Association Between Race and COVID-19 Outcomes Among 2.6 Million Children in England.
JAMA Pediatr
; 175(9): 928-938, 2021 09 01.
Article
in English
| MEDLINE | ID: covidwho-1274655
ABSTRACT
Importance Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. There is an established association between race and severe COVID-19 outcomes in adults in England; however, whether a similar association exists in children is unclear. Objective:
To investigate the association between race and childhood COVID-19 testing and hospital outcomes. Design, Setting,Participants:
In this cohort study, children (0-18 years of age) from participating family practices in England were identified in the QResearch database between January 24 and November 30, 2020. The QResearch database has individually linked patients with national SARS-CoV-2 testing, hospital admission, and mortality data. Exposures The main characteristic of interest is self-reported race. Other exposures were age, sex, deprivation level, geographic region, household size, and comorbidities (asthma; diabetes; and cardiac, neurologic, and hematologic conditions). Main Outcomes andMeasures:
The primary outcome was hospital admission with confirmed COVID-19. Secondary outcomes were SARS-CoV-2-positive test result and any hospital attendance with confirmed COVID-19 and intensive care admission.Results:
Of 2â¯576â¯353 children (mean [SD] age, 9.23 [5.24] years; 48.8% female), 410â¯726 (15.9%) were tested for SARS-CoV-2 and 26â¯322 (6.4%) tested positive. A total of 1853 children (0.07%) with confirmed COVID-19 attended hospital, 343 (0.01%) were admitted to the hospital, and 73 (0.002%) required intensive care. Testing varied across race. White children had the highest proportion of SARS-CoV-2 tests (223â¯701/1â¯311â¯041 [17.1%]), whereas Asian children (33â¯213/243â¯545 [13.6%]), Black children (7727/93â¯620 [8.3%]), and children of mixed or other races (18â¯971/147â¯529 [12.9%]) had lower proportions. Compared with White children, Asian children were more likely to have COVID-19 hospital admissions (adjusted odds ratio [OR], 1.62; 95% CI, 1.12-2.36), whereas Black children (adjusted OR, 1.44; 95% CI, 0.90-2.31) and children of mixed or other races (adjusted OR, 1.40; 95% CI, 0.93-2.10) had comparable hospital admissions. Asian children were more likely to be admitted to intensive care (adjusted OR, 2.11; 95% CI, 1.07-4.14), and Black children (adjusted OR, 2.31; 95% CI, 1.08-4.94) and children of mixed or other races (adjusted OR, 2.14; 95% CI, 1.25-3.65) had longer hospital admissions (≥36 hours). Conclusions and Relevance In this large population-based study exploring the association between race and childhood COVID-19 testing and hospital outcomes, several race-specific disparities were observed in severe COVID-19 outcomes. However, ascertainment bias and residual confounding in this cohort study should be considered before drawing any further conclusions. Overall, findings of this study have important public health implications internationally.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Ethnicity
/
Child Welfare
/
COVID-19 Testing
/
COVID-19
Type of study:
Cohort study
/
Diagnostic study
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Long Covid
Limits:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
/
Infant, Newborn
Country/Region as subject:
Europa
Language:
English
Journal:
JAMA Pediatr
Year:
2021
Document Type:
Article
Affiliation country:
Jamapediatrics.2021.1685
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