Is race associated with COVID-19 testing and hospital outcomes in children, finds NEJM study

Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. Studies have shown an established association between race and severe COVID-19 outcomes in adults, however whether a similar association in children exists is unclear. In the latest JAMA pediatrics, Saatci et al from University of Oxford explored the association between race, SARS-CoV2 infection and hospitalization rates and showed that Asian children were significantly more likely to have COVID-19 hospital and ICU admissions compared with White children.

In this large population based cohort study used 2576353 children (0-18 years of age) to investigate the association between race and pediatric COVID-19 outcomes in the United Kingdom. A total of 1 311 041 (50.9%) were identified as white children and 484 694 of the 2 576 353 patients (18.8 %) were. identified as Asian, Black, and mixed or other racial categories.During the study, 410726 children (15.9%) underwent SARS-CoV-2 testing, with positive results in 26322 (6.4%). A total of 343 (53.6%) required hospital admission and 73 children were admitted in ICU.

Important findings of the study are-

-White children had the highest percentage of SARS-CoV-2 tests whereas children of all other races had lower percentages (Asian; mixed or/ and Black).

-In children who were tested, those from Asian ,Black and mixed or other backgrounds had higher odds of positive test results compared to White children .

-Older children (16-18 years of age) were also more likely to have a positive test result for SARS-CoV-2 compared with infants (0-3 months of age) with p<0.001.

-Asian children were also more likely to be admitted to the hospital for confirmed COVID-19 compared with White children.

-Black children and children of mixed or other races had significantly more hospitalizations that were 36 hours or longer compared with White children.

-Race was also associated with ICU admissions. Asian children had a significantly higher odds ratio for COVID-19 ICU admissions compared with White children.

After accounting for important socio-demographic and clinical factors that are associated with COVID-19 disease, this population-based cohort study provides, to our knowledge, the most evidence to date of race-specific disparities across SARSCoV-2 testing and COVID-19 hospitalizations in children. Results of this study indicate that race-specific disparities in SARS-CoV-2 testing and COVID-19 hospital outcomes seen in adults also exist among children.

Authors conclude-"This study reinforces the continued need for race/ethnicity-tailored focus on health system performance and targeted public health interventions in children, not only during the ongoing COVID-19 pandemic but also in the event of future public health threats."

Source: Saatci D, Ranger TA, Garriga C, Clift AK, Zaccardi F, Tan PS, Patone M, Coupland C, Harnden A, Griffin SJ, Khunti K, Dambha-Miller H, Hippisley-Cox J. Association Between Race and COVID-19 Outcomes Among 2.6 Million Children in England. JAMA Pediatr. 2021 Jun 21. doi: 10.1001/jamapediatrics.2021.1685.