Assessment of COVID-19 as the Underlying Cause of Death Among Children and Young People Aged 0 to 19 Years in the US

Abstract

ImportanceCOVID-19 was the underlying cause of death for more than 940 000 individuals in the US, including at least 1289 children and young people (CYP) aged 0 to 19 years, with at least 821 CYP deaths occurring in the 1-year period from August 1, 2021, to July 31, 2022. Because deaths among US CYP are rare, the mortality burden of COVID-19 in CYP is best understood in the context of all other causes of CYP death.ObjectiveTo determine whether COVID-19 is a leading (top 10) cause of death in CYP in the US.Design, Setting, and ParticipantsThis national population-level cross-sectional epidemiological analysis for the years 2019 to 2022 used data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on underlying cause of death in the US to identify the ranking of COVID-19 relative to other causes of death among individuals aged 0 to 19 years. COVID-19 deaths were considered in 12-month periods between April 1, 2020, and August 31, 2022, compared with deaths from leading non–COVID-19 causes in 2019, 2020, and 2021.Main Outcomes and MeasuresCause of death rankings by total number of deaths, crude rates per 100 000 population, and percentage of all causes of death, using the National Center for Health Statistics 113 Selected Causes of Death, for ages 0 to 19 and by age groupings (<1 year, 1-4 years, 5-9 years, 10-14 years, 15-19 years).ResultsThere were 821 COVID-19 deaths among individuals aged 0 to 19 years during the study period, resulting in a crude death rate of 1.0 per 100 000 population overall; 4.3 per 100 000 for those younger than 1 year; 0.6 per 100 000 for those aged 1 to 4 years; 0.4 per 100 000 for those aged 5 to 9 years; 0.5 per 100 000 for those aged 10 to 14 years; and 1.8 per 100 000 for those aged 15 to 19 years. COVID-19 mortality in the time period of August 1, 2021, to July 31, 2022, was among the 10 leading causes of death in CYP aged 0 to 19 years in the US, ranking eighth among all causes of deaths, fifth in disease-related causes of deaths (excluding unintentional injuries, assault, and suicide), and first in deaths caused by infectious or respiratory diseases when compared with 2019. COVID-19 deaths constituted 2% of all causes of death in this age group.Conclusions and RelevanceThe findings of this study suggest that COVID-19 was a leading cause of death in CYP. It caused substantially more deaths in CYP annually than any vaccine-preventable disease historically in the recent period before vaccines became available. Various factors, including underreporting and not accounting for COVID-19’s role as a contributing cause of death from other diseases, mean that these estimates may understate the true mortality burden of COVID-19. The findings of this study underscore the public health relevance of COVID-19 to CYP. In the likely future context of sustained SARS-CoV-2 circulation, appropriate pharmaceutical and nonpharmaceutical interventions (eg, vaccines, ventilation, air cleaning) will continue to play an important role in limiting transmission of the virus and mitigating severe disease in CYP.

Critical care among newborns with and without a COVID-19 diagnosis, May 2020–February 2022

“…Findings from the period when wild-type SARS-CoV-2 virus was predominant (March-December 2020) showed that late preterm and term newborns (≥34 gestational weeks) with COVID-19 had an increased risk of neonatal intensive care unit (ICU) admission and early preterm newborns (<34 gestational weeks) with COVID-19 had an increased risk of invasive ventilation support [4]. Further, COVID-19 was a leading cause of death for infants <1 year during 2021-2022 [5].…”

Humoral profiles of toddlers and young children following SARS-CoV-2 mRNA vaccination

“…While most children experience mild symptoms with acute SARS-CoV-2 infection, severe complications can ensue, even in the youngest children, and myocarditis, cardiomyopathy, renal failure, as well as coagulation and hemorrhagic disorders occur at increased rates with COVID-19 2 . Concerningly, COVID-19 deaths in children far exceed deaths from influenza 3 and COVID-19 has now become one of the leading infectious cause of death in the Unites States 4 . SARS-CoV-2-targeting mRNA vaccines have become available for individuals six months of age and older 5,6,7,8,9,10,11 .…”

COVID-19 Vaccine Uptake in Immigrant, Refugee, and Nonimmigrant Children and Adolescents in Ontario, Canada

“…COVID-19 is the eighth leading cause of death in minors in the US and has negatively affected pediatric populations worldwide . Vaccination of children can mitigate risk of complications from SARS-CoV-2 infections and support their uninterrupted access to education and healthy psychosocial development .…”