TY - JOUR T1 - Pandemic inequity in a megacity: a multilevel analysis of individual, community and healthcare vulnerability risks for COVID-19 mortality in Jakarta, Indonesia JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-008329 VL - 7 IS - 6 SP - e008329 AU - Henry Surendra AU - Ngabila Salama AU - Karina D Lestari AU - Verry Adrian AU - Widyastuti Widyastuti AU - Dwi Oktavia AU - Rosa N Lina AU - Bimandra A Djaafara AU - Ihsan Fadilah AU - Rahmat Sagara AU - Lenny L Ekawati AU - Ahmad Nurhasim AU - Riris A Ahmad AU - Aria Kekalih AU - Ari F Syam AU - Anuraj H Shankar AU - Guy Thwaites AU - J Kevin Baird AU - Raph L Hamers AU - Iqbal R F Elyazar Y1 - 2022/06/01 UR - http://gh.bmj.com/content/7/6/e008329.abstract N2 - 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.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. ER -