Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children

Abstract

Importance: Information on underlying conditions and severe COVID-19 illness among children is limited.

Objective: To examine the risk of severe COVID-19 illness among children associated with underlying medical conditions and medical complexity.

Design, setting, and participants: This cross-sectional study included patients aged 18 years and younger with International Statistical Classification of Diseases, Tenth Revision, Clinical Modification code U07.1 (COVID-19) or B97.29 (other coronavirus) during an emergency department or inpatient encounter from March 2020 through January 2021. Data were collected from the Premier Healthcare Database Special COVID-19 Release, which included data from more than 800 US hospitals. Multivariable generalized linear models, controlling for patient and hospital characteristics, were used to estimate adjusted risk of severe COVID-19 illness associated with underlying medical conditions and medical complexity.

Exposures: Underlying medical conditions and medical complexity (ie, presence of complex or noncomplex chronic disease).

Main outcomes and measures: Hospitalization and severe illness when hospitalized (ie, combined outcome of intensive care unit admission, invasive mechanical ventilation, or death).

Results: Among 43 465 patients with COVID-19 aged 18 years or younger, the median (interquartile range) age was 12 (4-16) years, 22 943 (52.8%) were female patients, and 12 491 (28.7%) had underlying medical conditions. The most common diagnosed conditions were asthma (4416 [10.2%]), neurodevelopmental disorders (1690 [3.9%]), anxiety and fear-related disorders (1374 [3.2%]), depressive disorders (1209 [2.8%]), and obesity (1071 [2.5%]). The strongest risk factors for hospitalization were type 1 diabetes (adjusted risk ratio [aRR], 4.60; 95% CI, 3.91-5.42) and obesity (aRR, 3.07; 95% CI, 2.66-3.54), and the strongest risk factors for severe COVID-19 illness were type 1 diabetes (aRR, 2.38; 95% CI, 2.06-2.76) and cardiac and circulatory congenital anomalies (aRR, 1.72; 95% CI, 1.48-1.99). Prematurity was a risk factor for severe COVID-19 illness among children younger than 2 years (aRR, 1.83; 95% CI, 1.47-2.29). Chronic and complex chronic disease were risk factors for hospitalization, with aRRs of 2.91 (95% CI, 2.63-3.23) and 7.86 (95% CI, 6.91-8.95), respectively, as well as for severe COVID-19 illness, with aRRs of 1.95 (95% CI, 1.69-2.26) and 2.86 (95% CI, 2.47-3.32), respectively.

Conclusions and relevance: This cross-sectional study found a higher risk of severe COVID-19 illness among children with medical complexity and certain underlying conditions, such as type 1 diabetes, cardiac and circulatory congenital anomalies, and obesity. Health care practitioners could consider the potential need for close observation and cautious clinical management of children with these conditions and COVID-19.

Figure 1.. Association Between Underlying Medical Conditions and Risk of Hospitalization or Severe Illness When Hospitalized in the Sample

Underlying medical conditions were defined as described n the Methods section. The sample was defined as children aged 18 years or younger with a COVID-19 diagnosis during an emergency department or inpatient encounter in hospitals that reported both emergency department and inpatient encounters to Premier Healthcare Database Special COVID-19 Release, March 2020 through January 2021. Each panel represents results of a single generalized linear model with Poisson distribution and log link function, that includes the following covariates: frequent (ie, prevalence >0.7%) underlying medical conditions, age group, sex, race/ethnicity, payer type, hospital urbanicity, hospital US Census region, admission month, and admission month squared. The reference group for each underlying condition was absence of that condition; the reference group for type 1 and type 2 diabetes was no diabetes.

Figure 2.. Association Between Medical Complexity and Risk of Hospitalization or Severe Illness When Hospitalized in the Sample

Medical complexity was defined by the Pediatric Medical Complexity Algorithm. The sample was defined as children aged 18 years or younger with a COVID-19 diagnosis during an emergency department or inpatient encounter in hospitals that reported both emergency department and inpatient encounters to Premier Healthcare Database Special COVID-19 Release, March 2020 through January 2021. Each panel represents results of a single generalized linear model with Poisson distribution and log link function, that includes the following covariates: medical complexity (presence of noncomplex chronic disease, presence of complex chronic disease, and no chronic disease as reference group), age group, sex, race/ethnicity, payer type, hospital urbanicity, hospital US Census region, admission month, and admission month squared.