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. 2023 Aug 1;6(8):e2330495.
doi: 10.1001/jamanetworkopen.2023.30495.

Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States

Kaja Z LeWinn  1 , Leonardo Trasande  2   3 , Andrew Law  4 , Courtney K Blackwell  5 , Traci A Bekelman  6 , Jessica A Arizaga  1 , Alexis A Sullivan  1 , Theresa M Bastain  7 , Carrie V Breton  7 , Margaret R Karagas  8 , Amy J Elliott  9 , Catherine J Karr  10 , Kecia N Carroll  11 , Anne L Dunlop  12 , Lisa A Croen  13 , Amy E Margolis  14 , Akram N Alshawabkeh  15 , Jose F Cordero  16 , Anne Marie Singh  17 , Christine M Seroogy  17 , Daniel J Jackson  17 , Robert A Wood  18 , Tina V Hartert  19 , Young Shin Kim  1 , Cristiane S Duarte  14 , Julie B Schweitzer  20   21 , Barry M Lester  22 , Cynthia T McEvoy  23 , Thomas G O'Connor  24 , Emily Oken  25 , Nicole Bornkamp  25 , Eric D Brown Jr  26 , Christina A Porucznik  27 , Assiamira Ferrara  13 , Carlos A Camargo Jr  28 , Qi Zhao  29 , Jody M Ganiban  30 , Lisa P Jacobson  4 ; Environmental influences on Child Health Outcomes Consortium
Collaborators, Affiliations

Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States

Kaja Z LeWinn et al. JAMA Netw Open. .

Abstract

Importance: Few population-based studies in the US collected individual-level data from families during the COVID-19 pandemic.

Objective: To examine differences in COVID-19 pandemic-related experiences in a large sociodemographically diverse sample of children and caregivers.

Design, setting, and participants: The Environmental influences on Child Health Outcomes (ECHO) multi-cohort consortium is an ongoing study that brings together 64 individual cohorts with participants (24 757 children and 31 700 caregivers in this study) in all 50 US states and Puerto Rico. Participants who completed the ECHO COVID-19 survey between April 2020 and March 2022 were included in this cross-sectional analysis. Data were analyzed from July 2021 to September 2022.

Main outcomes and measures: Exposures of interest were caregiver education level, child life stage (infant, preschool, middle childhood, and adolescent), and urban or rural (population <50 000) residence. Dependent variables included COVID-19 infection status and testing; disruptions to school, child care, and health care; financial hardships; and remote work. Outcomes were examined separately in logistic regression models mutually adjusted for exposures of interest and race, ethnicity, US Census division, sex, and survey administration date.

Results: Analyses included 14 646 children (mean [SD] age, 7.1 [4.4] years; 7120 [49%] female) and 13 644 caregivers (mean [SD] age, 37.6 [7.2] years; 13 381 [98%] female). Caregivers were racially (3% Asian; 16% Black; 12% multiple race; 63% White) and ethnically (19% Hispanic) diverse and comparable with the US population. Less than high school education (vs master's degree or more) was associated with more challenges accessing COVID-19 tests (adjusted odds ratio [aOR], 1.88; 95% CI, 1.06-1.58), lower odds of working remotely (aOR, 0.04; 95% CI, 0.03-0.07), and more food access concerns (aOR, 4.14; 95% CI, 3.20-5.36). Compared with other age groups, young children (age 1 to 5 years) were least likely to receive support from schools during school closures, and their caregivers were most likely to have challenges arranging childcare and concerns about work impacts. Rural caregivers were less likely to rank health concerns (aOR, 0.77; 95% CI, 0.69-0.86) and social distancing (aOR, 0.82; 95% CI, 0.73-0.91) as top stressors compared with urban caregivers.

Conclusions: Findings in this cohort study of US families highlighted pandemic-related burdens faced by families with lower socioeconomic status and young children. Populations more vulnerable to public health crises should be prioritized in recovery efforts and future planning.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs LeWinn, Law, Blackwell, Bekelman, Bastain, Breton, Elliott, Carroll, Dunlop, Margolis, Alshawabkeh, Cordero, Singh, Seroogy, Schweitzer, McEvoy, Oken, Porucznik, Ganiban, and Jacobson reported grants from the National Institutes of Health during the conduct of the study. Dr Margolis reported grants from the National Institute of Environmental Health Sciences and the Eunice Kennedy Shriver National Institute of Child Health and Human Development outside the submitted work. Dr Cordero reported personal fees from Sanofi Pasteur and Takeda outside the submitted work. Dr Singh reported grants from the United States Department of Agriculture and personal fees from Incyte (advisory board) and Genentech (advisory board) outside the submitted work. Dr Seroogy reported personal fees from UpToDate (royalties), Chiesi (medical advisory board meeting), and Enzyvant (medical advisory board meeting) outside the submitted work. Dr Jackson reported grants from Regeneron and GSK and personal fees from AstraZeneca, Avillion, Areteia, and Pfizer (data safety monitoring board) outside the submitted work. Dr Wood reported grants from Aimmune, ALK, Novartis, Genentech, Siolta, Food Allergy and Anaphylaxis Emergency Care Plan, DBV Technologies, and Regeneron and royalties from UpToDate outside the submitted work. Dr Hartert reported personal fees from Pfizer (data safety monitoring board member) outside the submitted work. Dr Porucznik reported personal fees from MCKesson Corporation outside the submitted work and serving as the public member on the Board of Directors for the International Board of Lactation Consultant Examiners. No other disclosures were reported.

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