Healthcare use in 700 000 children and adolescents for six months after covid-19: before and after register based cohort study

Abstract

Objectives: To explore whether and for how long use of healthcare services is increased among children and adolescents after covid-19.

Design: Before and after register based study.

Setting: General population of Norway.

Participants: Norwegians aged 1-19 years (n=706 885) who were tested for SARS-CoV-2 from 1 August 2020 to 1 February 2021 (n=10 279 positive, n=275 859 negative) or not tested (n=420 747) and were not admitted to hospital, by age groups 1-5, 6-15, and 16-19 years.

Main outcome measures: Monthly percentages of all cause and cause specific healthcare use in primary care (general practitioner, emergency ward) and specialist care (outpatient, inpatient) from six months before to about six months after the week of being tested for SARS-CoV-2, using a difference-in-differences approach.

Results: A substantial short term relative increase in primary care use was observed for participants during the first month after a positive SARS-CoV-2 test result compared with those who tested negative (age 1-5 years: 339%, 95% confidence interval 308% to 369%; 6-15 years: 471%, 450% to 491%; 16-19 years: 401%, 380% to 422%). Use of primary care for the younger age groups was still increased at two months (1-5 years: 22%, 4% to 40%; 6-15 years: 14%, 2% to 26%) and three months (1-5 years: 26%, 7% to 46%, 6-15 years: 15%, 3% to 28%), but not for the oldest group (16-19 years: 11%, -2% to 24% and 6%, -7% to 19%, respectively). Children aged 1-5 years who tested positive also showed a minor long term (≤6 months) relative increase in primary care use (13%, -0% to 26%) that was not observed for the older age groups, compared with same aged children who tested negative. Results were similar yet the age differences less pronounced compared with untested controls. For all age groups, the increase in primary care visits was due to respiratory and general or unspecified conditions. No increased use of specialist care was observed.

Conclusion: Covid-19 among children and adolescents was found to have limited impact on healthcare services in Norway. Preschool aged children might take longer to recover (3-6 months) than primary or secondary school students (1-3 months), usually because of respiratory conditions.

Fig 1

Percentage of population (n=1 288 232) tested for SARS-CoV-2 using polymerase chain reaction, August to December 2020 and January 2021, and percentage testing positive each month, by age group

Fig 2

Estimated percentages (95% confidence intervals) of young people using primary or specialist care (inpatient and outpatient) per week, from six months before to about six months after the week of a polymerase chain reaction test for SARS-CoV-2 for those who tested positive, tested negative, and were untested controls, by age groups. Estimates adjusted for age, sex, comorbidities, country of birth, and calendar month. The dip for specialist care around the test week is a mechanical result owing to the exclusion of participants who were admitted to hospital with covid-19 in the test week and two subsequent weeks. Estimates beyond 24 weeks include observations from weeks 25-36 for some individuals (both numerator and denominator)

Fig 3

Reasons for primary care visits from first week after being tested for SARS-CoV-2 for participants who tested positive, tested negative, and were untested controls with a hypothetical test week, by age group

Fig 4

Reasons for specialist care visits from first week after being tested for SARS-CoV-2 for participants who tested positive, tested negative, and were untested controls with a hypothetical test week, by age group