Health Disparities in Children with Covid-19 Early in the Pandemic: Socioeconomic Disadvantages Contributing to Severe Disease

Purpose of Study: Ethnic disparities are associated with increased risk for severe disease in pediatric patients with COVID-19. Identifying the underlying social determinants of health are necessary to lead to improved health care utilization and mitigation strategies. Methods Used: This is an observational cohort study of children with COVID-19 in Colorado (the CCC study) from March 15 2020-October 31 2020. Pediatric patients between 2-20 years of age with positive SARS-CoV-2 PCR were included. Multivariable logistical regression models were fitted to identify demographic, socioeconomic, and comorbid health conditions as predictors of severe COVID-19 disease, as defined by hospital admission and need for respiratory support. Summary of Results: We identified 1572 pediatric patients with COVID-19 (45% Hispanic, 54% Medicaid or uninsured, 16% non-English language, and 20% obese). In univariable analyses, Hispanic ethnicity was associated with severe outcomes, including hospital admission (OR 2.4, CI: 1.57, 3.80, p<0.01) and respiratory support (OR 2.4, CI: 1.38, 4.14, p<0.01). Patients who identified as Hispanic or Latino had significantly increased rates of obesity (28% vs. 14%, p<0.01), preferred non-English language (31% vs. 3%, p<0.01), and had Medicaid or no insurance (79% vs. 33%, p<0.01) when compared to non-Hispanic or Latino children. After adjusting for covariables, ethnicity was no longer associated with hospital admission (OR 0.9, CI: 0.53, 1.63, p=0.79) or respiratory support (OR 0.6, CI: 0.29, 1.21, p=0.15). Obesity (OR 1.9, CI: 1.15, 3.08, p=0.01), non-English language (OR 2.4, CI: 1.35, 4.23, p<0.01), and Medicaid insurance (OR 2.0, CI: 1.10, 3.71, p=0.02) were identified as independent risk factors for severe disease. Conclusion(s): Severe COVID-19 disease observed in Hispanic or Latino patients early in the pandemic appears to be secondary to underlying comorbid conditions, such as obesity, and socioeconomic disadvantages that may have influenced access to care, such as language and insurance status. Pediatric healthcare providers and public health officials should use this knowledge to tailor resource allocation to better target this underserved patient population.

COVID-19 in CHILDREN: WORSENING OUTCOMES during DELTA VARIANT WAVE

Background: Pediatric cases of COVID-19 surged in the summer/fall of 2021 coinciding with the SARS-CoV-2 Delta variant. It is unclear whether the Delta variant caused more severe illness among pediatric patients. We leveraged the Children and COVID-19 in Colorado database to determine whether differences exist in demographics, underlying comorbidities, and outcomes among children requiring hospital admission due to the SARS-CoV-2 Delta variant vs. wild type virus. Methods: We performed a retrospective review of children <21 years with symptomatic COVID-19 and detectable SARS-CoV-2 NAAT hospitalized at Children's Hospital Colorado during pre-Delta (Mar-Nov 2020) and Delta (Jun-Sep 2021) periods. We compared variables using Fisher's exact or Pearson's chi square tests for categorical variables and Wilcoxon rank sum tests for continuous variables. Results: There were 119 children hospitalized with symptomatic COVID-19 during the pre-Delta and 137 in the Delta period. There was a slight male predominance in both periods. Children hospitalized during the Delta period were younger, with median (interquartile range) age of 5.9 (1.0-14.5) vs. 12.2 (1.5-16.9) years, p=0.02;and were less likely to identify as Hispanic and Spanish-speaking, compared to the pre-Delta period (Table). There was a trend toward decreasing proportions of hospitalized children with underlying comorbidities in the Delta vs. pre-Delta period (59.1% vs. 69.8%;p=0.07). The most prevalent types of comorbidities were similar between periods;but the proportion of hospitalized immunocompromised patients was lower in the Delta vs. pre-Delta period (p=0.005). Half of all children were overweight/obese in both periods. Similar proportions of hospitalized children required respiratory support in both periods, but more children required intensive care in the Delta vs. pre-Delta periods (36.5% vs. 23.5%, p=0.03). Conclusion: Children hospitalized with the Delta variant of COVID-19 were younger, less likely to be Hispanic, and had fewer comorbidities than children hospitalized with wild type SARS-CoV-2. Children hospitalized with the Delta variant were more likely to require ICU admission compared to children hospitalized with wild type SARS-CoV-2, which may indicate increased severity of the Delta variant in the pediatric population. Close monitoring of pediatric outcomes is needed as new SARS-CoV-2 variants emerge.

Children and COVID-19 in Colorado: The children's hospital Colorado experience

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease of 2019 (COVID-19) and has been reported in > 98,000 children in the U.S (5% of reported cases) as of early June 2020. Most published literature focuses on adults with COVID-19, but little is understood on the impact of SARS-CoV-2 in children. We created a database for children with COVID-19 at Children's Hospital Colorado (CHCO), a large tertiary care pediatric hospital, to better understand the epidemiology and clinical outcomes of this disease in children. Methods: We retrospectively reviewed the medical records of all pediatric and youth patients with positive SARS-CoV-2 PCR test results from March-May 2020. Univariate logistic regression models were used to identify predictors of hospital admission, need for critical care, and need for respiratory support among symptomatic patients, with p-values < 0.05 considered statistically significant. Results: We identified 246 patients with SARS-CoV-2 (age range: 17 days- 25 years). We noted a Hispanic predominance with 68% of all patients with SARSCoV- 2 identifying as Hispanic or Latino, compared to 29% among all CHCO visits in 2019 (Figure 1). The most common symptoms at presentation were fever, cough, or shortness of breath in 94% of symptomatic patients. Sixty-eight patients (28%) were admitted, of which 7 (10%) required admission to the pediatric intensive care unit (PICU) for symptomatic COVID-19 disease (Figure 2). Age 0-3 months, certain symptoms at presentation, and several types of underlying medical conditions were predictors for both hospital admission and need for respiratory support (Figure 3). Initial and peak C-reactive protein (CRP) values were predictors for PICU admission with median peaks of 24.8mg/dL vs. 2.0mg/dL among PICU vs. non-PICU patients (OR 1.27, p=0.004). Conclusion: There is a wide spectrum of illness in children with SARS-CoV-2, ranging from asymptomatic to critical illness. Hispanic ethnicity was disproportionately represented in our cohort, which requires further evaluation. We found that young age, comorbid conditions, and CRP appear to be risk factors for severe disease in children.