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

ABSTRACT

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.