Black-White Risk Differentials in Pediatric COVID-19 Hospitalization and Intensive Care Unit Admissions in the USA

Abstract

Purpose The COVID-19 morbidity with SARS-CoV-2 as a causative pathogenic microbe remains a pandemic with children experiencing less mortality but with severe manifestations. The current study aimed to assess SARS-CoV-2 cumulative incidence, COVID-19 hospitalization, and ICU admission with respect to racial differentials. Materials and Methods A cross-sectional nonexperimental epidemiologic design was used to examine pediatric COVID-19 data from CDC during 2020. The variables assessed were ICU admissions, hospitalization, sex, race, and region. The Chi-Square ( X 2 ) statistic was used to examine the independence of the variables by race, while the binomial regression model was used to predict racial risk differentials in hospitalization and ICU admissions. Results The pediatric COVID-19 data observed the cumulative incidence of hospitalization to be 96,376, while ICU admission was 12,448. Racial differences were observed in hospitalization, ICU admissions, sex, and region. With respect to COVID-19 hospitalization, Black/African American (AA) children were two times as likely to be hospitalized compared to their White counterparts, prevalence risk ratio ( pRR ) = 2.20, 99% confidence interval ( CI = 2.12–2.28). Similarly, Asians were 45% more likely to be hospitalized relative to their White counterparts, pRR = 1.45, 99% CI = 1.32–1.60. Regarding ICU admission, there was a disproportionate racial burden, implying excess ICU admission among Black/AA children relative to their White counterparts, pRR = 5.18, 99% CI = 4.44–6.04. Likewise, Asian children were 3 times as likely to be admitted to the ICU compared to their White counterparts, pRR = 3.36, 99% CI = 2.37–4.77. Additionally, American Indians/Alaska Natives were 2 times as likely to be admitted to ICU, pRR = 2.54, 99% CI = 0.82–7.85. Conclusion Racial disparities were observed in COVID-19 hospitalization and ICU admission among the US children, with Black/AA children being disproportionately affected, implying health equity transformation.

Effect Modification of Racial Differences in Pediatric COVID-19 Inpatient Admissions in a Large Healthcare Database

“…Racial disparities in COVID-19 rates, severity and COVID-19-related mortality rates have been observed throughout the pandemic. 5,6,26,27 Substantial disparities in COVID-19 incidence occurred among minoritized groups early in the pandemic. 28 Factors such as residence in areas of high COVID-19 incidence, disproportionate representation in essential work settings, and crowded housing likely contribute to higher risk for COVID-19 exposure among members of racial and ethnic minority groups.…”

“…COVID-19-related hospitalization rates are higher for Hispanic children and non-Hispanic Black children compared with non-Hispanic White children in the US [4][5][6][7][8] ; however, the magnitude of racial disparities has varied across studies at different times throughout the pandemic and across the geographic locations. Few studies have examined specific factors that might explain this variation.…”