Pre-COVID-19 pandemic health-related behaviours in children (2018-2020) and association with being tested for SARS-CoV-2 and testing positive for SARS-CoV-2 (2020-2021): a retrospective cohort study using survey data linked with routine health data in Wales, UK

Abstract

Objectives Examine if prior health-related behaviours during primary school are associated with being tested for SARS-CoV-2 and testing positive during adolescence. Design Retrospective cohort study using an online cohort survey (1 April 2014 to 28 February 2020) linked to routine PCR SARS-CoV-2 test results (1 March 2020 to 31 August 2021) Setting Children attending primary schools in Wales (2014-2020), UK who were part of the HAPPEN schools network. Participants Complete linked records of eligible participants were obtained for n=6,891 individuals. 43.2% (n=3,021) were tested (baseline age 12.3 ± 2.0, 48% boys) and 11.2% (n=774) tested positive for SARS-CoV-2 (baseline age 12.8 ± 2.1, 43.9% boys). Main outcome measures Logistic regression of health-related behaviours and sex, age, deprivation, clustered by school was used to determine Odds Ratios (OR) of factors associated with being tested for or testing positive for SARS-CoV-2. Results Sleeping 9+ hours (OR=1.15, 95% CI 1.01 to 1.29), participating in 3+ out of school clubs (OR=1.15, 95% CI 1.02 to 1.31), able to swim (OR=1.29, 95% CI 1.10 to 1.52) and ride a bike (OR=1.16, 95% CI 0.98 to 1.37, p<0.1) were associated with being tested for SARS-CoV-2. Participating in 3+ out of school clubs (OR=1.12, 95% CI 1.02 to 1.56), able to ride a bike (OR=1.36, 95% CI 0.97 to 1.92, p<0.1), sex (girl; OR=1.25, 95% CI 1.06 to 1.47) and baseline age (OR=1.16, 95% CI 1.10 to 1.22) were associated with an increased likelihood of testing 1.06 to 1.47 Conclusions Actions associated with a child being PCR-tested and identified as positive may be related to parental health literacy e.g. parents recognising symptoms, knowledge of testing services. Identification of adolescent positive cases may be highly skewed towards children whose parents have higher health literacy. As those not accessing testing services remain undetected true rates of COVID-19 are not known in adolescence.