A nationwide analysis of population group differences in the COVID-19 epidemic in Israel, February 2020–February 2021

Khitam Muhsen, Wasef Na'aminh, Yelena Lapidot, Sophy Goren, Yonatan Amir, Saritte Perlman, Manfred S. Green, Gabriel Chodick, Dani Cohen

Research output: Contribution to journalArticlepeer-review


Background: Social inequalities affect the COVID-19 burden and vaccine uptake. The aim of this study was to explore inequalities in the incidence and mortality rate of SARS-CoV-2 infection and vaccine uptake in various sociodemographic and population group strata in Israel. Methods: We analysed nationwide publicly available, aggregated data on PCR-confirmed SARS-CoV-2 infections and COVID-19 deaths between March 2020 and February 2021, as well as the first three months of COVID-19 immunisation according to sociodemographics, including population group and residential socioeconomic status (SES). We computed incidence and mortality rates of COVID-19. Comparisons between towns with predominantly Arab, ultra-Orthodox Jewish (the minorities), general Jewish populations, and according to SES, were conducted using generalised linear models with negative binomial distribution. Findings: Overall, 774,030 individuals had SARS-CoV-2 infection (cumulative incidence 84•5 per 1,000 persons) and 5687 COVID-19 patients had died (mortality rate 62•8 per 100,000 persons). The highest mortality rate was found amongst the elderly. Most (>75%) individuals aged 60 years or above have been vaccinated with BNT162b2 vaccine. The risk of SARS-CoV-2 infection was higher in towns with predominantly Arab and ultra-Orthodox Jewish populations than in the general Jewish population, and in low SES communities. COVID-19 mortality rate was highest amongst Arabs. Conversely, vaccine uptake was lower amongst Arab and ultra-Orthodox Jewish populations and low SES communities. Interpretation: Ethnic and religious minorities and low SES communities experience substantial COVID-19 burden, and have lower vaccine uptake, even in a society with universal accessibility to healthcare. Quantifying these inequalities is fundamental towards reducing these gaps, which imposes a designated apportion of resources to adequately control the pandemic. Funding: No external funding was available for this study.

Original languageEnglish
Article number100130
JournalThe Lancet Regional Health - Europe
StatePublished - Aug 2021

Bibliographical note

Publisher Copyright:
© 2021 The Authors


  • BNT162b2 vaccine
  • Immunisation uptake
  • Incidence
  • Israel
  • Minority
  • Mortality
  • SARS-CoV-2
  • Social determinants

ASJC Scopus subject areas

  • Health Policy
  • Oncology
  • Internal Medicine


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