Association between race and COVID-19 outcomes among 2.6 million children in England
<p><strong>Importance: </strong>Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. There is an established association between race and severe COVID-19 outcomes in adults in England; how...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
American Medical Association
2021
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| _version_ | 1797110578898010112 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Saatci, D |
| collection | OXFORD |
| description | <p><strong>Importance: </strong>Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. There is an established association between race and severe COVID-19 outcomes in adults in England; however, whether a similar association exists in children is unclear.</p>
<p><strong>Objective: </strong>To investigate the association between race and childhood COVID-19 testing and hospital outcomes.</p>
<p><strong>Design, Setting, Participants: </strong>In this cohort study, children (0-18 years of age) from participating family practices in England were identified in the QResearch database between January 24 and November 30, 2020. The QResearch database has individually linked patients with national SARS-CoV-2 testing, hospital admission, and mortality data.</p>
<p><strong>Exposures: </strong>The main characteristic of interest is self-reported race. Other exposures were age, sex, deprivation level, geographic region, household size, and comorbidities (asthma; diabetes; and cardiac, neurologic, and hematologic conditions).</p>
<p><strong>Main Outcomes and Measures: </strong>The primary outcome was hospital admission with confirmed COVID-19. Secondary outcomes were SARS-CoV-2–positive test result and any hospital attendance with confirmed COVID-19 and intensive care admission.</p>
<p><strong>Results: </strong>Of 2 576 353 children (mean [SD] age, 9.23 [5.24] years; 48.8% female), 410 726 (15.9%) were tested for SARS-CoV-2 and 26 322 (6.4%) tested positive. A total of 1853 children (0.07%) with confirmed COVID-19 attended hospital, 343 (0.01%) were admitted to the hospital, and 73 (0.002%) required intensive care. Testing varied across race. White children had the highest proportion of SARS-CoV-2 tests (223 701/1 311 041 [17.1%]), whereas Asian children (33 213/243 545 [13.6%]), Black children (7727/93 620 [8.3%]), and children of mixed or other races (18 971/147 529 [12.9%]) had lower proportions. Compared with White children, Asian children were more likely to have COVID-19 hospital admissions (adjusted odds ratio [OR], 1.62; 95% CI, 1.12-2.36), whereas Black children (adjusted OR, 1.44; 95% CI, 0.90-2.31) and children of mixed or other races (adjusted OR, 1.40; 95% CI, 0.93-2.10) had comparable hospital admissions. Asian children were more likely to be admitted to intensive care (adjusted OR, 2.11; 95% CI, 1.07-4.14), and Black children (adjusted OR, 2.31; 95% CI, 1.08-4.94) and children of mixed or other races (adjusted OR, 2.14; 95% CI, 1.25-3.65) had longer hospital admissions (≥36 hours).</p>
<p><strong>Conclusions and Relevance: </strong>In this large population-based study exploring the association between race and childhood COVID-19 testing and hospital outcomes, several race-specific disparities were observed in severe COVID-19 outcomes. However, ascertainment bias and residual confounding in this cohort study should be considered before drawing any further conclusions. Overall, findings of this study have important public health implications internationally.</p> |
| first_indexed | 2024-03-07T07:56:46Z |
| format | Journal article |
| id | oxford-uuid:f14db9cf-44cb-41ec-93e2-89a4bbb6c54e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:56:46Z |
| publishDate | 2021 |
| publisher | American Medical Association |
| record_format | dspace |
| spelling | oxford-uuid:f14db9cf-44cb-41ec-93e2-89a4bbb6c54e2023-08-23T14:34:35ZAssociation between race and COVID-19 outcomes among 2.6 million children in EnglandJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:f14db9cf-44cb-41ec-93e2-89a4bbb6c54eEnglishSymplectic ElementsAmerican Medical Association2021Saatci, DRanger, TAGarriga, CClift, AKZaccardi, FTan, PSPatone, MCoupland, CHarnden, AGriffin, SJKhunti, KDambha-Miller, HHippisley-Cox, J<p><strong>Importance: </strong>Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. There is an established association between race and severe COVID-19 outcomes in adults in England; however, whether a similar association exists in children is unclear.</p> <p><strong>Objective: </strong>To investigate the association between race and childhood COVID-19 testing and hospital outcomes.</p> <p><strong>Design, Setting, Participants: </strong>In this cohort study, children (0-18 years of age) from participating family practices in England were identified in the QResearch database between January 24 and November 30, 2020. The QResearch database has individually linked patients with national SARS-CoV-2 testing, hospital admission, and mortality data.</p> <p><strong>Exposures: </strong>The main characteristic of interest is self-reported race. Other exposures were age, sex, deprivation level, geographic region, household size, and comorbidities (asthma; diabetes; and cardiac, neurologic, and hematologic conditions).</p> <p><strong>Main Outcomes and Measures: </strong>The primary outcome was hospital admission with confirmed COVID-19. Secondary outcomes were SARS-CoV-2–positive test result and any hospital attendance with confirmed COVID-19 and intensive care admission.</p> <p><strong>Results: </strong>Of 2 576 353 children (mean [SD] age, 9.23 [5.24] years; 48.8% female), 410 726 (15.9%) were tested for SARS-CoV-2 and 26 322 (6.4%) tested positive. A total of 1853 children (0.07%) with confirmed COVID-19 attended hospital, 343 (0.01%) were admitted to the hospital, and 73 (0.002%) required intensive care. Testing varied across race. White children had the highest proportion of SARS-CoV-2 tests (223 701/1 311 041 [17.1%]), whereas Asian children (33 213/243 545 [13.6%]), Black children (7727/93 620 [8.3%]), and children of mixed or other races (18 971/147 529 [12.9%]) had lower proportions. Compared with White children, Asian children were more likely to have COVID-19 hospital admissions (adjusted odds ratio [OR], 1.62; 95% CI, 1.12-2.36), whereas Black children (adjusted OR, 1.44; 95% CI, 0.90-2.31) and children of mixed or other races (adjusted OR, 1.40; 95% CI, 0.93-2.10) had comparable hospital admissions. Asian children were more likely to be admitted to intensive care (adjusted OR, 2.11; 95% CI, 1.07-4.14), and Black children (adjusted OR, 2.31; 95% CI, 1.08-4.94) and children of mixed or other races (adjusted OR, 2.14; 95% CI, 1.25-3.65) had longer hospital admissions (≥36 hours).</p> <p><strong>Conclusions and Relevance: </strong>In this large population-based study exploring the association between race and childhood COVID-19 testing and hospital outcomes, several race-specific disparities were observed in severe COVID-19 outcomes. However, ascertainment bias and residual confounding in this cohort study should be considered before drawing any further conclusions. Overall, findings of this study have important public health implications internationally.</p> |
| spellingShingle | 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 |
| title | Association between race and COVID-19 outcomes among 2.6 million children in England |
| title_full | Association between race and COVID-19 outcomes among 2.6 million children in England |
| title_fullStr | Association between race and COVID-19 outcomes among 2.6 million children in England |
| title_full_unstemmed | Association between race and COVID-19 outcomes among 2.6 million children in England |
| title_short | Association between race and COVID-19 outcomes among 2.6 million children in England |
| title_sort | association between race and covid 19 outcomes among 2 6 million children in england |
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