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Identifying Post-Acute Sequelae of SARS-CoV-2 Among Children in New York State Medicaid Managed Care
Philip M DiMura1, Victoria L Wagner2, Tom W Robertson2
1Center for Applied Research and Evaluation, Office of Health Service Quality and Analytics, New York State Department of Health, Albany, NY, 12237, USA. philip.dimura@health.ny.gov.
Insights
Children diagnosed with COVID-19 (SARS-CoV-2) showed a low incidence of post-acute sequelae (PASC). While some PASC risks increased, associations were generally weak or marginal in this pediatric Medicaid population.
Area of Science:
- Pediatric Health
- Infectious Diseases
- Public Health
Background:
- Post-acute sequelae of SARS-CoV-2 (PASC) can affect individuals after COVID-19 infection.
- Understanding PASC incidence in pediatric populations is crucial for public health.
- Pediatric Medicaid populations represent a vulnerable group for health outcome disparities.
Purpose of the Study:
- To determine the incidence of PASC in a pediatric Medicaid population.
- To compare PASC diagnoses in children with and without SARS-CoV-2 infection.
- To identify specific PASC outcomes associated with SARS-CoV-2 in children.
Main Methods:
- Retrospective cohort study design using New York State Medicaid Managed Care data.
- Comparison of incident diagnoses between children with SARS-CoV-2 (2021), a control group (2021), and a viral respiratory diagnosis group (2019).
- Logistic regression models and Cohen's d statistic were used to analyze associations.
Main Results:
- Most unadjusted PASC incidence rates were below 1% across all cohorts.
- SARS-CoV-2 infection was associated with increased incidence of infectious disease sequelae, general symptoms, and pericarditis compared to the 2021 control.
- Associations between SARS-CoV-2 and PASC were predominantly weak or marginal.
- Some PASC outcomes, like suicidal ideation, showed associations with the 2019 comparison group.
Conclusions:
- The incidence of new clinical sequelae following SARS-CoV-2 infection was low in this low socioeconomic status pediatric population.
- While overall incidence was low, certain severe PASC outcomes were observed.
- Pandemic-related behavioral changes may have influenced the observed associations.
Abstract:
Persons who contract COVID-19 are at risk of developing post-acute sequelae of SARS-CoV-2 (PASC). The objective of this study was to describe the incidence of PASC in a pediatric Medicaid population. Using a retrospective cohort of children enrolled in New York State Medicaid Managed Care we compared incident diagnoses between children with a positive laboratory test for SARS-CoV-2 in 2021 to children without a positive test in 2021 and children with a viral respiratory diagnosis in 2019. Logistic regression models estimated adjusted odds ratios using the Cohen's d statistic to assess the strength of associations. Most unadjusted incidence of clinical outcomes were less than 1% for all cohorts. Relative to the 2021 comparison cohort, significant increases among SARS-CoV-2 cases were observed in sequela of infectious disease conditions, general signs and symptoms, and pericarditis and pericardial disease and for the 2019 comparison, sequela of infectious disease conditions and suicidal ideation. However, associations were mostly determined to be weak or marginal. In this low socioeconomic status pediatric population, incidence of new clinical sequelae was low with mostly weak or marginal increases associated with SARS-CoV-2 infection. Though the incidence was low, some outcomes may be severe. Observed associations may have been impacted by pandemic behavior modification including social distancing policies.
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