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Association Between Race and COVID-19 Outcomes Among 2.6 Million Children in England.
Saatci, Defne; Ranger, Tom A; Garriga, Cesar; Clift, Ash Kieran; Zaccardi, Francesco; Tan, Pui San; Patone, Martina; Coupland, Carol; Harnden, Anthony; Griffin, Simon J; Khunti, Kamlesh; Dambha-Miller, Hajira; Hippisley-Cox, Julia.
  • Saatci D; Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
  • Ranger TA; Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
  • Garriga C; Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
  • Clift AK; Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
  • Zaccardi F; Cancer Research UK Oxford Centre, Department of Oncology, University of Oxford, Oxford, United Kingdom.
  • Tan PS; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom.
  • Patone M; Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
  • Coupland C; Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
  • Harnden A; Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
  • Griffin SJ; Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
  • Khunti K; Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
  • Dambha-Miller H; MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
  • Hippisley-Cox J; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom.
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 and

Measures:

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 2 576 353 children (mean [SD] age, 9.23 [5.24] years; 48.8% female), 410 726 (15.9%) were tested for SARS-CoV-2 and 26 322 (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 (223 701/1 311 041 [17.1%]), whereas Asian children (33 213/243 545 [13.6%]), Black children (7727/93 620 [8.3%]), and children of mixed or other races (18 971/147 529 [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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Child Welfare / COVID-19 Testing / COVID-19 Subject: Child Welfare / COVID-19 Testing / COVID-19 Type of study: Determinantes_sociais_saude / Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Language: English Journal: JAMA Pediatr Clinical aspect: Diagnosis / Etiology Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Child Welfare / COVID-19 Testing / COVID-19 Subject: Child Welfare / COVID-19 Testing / COVID-19 Type of study: Determinantes_sociais_saude / Etiology study / Incidence study / Observational study / Prognostic study / Risk factors Language: English Journal: JAMA Pediatr Clinical aspect: Diagnosis / Etiology Year: 2021
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