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Association Between Race and COVID-19 Outcomes Among 2.6 Million Children in England

Defne Saatci1, Tom A Ranger1, Cesar Garriga1

  • 1Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.

JAMA Pediatrics
|June 21, 2021
PubMed

Insights

This study found that Asian children had higher COVID-19 hospital admission rates and intensive care admissions compared to White children. Black children and those of mixed or other races experienced longer hospital stays, highlighting racial disparities in severe COVID-19 outcomes among children.

Area of Science:

  • Pediatric infectious diseases
  • Epidemiology
  • Health disparities

Background:

  • While most children experience mild COVID-19, hospitalization rates are rising, with unknown factors contributing to severe outcomes.
  • Existing research shows a link between race and severe COVID-19 in adults, but this association in children remains unclear.

Purpose of the Study:

  • To investigate the relationship between race and COVID-19 testing and hospital outcomes in children.
  • To identify potential racial disparities in severe COVID-19 outcomes among pediatric populations.

Main Methods:

  • A cohort study utilizing the QResearch database in England, linking children (0-18 years) to national SARS-CoV-2 testing and hospital data (January 24 - November 30, 2020).
  • Self-reported race was the primary exposure of interest, with adjustments for age, sex, deprivation, region, household size, and comorbidities.
  • Primary outcome: hospital admission with confirmed COVID-19. Secondary outcomes included positive SARS-CoV-2 tests, hospital attendance, and intensive care admissions.

Main Results:

  • Asian children showed a higher likelihood of COVID-19 hospital admissions (aOR, 1.62) and intensive care admissions (aOR, 2.11) compared to White children.
  • Black children and children of mixed/other races had comparable hospital admission rates but longer hospital stays (≥36 hours) (aOR, 2.31 and 2.14, respectively).
  • Testing proportions for SARS-CoV-2 varied significantly across racial groups, with White children having the highest proportion of tests.

Conclusions:

  • The study identified significant race-specific disparities in severe COVID-19 outcomes among children in England.
  • Findings suggest potential inequities in healthcare access or disease severity based on race, warranting further investigation.
  • Consideration of ascertainment bias and residual confounding is crucial; results have international public health implications.
Abstract

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