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Hospitalization for COVID-19 and Risk Factors for Severe Disease Among Children: 2022-2024

Rebecca J Free1, Kadam Patel1, Christopher A Taylor1

  • 1Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia.

Pediatrics
|July 3, 2025
PubMed

Insights

Most hospitalized children with COVID-19 had underlying conditions and low vaccination rates. Chronic lung disease, cardiovascular disease, diabetes, and neurologic disorders increased severe illness risk in pediatric COVID-19 patients.

Area of Science:

  • Pediatric Infectious Diseases
  • Public Health Surveillance
  • Vaccinology

Background:

  • COVID-19 continues to pose a significant health threat to children, necessitating an understanding of hospitalization characteristics and risk factors for severe disease.
  • Previous research has highlighted the impact of COVID-19 on pediatric populations, but ongoing surveillance is crucial given evolving variants and vaccination landscapes.

Purpose of the Study:

  • To assess the demographic characteristics and underlying medical conditions of children hospitalized with COVID-19.
  • To identify risk factors associated with severe disease outcomes among hospitalized pediatric patients.
  • To evaluate the role of COVID-19 vaccination status in pediatric hospitalizations and disease severity.

Main Methods:

  • Utilized data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) from October 1, 2022, to April 30, 2024.
  • Described characteristics of 2490 hospitalized children aged 6 months to 17 years with laboratory-confirmed SARS-CoV-2 infection.
  • Employed multivariable generalized estimating equations to identify risk factors for severe disease in different pediatric age groups.

Main Results:

  • The majority of hospitalized children (58.9%) had at least one underlying medical condition, with prevalence increasing with age.
  • Only 3.8% of hospitalized children were up to date with COVID-19 vaccination.
  • Among younger children (6-23 months), chronic lung and cardiovascular diseases were associated with severe COVID-19. In older children (2+ years), chronic lung disease, diabetes, and neurologic disorders increased the risk of severe illness.

Conclusions:

  • A significant proportion of hospitalized children have underlying conditions, underscoring their vulnerability to severe COVID-19 outcomes.
  • Low COVID-19 vaccination coverage among hospitalized children highlights a critical gap in prevention efforts.
  • Targeted vaccination strategies, especially for children with high-risk conditions, are essential to reduce pediatric COVID-19 hospitalizations and severe disease.
Abstract

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