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Increased disease severity during COVID-19 related hospitalization in black non-hispanic, hispanic and
Monica Oyidu Ochapa1,2, Leah J McGrath3, Tamuno Alfred4
1Morgan State University School of Community Health and Policy, Baltimore, MD, United States.
Insights
COVID-19 outcomes in young children showed significant racial and insurance disparities. Black and Hispanic children, along with those insured by Medicaid, experienced longer hospital stays and intensive care unit (ICU) admissions.
Area of Science:
- Pediatric Health
- Epidemiology
- Health Disparities
Background:
- The COVID-19 pandemic has disproportionately impacted marginalized communities in the US.
- While most children experience mild COVID-19, severe cases and long-term complications occur, with limited research on health disparities in severe outcomes among US children.
Purpose of the Study:
- To investigate disparities in clinical outcomes for infants and children under 5 years old hospitalized with COVID-19.
- Analysis focused on differences by race/ethnicity and payer status.
Main Methods:
- Utilized the PINC AI™ Healthcare Database for children under 5 hospitalized with COVID-19 (April 2021-February 2023).
- Examined outcomes including length of stay (LOS), intensive care unit (ICU) admission, oxygen supplementation, and invasive mechanical ventilation (IMV), focusing on prolonged durations.
- Employed multivariable logistic regression to compare outcomes across racial/ethnic groups and payer statuses.
Main Results:
- Out of 10,190 children, Black non-Hispanic children had higher odds of prolonged LOS (aOR=1.20), ICU days (aOR=1.44), and invasive mechanical ventilation (IMV) days (aOR=1.80) compared to White non-Hispanic children.
- Similar disparities were noted for Hispanic and other racial/ethnic groups.
- Medicaid-insured children faced higher odds of prolonged LOS and oxygen use compared to commercially insured children.
Conclusions:
- Significant disparities in COVID-19 clinical outcomes exist among young children based on race/ethnicity and insurance type, particularly for prolonged outcomes.
- Further research is essential to understand the root causes and consequences of these disparities.
- Strategies are needed to ensure equitable healthcare delivery and reduce identified disparities.
Background:
The COVID-19 pandemic has disproportionately affected marginalized groups in the United States. Although most children have mild or asymptomatic COVID-19, some experience severe disease and long-term complications. However, few studies have examined health disparities in severe COVID-19 outcomes among US children.
Objective:
To examine disparities in the clinical outcomes of infants and children aged <5 years hospitalized with COVID-19 by race/ethnicity and payer status.
Methods:
Children aged <5 years hospitalized with an admission diagnosis of COVID-19 (April 2021-February 2023) were selected from the PINC AI™ Healthcare Database. Hospital outcomes included length of stay (LOS), intensive care unit (ICU) admission, oxygen supplementation, invasive mechanical ventilation (IMV), and prolonged duration of each outcome. Multivariable logistic regression models compared hospitalization outcomes by race/ethnicity and payer status.
Results:
Among 10,190 children (mean age: 0.9 years, 56.5% male, 66.7% Medicaid-insured), race/ethnicity was distributed as follows: White non-Hispanic (35.1%), Hispanic (any or Unknown race; 28.3%), Black non-Hispanic (15.2%), Other race/ethnicity (8.9%) and Unknown (12.5%). Payer status varied by race/ethnicity. White non-Hispanic children had the highest proportion with commercial insurance (42.9%) while other racial/ethnic groups ranged between 13.8% to 26.1%. Black non-Hispanic children had the highest proportion with Medicaid (82.3%) followed by Hispanic children (76.9%). Black non-Hispanic children had higher odds of prolonged outcomes: LOS (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI]:1.05-1.38), ICU days (aOR = 1.44, 95% CI: 1.07-1.93), and IMV days (aOR = 1.80, 95% CI: 1.09-2.97) compared to White non-Hispanic children. Similar patterns were observed for Hispanic and children of Other race/ethnicity. Medicaid-insured and children with other insurance had higher odds of prolonged LOS and oxygen days than commercially insured patients.
Conclusion:
There were disparities in clinical outcomes of COVID-19 by race/ethnicity and insurance type, particularly for prolonged-duration outcomes. Further research is required to fully comprehend the causes and consequences of these disparities and develop strategies to reduce them while ensuring equitable healthcare delivery.
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