Examining the racial disparities in severe COVID-19 among kids

Although cases of COVID-19 in children are often mild, there has been an increase in the rates of hospitalization in the past few months. Research has indicated that there is a link between race and severe COVID-19 in adults, but whether this is also true in children has not yet been clear. A report in JAMA Pediatrics that used a large cohort of children in England sought to offer some evidence on whether this connection also existed in children.¹

The QResearch database was used to find children aged 0 to 18 years who had received medical care at family practices across England. The database had linked patients individually with national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, hospital admission, and mortality data. The primary outcome was admission to the hospital with a confirmed COVID-19 infection. Other outcomes included any hospital attendance with confirmed COVID-19 and intensive care admission as well as a SARS-CoV-2–positive test result.

From a possible pool of 2,576,353 children, 410,726 were tested for SARS-CoV-2 and 26,322 had a positive test result. From the subcohort of children who tested positive, 1853 had some hospital attendance and 343 were admitted to the hospital, of which 73 required intensive care. There was significant variance in test across race, with White children having the highest proportion of testing (223 701/1 311 041 [17.1%]), in contrast to 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%]). When compared to White children, Black (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 rates of hospital admissions for COVID-19, whereas Asian children were more likely to be admitted to the hospital for COVID-19 (adjusted odds ratio [OR], 1.62; 95% CI, 1.12-2.36). Asian children were also more likely be admitted to intensive care (adjusted OR, 2.11; 95% CI, 1.07-4.14). Furthermore, children of mixed or other races (adjusted OR, 2.14; 95% CI, 1.25-3.65) and Black children (adjusted OR, 2.31; 95% CI, 1.08-4.94) were found to have longer hospital admissions ≥36 hours.

The investigators concluded that there were multiple race-specific disparities seen in severe COVID-19 outcomes in children. They believe that the results have important international public health implications.

Reference

1. Saatci D, Ranger T, Garriga C, et al. Association Between race and COVID-19 outcomes among 2.6 million children in England. JAMA Pediatr. June 21, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.1685