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Abstract
Introduction Worldwide, 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.
Methods This 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.
Results Of 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).
Conclusion In 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.
- COVID-19
- epidemiology
- health systems
- public health
Data availability statement
Data are available on reasonable request. After publication, the datasets used for this study will be made available to others on reasonable requests to the corresponding author, including a detailed research proposal, study objectives and statistical analysis plan. Deidentified participant data will be provided after written approval from the corresponding author and the DKI Jakarta Health Office.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available on reasonable request. After publication, the datasets used for this study will be made available to others on reasonable requests to the corresponding author, including a detailed research proposal, study objectives and statistical analysis plan. Deidentified participant data will be provided after written approval from the corresponding author and the DKI Jakarta Health Office.
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Footnotes
Handling editor Seye Abimbola
Twitter @henryonce, @lenny_zanri
Contributors HS was the principal investigator of this study. HS designed the study, did the analysis, accepted full responsibility for the work and/or the conduct of the study, had full access to the data, and controlled the decision to publish. NS, VA, WW and DO did data collection and verification. KDL did the data cleaning. HS, AHS, RLH, JKB and IRFE contributed to the analysis and drafted the paper. All authors critically revised the manuscript for important intellectual content and all authors gave final approval for the version to be published.
Funding Wellcome Africa Asia Programme Vietnam (106680/Z/14/Z).
Disclaimer The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all of the data and the final responsibility to submit for publication. All authors were not precluded from accessing data in the study, and accepted responsibility to submit for publication.
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Competing interests None declared.
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