and ICU admissions due to COVID-19 in the Haaglanden region of the Netherlands.

## Contribution

The study identifies neighborhood and individual risk factors for severe COVID-19 outcomes, emphasizing socio-economic disparities.

## Key findings

- Older age, lower education, and poor health were linked to higher hospital and ICU admission odds.
- Neighborhoods with low vaccination coverage and socio-economic status had higher admission rates.
- Risk factors were concentrated in disadvantaged areas, highlighting the need for targeted public health interventions.

## Abstract

The COVID-19 pandemic has been a global health crisis since late 2019. By the end of 2021, the Netherlands reported over 3 million cases, leading to significant hospital and Intensive Care Unit (ICU) admissions. This study investigated the impact of demographic, socio-economic, health, including vaccination coverage, and neighborhood characteristics on COVID-19-related hospital and ICU admissions, with a focus on neighborhood differences in the region Haaglanden, the Netherlands.

This cross-sectional study included residents aged 25–79 years from the region Haaglanden. Data were stratified across three COVID-19 waves. Individual-level registry data from 2020 to 2021 were used, covering demographics, socio-economic factors, health information and neighborhood characteristics, linked to COVID-19-related hospital and ICU admissions. Multivariable logistic models were conducted per wave to estimate the odds of both COVID-19-related hospital and ICU admissions.

More than 700.000 inhabitants from the region Haaglanden were included per wave. COVID-19-related hospital admissions were 0.08% (n = 571) in the first wave, 0.40% (n = 2.865) in the second, and 0.17% (n = 858) in the third wave. ICU admissions were 0.02% (n = 159) in the first wave, 0.07% (n = 530) in the second, and 0.03% (n = 192) in the third wave. Hospital and ICU admission odds were higher among older individuals, males, lower-educated individuals, those of Moroccan origin, residents with lower income and wealth, poor physical health and those living in low socio-economic neighborhoods. In the third wave, neighborhoods with vaccination coverage below 60% had the highest rates of hospital and ICU admissions.

This study highlighted that individual and neighborhood factors were associated with a higher risk of COVID-19-related hospital and ICU admissions, with the individual risk factors often concentrated in neighborhoods with low socio-economic status scores. Public health strategies should focus on high-risk individuals and incorporate tailored interventions, while early identification of disadvantaged areas is key for effective resource allocation and reducing disparities during future outbreaks.

The online version contains supplementary material available at 10.1186/s12889-025-23364-1.