How can physicians identify children who may be at increased risk for severe complications due to COVID-19? Are there key social factors, such as poverty and unemployment, which could indicate an increased risk of hospitalization for COVID-19? These are the types of questions two researchers, Liam O’Neill, PhD, of the University of North Texas, and Neale R. Chumbler, PhD, of the University of Tennessee Health Science Center, were interested in answering in their paper published recently in Health Services Research and Managerial Epidemiology.
Combing through data collected from the Texas Inpatient Public Use Data File (TIPUDF), Drs. O’Neill and Chumbler identified a pool of 1,187 patients, ages 5 to 19, from 164 acute-care Texas hospitals who were hospitalized from April to September 2020 with COVID-19. To provide a baseline comparison, they also identified a group of more than 38,000 pediatric patients, who were hospitalized in 2020 for other reasons and who did not have COVID-19.
In addition to noting clinical comorbidities, such as obesity and type I diabetes, Drs. O’Neill and Chumbler went further to identify key social determinants of health (SDOH) that were associated with a higher risk of hospitalization. Using patient ZIP code information from the U.S. Census’s 2019 American Community Survey, researchers identified several SDOH, including unemployment rate, proportion of adults with at least a high school diploma, proportion of single parent households, and proportion of households living below the poverty line.
After analyzing their findings, the researchers found that children living in single-parent households were associated with an increased risk of severe illness due to COVID-19. In fact, this was a better predictor than many other variables, including poverty, unemployment, and household income
“While it was well known that chronic illnesses, such as obesity and diabetes, were correlated with poor COVID-19 outcomes for pediatric patients, this is one of the few studies that considered indicators of social determinants of health, community level and socioeconomic factors as predictors of COVID-19 outcomes among children. In fact, this was the first study to identify single-parent households as a risk factor for hospitalization for COVID-19 among children,” said Dr. Chumbler, who also serves as the executive associate dean for Academic, Faculty, and Student Affairs in the College of Health Professions at UTHSC. This finding calls attention to the burden that single- parent households may have experienced as they cared for children with COVID-19 and was a key social determinant of health.
With the recent rise in the Omicron variant causing an unprecedented surge in hospitalizations among children, this study can help the medical community better identify pediatric patients with an elevated risk for severe complications due to COVID-19. Findings from the study may be used to communicate risks more clearly with families of children with these risk factors and to prioritize prevention measures more effectively, including vaccinations.
Even as there has been much concern in the media lately over the risks to children, the results from the study are not all bad news. According to Dr. O’Neill, “Asthmatic children may be at less risk for severe COVID-19 than was previously thought. Younger children who were hospitalized with this disease were less likely to have asthma than the comparison group without COVID-19.” The authors also stressed the importance of primary care for controlling asthma and diabetes in children.