Clinical Features and Outcomes of Pediatric and Adult Patients Hospitalized for Coronavirus Disease 2019: A Comparison Across Age Strata

Abstract

Background: Coronavirus disease 2019 (COVID-19) continues to cause hospitalizations and severe disease in children and adults.

Methods: This study compared the risk factors, symptoms, and outcomes of children and adults hospitalized for COVID-19 from March 2020 to May 2023 across age strata at 5 US sites participating in the Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence consortium. Eligible patients had an upper respiratory swab that tested positive for severe acute respiratory syndrome coronavirus 2 by nucleic acid amplification. Adjusted odds ratios (aOR) of clinical outcomes were determined for children versus adults, for pediatric age strata compared to adolescents (12-17 years), and for adult age strata compared to young adults (22-49 years).

Results: Of 9101 patients in the Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence cohort, 1560 were hospitalized for COVID-19 as the primary reason. Compared to adults (22-105 years, n = 675), children (0-21 years, n = 885) were less commonly vaccinated (14.3% vs 34.5%), more commonly infected with the Omicron variant (49.5% vs 26.1%) and had fewer comorbidities (P < .001 for most comparisons), except for lung disease (P = .24). After adjusting for confounding variables, children had significantly lower odds of receiving supplemental oxygen (aOR, 0.57; 95% confidence interval, .35-.92) and death (aOR, 0.011; 95% confidence interval, <.01-.58) compa--red to adults. Among pediatric age strata, adolescents 12-17 years had the highest odds of receiving supplemental oxygen, high-flow oxygen, and ICU admission. Among adults, those 50-64 years had the highest odds of mechanical ventilation and ICU admission.

Conclusions: Clinical outcomes of COVID-19 differed across pediatric and adult age strata. Adolescents experienced the most severe disease among children, whereas adults 50-64 years experienced the most severe disease among adults.

Keywords: SARS-CoV-2; adults; children; coronavirus; coronavirus disease 2019.

Figure 1.

Adjusted odds ratios (aOR) with 95% confidence intervals (CI) of severe outcomes* among (A) children and (B) adults hospitalized for COVID-19. Multivariate logistic regression analysis was performed to determine odds ratios adjusting for age, sex, race, Latinx ethnicity, vaccination status (yes/no), SARS-CoV-2 variant, co-infection (yes/no), and study site. Adjusted odds ratios are presented for each pediatric age stratum compared to children aged 12–17 y (n = 224, reference), and for each adult age stratum compared to adults aged 22–49 y (n = 185, reference). *The adjusted odds of death was not estimable because of low quantities of this outcome among the age strata. Bolded numbers denote statistical significance.