Factors Influencing US Hospital and Medical School Participation in Pediatric COVID-19 Research

Abstract

BACKGROUND AND OBJECTIVES: Literature suggests that funding for pediatric clinical trials is inequitably awarded. Furthermore, although coronavirus disease 2019 (COVID-19) affected all hospitals, institutions with already limited resources were more severely impacted. We hypothesized that there would be difference in schools and hospitals that were able to participate in the initial round of pediatric COVID-19 clinical research. METHODS: We searched online databases for preregistered studies using the keywords “COVID-19,” “COVID,” “SARS-CoV-2,” “2019-nCov,” “2019 novel coronavirus,” and “severe acute respiratory syndrome coronavirus 2.” Search results were limited to studies enrolling participants from birth to 17 years, studies started in 2020, and studies originating in the United states. We calculated the proportion of institutions with active COVID-19 pediatric clinical studies in 2020 and compared institutional characteristics between institutions with and without at least one qualifying COVID-19 study, using rank-sum tests, χ2 tests, or Fisher’s exact tests, as appropriate. RESULTS: We identified 150 allopathic medical schools, 34 osteopathic medical schools, and 178 children’s hospitals meeting inclusion criteria. Among included institutions, 25% of medical schools and 20% children’s hospitals participated in 1 of the registered pediatric COVID-19 studies the year before the study period. Institutions that participated in pediatric COVID-19 studies had more publications, more National Institutes of Health funding, and more studies registered on Clinicaltrials.gov in 2019. CONCLUSIONS: Despite the pandemic affecting everyone, participation in early clinical research on the impact of COVID-19 in pediatric populations was concentrated in a few well-resourced institutions that were highly experienced in research.

Scholarly Productivity of US Medical Schools Before and During the COVID-19 Pandemic

“…These variables included medical school type (public vs private), school location (based on US Census region), school ranking in the US News and World Report top 10, NIH funding in 2019, number of full-time faculty in 2019, faculty diversity, and the ratio of full-time faculty to total enrollment in the academic year 2019–2020. School type, location, ranking, and NIH funding data were obtained from a previous study 12 . The number of faculty and data on faculty diversity were obtained by a custom query from the AAMC Faculty Administrative Management Online User System database 13 .…”

“…Among schools in the sustained increase category, the association between each covariate and the rate of scholarly productivity growth was assessed using quantile regression. Multivariable analysis could not be used because of substantial collinearity among study variables 12 . Data analysis was completed using STATA/SE 16.1 (StataCorp, College Station, TX), and P < 0.05 was considered statistically significant.…”

“…Medical schools that could not be identified in the Scopus bibliographic database were excluded from the analysis. 12 The Scopus database was queried by affiliation in January 2022 to determine the number of publications associated with each medical school in the calendar years 2019, 2020, and 2021. The primary outcome was a categorical measure of change in publication productivity during the pandemic.…”

“…In the United States, well-resourced, research-focused medical schools may have been best positioned to lead the wave of novel COVID-19–related research while sustaining and expanding their existing research agenda. For example, a recent analysis showed that only 25% of US MD-granting medical schools participated in registered pediatric COVID-19 clinical trials, with schools in this group tending to have high levels of federal funding and publication output prepandemic 12 . Conversely, institutions with fewer resources may have had fewer opportunities to participate in COVID-19–related research and may have encountered more obstacles to maintaining faculty scholarly productivity.…”

“…For example, a recent analysis showed that only 25% of US MD-granting medical schools participated in registered pediatric COVID-19 clinical trials, with schools in this group tending to have high levels of federal funding and publication output prepandemic. 12 Conversely, institutions with fewer resources may have had fewer opportunities to participate in COVID-19-related research and may have encountered more obstacles to maintaining faculty scholarly productivity. In this study, we aimed to determine how many and which US medical schools experienced sustained growth of scholarly productivity during the pandemic, compared with transient increases in scholarly productivity or the decline in scholarly output that some commentators had anticipated.…”