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Heterogeneity in Racial and Ethnic Disparities in COVID-19 Severity Among Pediatric Inpatients in a National

David Watson1,2, Alicen B Spaulding2, Laura Norton3

  • 1Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, United States.

Journal of the Pediatric Infectious Diseases Society
|October 8, 2025
PubMed

Insights

Racial and ethnic disparities in pediatric COVID-19 severity were greatest among children with complex chronic conditions or government insurance. These findings highlight vulnerable populations needing targeted interventions to reduce health inequities.

Area of Science:

  • Pediatric Health
  • Epidemiology
  • Health Disparities

Background:

  • The COVID-19 pandemic exacerbated existing racial and ethnic disparities in pediatric healthcare.
  • However, the specific populations most affected by these disparities remained unclear.

Purpose of the Study:

  • To investigate whether racial and ethnic disparities in COVID-19 severity varied based on patient factors.
  • To identify specific subgroups experiencing the largest disparities in pediatric COVID-19 outcomes.

Main Methods:

  • Retrospective cohort study using the Premier Healthcare Database (April 2020-September 2022).
  • Included US inpatients under 19 with a COVID-19 diagnosis.
  • COVID-19 severity outcomes included ICU admission and ventilator use, analyzed with propensity score weights and tested for interaction across subgroups like complex chronic conditions (CCCs) and insurance status.

Main Results:

  • Ventilator use disparities were larger for Black vs. White children with CCCs (4.5% RD) compared to those without CCCs (0.0% RD).
  • Hispanic vs. White children also showed larger ventilator use disparities with CCCs (2.7% RD).
  • ICU admission disparities for Black vs. White children were greater with government insurance (5.1% RD) than private insurance (-1.4% RD).

Conclusions:

  • Racial and ethnic disparities in pediatric COVID-19 severity were most pronounced in hospitalized children with complex chronic conditions or government insurance.
  • These findings are crucial for identifying high-risk populations requiring targeted interventions to mitigate health inequities.
Abstract

Keywords:
effect modificationhealth equityhospitalizationsventilator

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