Article Text

Download PDFPDF
Sociodemographic disparities in COVID-19 burden: changing patterns over four pandemic waves in Israel
  1. Osnat Luxenburg1,
  2. Clara Singer2,
  3. Vicki Myers2,
  4. Rachel Wilf-Miron2,3,
  5. Mor Saban2
  1. 1 Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
  2. 2 Health Technology Assessment and Policy Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
  3. 3 School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
  1. Correspondence to Dr Rachel Wilf-Miron, Gertner Institute for Health Policy and Epidemiology, Tel HaShomer 52621, Israel; r.w.miron{at}


Background Worldwide, the COVID-19 pandemic hit weakest populations hardest, with socioeconomic (SE), racial and ethnic disparities in COVID-19 burden. The study aimed to analyse patterns of SE and ethnic disparities in morbidity, hospitalisation, and vaccination throughout four pandemic waves.

Methods A retrospective-archive study was conducted in Israel from 11 March 2020 to 1 December 2021, with data on confirmed cases, hospitalisations, mortality and vaccinations (three doses), obtained from the Israeli Ministry of Health’s open COVID-19 database, covering 98.8% of the population, by SE and ethnic characteristics of localities.

Findings At the outbreak of the pandemic, there was a higher caseload in Jewish, compared with Arab localities. In the second and third waves, low SE and Arab minority populations suffered 2–3 times higher morbidity, with a similar but attenuated pattern in the fourth wave. A similar trend was observed in hospitalisation of confirmed patients. COVID-19-associated mortality did not demonstrate a clear SE gradient.

A strong social gradient in vaccine uptake was demonstrated throughout the period, with 71% and 74% double vaccinated in the two highest SE clusters, and 43% and 27% in the two lowest clusters by December 2021. Uptake of the third dose was 57%–60% in the highest SE clusters and 31%–25% in the lowest clusters. SE disparities in vaccine uptake were larger among the younger age groups and gradually increased from first to third doses.

Conclusions Israel was among the first to lead a rapid vaccination drive, as well as to experience a fourth wave fuelled by diminishing immunity and the delta variant. SE and ethnic disparities were evident throughout most of the pandemic months, though less so for mortality. Despite higher COVID-19 burden, vaccine uptake was lower in disadvantaged groups, with greater disparities in the younger population which widened with subsequent doses.

  • COVID-19

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. N/A.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. N/A.

View Full Text


  • RW-M and MS contributed equally.

  • Contributors Rachel Wilf-Miron accepts full responsibility for the work and/or the conduct of the study, has access to the data, and controlled the decision to publish.

    All authors interpreted the data and edited and approved the final article. MS, CS, VM and RW-M conceptualised and designed the study, drafted the initial manuscript and reviewed and revised the manuscript. CS and MS designed the methods section, analysed the data and reviewed and revised the manuscript. OL and RW-M critically reviewed the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.