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Published on: November 10, 2023
Incidence and Risk Factors for Severe Outcomes in Pediatric Patients With COVID-19
Milan Ho1, Zachary M Most2, Trish M Perl3
1UT Southwestern Medical School, Dallas, Texas.
Insights
Children with COVID-19 are at risk for severe outcomes, especially those with comorbidities or in the Southern US. Vaccination offers protection against severe COVID-19 in older children.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Children with COVID-19 have faced severe outcomes including hospitalization, ICU admission, and death.
- Understanding risk factors is crucial for mitigating severe disease in pediatric populations.
Purpose of the Study:
- To investigate risk factors associated with severe outcomes in children diagnosed with COVID-19.
- To identify factors influencing hospitalization, ICU admission, invasive respiratory support, and death in pediatric COVID-19 cases.
Main Methods:
- Utilized a national deidentified electronic health record dataset (Optum) of children (0-18 years) with COVID-19 from January 2020 to January 2022.
- Employed ordinal logistic regression to analyze outcomes including non-hospitalization, hospitalization, and severe composite outcomes (ICU, intensive respiratory support, death).
- Conducted a secondary analysis focusing on hospitalizations with a primary COVID-19 diagnosis.
Main Results:
- Over 165,000 children with COVID-19 were analyzed; 1.8% were hospitalized, 1.8% required ICU/intensive respiratory support, and 0.02% died.
- Preexisting comorbidities and Southern US residency were linked to worse outcomes.
- Vaccination demonstrated a protective effect in children aged 5-18 years, with a nonlinear age association observed in younger children (0-4 years).
Conclusions:
- Preexisting comorbidities and Southern US residency are significant risk factors for severe COVID-19 outcomes in children.
- Vaccination is a protective factor against severe outcomes in pediatric COVID-19 patients aged 5-18.
- Future research should explore generalizability in underinsured pediatric populations.
Objectives:
Throughout the pandemic, children with COVID-19 have experienced hospitalization, ICU admission, invasive respiratory support, and death. Using a multisite, national dataset, we investigate risk factors associated with these outcomes in children with COVID-19.
Methods:
Our data source (Optum deidentified COVID-19 Electronic Health Record Dataset) included children aged 0 to 18 years testing positive for COVID-19 between January 1, 2020, and January 20, 2022. Using ordinal logistic regression, we identified factors associated with an ordinal outcome scale: nonhospitalization, hospitalization, or a severe composite outcome (ICU, intensive respiratory support, death). To contrast hospitalization for COVID-19 and incidental positivity on hospitalization, we secondarily identified patient factors associated with hospitalizations with a primary diagnosis of COVID-19.
Results:
In 165 437 children with COVID-19, 3087 (1.8%) were hospitalized without complication, 2954 (1.8%) experienced ICU admission and/or intensive respiratory support, and 31 (0.02%) died. We grouped patients by age: 0 to 4 years old (35 088), and 5 to 11 years old (75 574), 12 to 18 years old (54 775). Factors positively associated with worse outcomes were preexisting comorbidities and residency in the Southern United States. In 0- to 4-year-old children, there was a nonlinear association between age and worse outcomes, with worse outcomes in 0- to 2-year-old children. In 5- to 18-year-old patients, vaccination was protective. Findings were similar in our secondary analysis of hospitalizations with a primary diagnosis of COVID-19, though region effects were no longer observed.
Conclusions:
Among children with COVID-19, preexisting comorbidities and residency in the Southern United States were positively associated with worse outcomes, whereas vaccination was negatively associated. Our study population was highly insured; future studies should evaluate underinsured populations to confirm generalizability.
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