Research Examines Which Children Were Most Severely Sickened by COVID-19 and Finds Vaccinations Were Significantly Protective

Health disparities along racial, geographic lines increased risks of those most likely to become severely ill or die, according to abstract presented during national conference.

ANAHEIM, CA-Children with a pre-existing illness were at highest risk of severe illness or death due to a COVID-19 infection, but those who were vaccinated had a significantly higher level of protection, according to research presented during the 2022 American Academy of Pediatrics National Conference & Exhibition.

The abstract, “Identifying Risk Factors for Severe Clinical Outcomes in Pediatric COVID-19 Patients In a National Electronic Health Record Repository,” examined the effect of vaccination, clinical and demographic factors on severe outcomes in children with COVID-19­ from March 12, 2020, through January 20, 2022.

“Using a large-scale, national electronic health record pipeline allowed us to explore the associations between risk factors and worse outcomes in children with greater statistical power,” said author Lyndie Ho, a medical student at the University of Texas Southwestern Medical Center.

“Our study found that the national disease burden of COVID-19 in children is unequally distributed, with worse outcomes in children with pre-existing illnesses and along racial and geographic lines. Given the variance in child vaccination rates in the United States, we hope our research can inform outreach and other efforts to increase vaccination rates in children and adolescents, particularly in vulnerable regions and populations.”

The research found that, across all age groups, presence of pre-existing illness and residence in the Census-defined South region were most often associated with severe outcomes (including hospitalization, ICU admission, use of inpatient respiratory support, and death). In eligible age groups, vaccination was significantly associated with less severe outcomes. Infants had more severe illness than older children, the author found.

The research revealed persistent health disparities across racial and geographic lines throughout the pandemic. The study shows that infancy, African-American race, Asian race, Hispanic ethnicity, and preexisting illnesses are significantly associated with worse outcomes in children with COVID-19 nationally.

Ms. Ho is scheduled to present an abstract of the study, available below, at 4 p.m. PT Sunday, Oct. 9, as part of the Council on Clinical Information Technology Session at Anaheim Convention Center, 264A.

To request an interview with the author, journalists may contact UTSW Media Relations at news@utsouthwestern.edu or 214-648-3404.

In addition, Ms. Ho will be among highlighted abstract authors who will give brief presentations and be available for interviews during a press conference from 8:30 a.m.- 10 a.m. PT Sunday, Oct. 9 in the National Press Conference Room, 213 AB. During the meeting, you may reach AAP media relations staff in the Press Room.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

ABSTRACT

Program Name: 2022 AAP National Conference & Exhibition

Abstract Title: Identifying Risk Factors for Severe Clinical Outcomes in Pediatric COVID-19 Patients In a National Electronic Health Record Repository

Milan Ho, Zachary M. Most, MD, MSc, Marlon Diaz, Sameh N. Saleh, MD, Madison Pickering, MS, Trish M. Perl, MD, MSc, Christoph U. Lehmann, MD, Richard J. Medford, MD, Robert W. Turer, MD, MSE, MSACI

Dallas, TX, United States

Over 12.8 million pediatric COVID-19 cases have been reported in the US, representing 19.0% of all cases. However, inconsistent reporting of severity outcomes in children clouds the impact of COVID-19 on children in the US and child vaccination rates vary widely across states. Hence, we used a national electronic health record data pipeline to assess the effect of vaccination, clinical and demographic factors on severe outcomes in children with COVID-19¬.

This retrospective observational study examined clinical, demographic factors, and vaccination on COVID-19 outcomes among children less than 18 years using the Optum® COVID-19 low-latency data pipeline (Optum Inc, Eden Prairie, MN). We included patients who tested positive by polymerase chain reaction or antigen from March 12, 2020 through January 20, 2022. Our primary outcome was illness severity (non-hospitalization, hospitalization, ICU or worse). We performed multivariable logistic regression (R version 4.1.2; α = 0.05) accounting for age, BMI, validated pediatric comorbidity index (PCI) score indicating pre-test comorbidities, race and ethnicity, gender, region, and predominant COVID-19 variant at time of diagnosis for the patient's geographic region. Three models were developed bucketing children by age (0-2, 3-10, and 11-18 years) because of clinical differences between ages, data set coding limitations, and vaccine eligibility (BMI excluded for 0-2 years, vaccination status included for 11-18 years).

Among pediatric patients, 218,759 (18.7%) tested positive for COVID-19. 8,717 (4.0%) were hospitalized, required ICU care or ventilation, or died. By far, the strongest predictors of severe outcome in all groups were from higher PCI scores (representing pre-COVID-19 comorbidities, ORs 2.27 [2.02-2.56], 4.21 [3.62-4.91], 5.33 [4.75-5.97]) or from residency in the US South region (ORs for the Midwest compared to the South: 0.28 [0.24-0.32], 0.18 [0.16-0.21], 0.18 [1.70-0.20]) . In all groups, "unknown insurance status", Alpha variant, and Black race were statistically significant and borderline clinically significant predictors of severe outcome (p< 0.0001). Of note, the odds ratio of severe disease comparing at least one vaccination to no known vaccination is 0.55 (0.48 - 0.63) in the vaccine-eligible cohort. Odds ratios for all models are depicted in Figure 1. Individual feature contributions to each model via Wald score minus df are depicted in Figure 2, where increased Wald score minus df indicates increased significance of the parameter to predict severe outcomes.

Pre-existing illness was the strongest independent predictor of severe COVID-19 outcomes among pediatric patients, and vaccination was significantly protective. Use of a large-scale, national data pipeline allowed for up-to-date, centralized assessment of outcomes across a diverse patient population, revealing persistent health disparities across racial and geographic lines throughout the pandemic. Our study demonstrates that many easily assessed parameters can reliably predict adverse outcomes in pediatric COVID-19, indicating populations in need of outreach for vaccination and other preventative efforts.

Figure 1: Odds ratios for clinically severe outcomes

Odds ratios for predictors of clinically severe outcomes in models for 0-2, 3-10, and 11-18 year olds, 95% CI. Dotted line indicates OR of 1.

Figure 2: Wald χ2 tests and P values

Wald χ2 tests and P values for each predictor in models for 0-2, 3-10, and 11-18 year olds. Increased Wald score minus df indicates increased significance of the parameter to predict severe outcomes