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AIMS Public Health

2025, Volume 12, Issue 1: 124-136. doi: 10.3934/publichealth.2025009
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Research article Special Issues

Lessons learned for preventing health disparities in future pandemics: the role of social vulnerabilities among children diagnosed with severe COVID-19 early in the pandemic

  • 1.
    Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
  • 2.
    University of Colorado School of Public Health, Aurora, CO, USA
  • 3.
    Department of Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
  • 4.
    Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
  • 5.
    Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  • Received: 03 July 2024 Revised: 09 September 2024 Accepted: 12 November 2024 Published: 15 January 2025

  • Background 

    Hispanic ethnicity is associated with an increased risk for severe disease in children with COVID-19. Identifying underlying contributors to this disparity can lead to improved health care utilization and prevention strategies.

    Methods 

    This is a retrospective cohort study of children 2–20 years of age with positive SARS-CoV-2 testing from March–October 2020. Univariable and multivariable logistic regression models were fitted to identify demographic, comorbid health conditions, and social vulnerabilities as predictors of severe COVID-19 (need for hospital admission or respiratory support).

    Results 

    We included 1572 children with COVID-19, of whom 45% identified as Hispanic. Compared to non-Hispanic children, patients who identified as Hispanic were more often obese (28% vs. 14%, p < 0.0001), preferred a non-English language (31% vs. 3%, p < 0.0001), and had Medicaid or no insurance (79% vs. 33%, p < 0.0001). In univariable analyses, children who identified as Hispanic were more likely to require hospital admission (OR 2.4, CI: 1.57–3.80) and respiratory support (OR 2.4, CI: 1.38–4.14). In multivariable analyses, hospital admission was associated with obesity (OR 1.9, CI: 1.15–3.08), non-English language (OR 2.4, CI: 1.35–4.23), and Medicaid insurance (OR 2.0, CI: 1.10–3.71), but ethnicity was not a significant predictor of severe disease.

    Conclusions and Relevance 

    The high rates of severe COVID-19 observed in Hispanic children early in the pandemic appeared to be secondary to underlying co-morbidities and social vulnerabilities that may have influenced access to care, such as language and insurance status. Pediatric providers and public health officials should tailor resource allocation to better target this underserved patient population.

    Citation: Kelly Graff, Ye Ji Choi, Lori Silveira, Christiana Smith, Lisa Abuogi, Lisa Ross DeCamp, Jane Jarjour, Chloe Friedman, Meredith A. Ware, Jill L Kaar. Lessons learned for preventing health disparities in future pandemics: the role of social vulnerabilities among children diagnosed with severe COVID-19 early in the pandemic[J]. AIMS Public Health, 2025, 12(1): 124-136. doi: 10.3934/publichealth.2025009

    Related Papers:

  • Background 

    Hispanic ethnicity is associated with an increased risk for severe disease in children with COVID-19. Identifying underlying contributors to this disparity can lead to improved health care utilization and prevention strategies.

    Methods 

    This is a retrospective cohort study of children 2–20 years of age with positive SARS-CoV-2 testing from March–October 2020. Univariable and multivariable logistic regression models were fitted to identify demographic, comorbid health conditions, and social vulnerabilities as predictors of severe COVID-19 (need for hospital admission or respiratory support).

    Results 

    We included 1572 children with COVID-19, of whom 45% identified as Hispanic. Compared to non-Hispanic children, patients who identified as Hispanic were more often obese (28% vs. 14%, p < 0.0001), preferred a non-English language (31% vs. 3%, p < 0.0001), and had Medicaid or no insurance (79% vs. 33%, p < 0.0001). In univariable analyses, children who identified as Hispanic were more likely to require hospital admission (OR 2.4, CI: 1.57–3.80) and respiratory support (OR 2.4, CI: 1.38–4.14). In multivariable analyses, hospital admission was associated with obesity (OR 1.9, CI: 1.15–3.08), non-English language (OR 2.4, CI: 1.35–4.23), and Medicaid insurance (OR 2.0, CI: 1.10–3.71), but ethnicity was not a significant predictor of severe disease.

    Conclusions and Relevance 

    The high rates of severe COVID-19 observed in Hispanic children early in the pandemic appeared to be secondary to underlying co-morbidities and social vulnerabilities that may have influenced access to care, such as language and insurance status. Pediatric providers and public health officials should tailor resource allocation to better target this underserved patient population.


    Abbreviations

    COVID-19

    coronavirus disease 2019

         SARS-CoV-2

    severe acute respiratory syndrome coronavirus-2

         CHCO

    Children's Hospital Colorado

         CCC

    Children and COVID-19 in Colorado study

         HER

    electronic health record

         SDoH

    social determinants of health

         BMI

    body mass index

         CDC

    Centers for Disease Control and Prevention

         NAFLD

    nonalcoholic fatty liver disease

         NASH

    nonalcoholic steatohepatitis

         SES

    socioeconomic status
    加载中

    Acknowledgments


    We would like to acknowledge the patients and families affected by COVID-19 and the Children's Hospital staff working to care for them. We would especially like to acknowledge the Children's Hospital Colorado Microbiology Laboratory for their efforts in early creation and implementation of the SARS-CoV-2 PCR test at Children's Hospital Colorado.

    Authors' contribution


    All authors contributed to the study conception and design or data collection. Data analysis was performed by YC, LS, and JK. The first draft of the manuscript was written by KG and MW. All authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

    Conflict of interest


    The authors have no relevant financial or non-financial interests to disclose.

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