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

JAMA Netw Open. 2021 Jun 1;4(6):e2111182. doi: 10.1001/jamanetworkopen.2021.11182.

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.

MeSH terms

  • Adolescent
  • Adolescent Health*
  • COVID-19 / epidemiology*
  • COVID-19 / mortality
  • Cardiovascular Abnormalities / epidemiology*
  • Child
  • Child Health*
  • Child, Preschool
  • Chronic Disease
  • Comorbidity
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Intensive Care Units
  • Male
  • Obesity / epidemiology*
  • Pandemics
  • Premature Birth
  • Respiration, Artificial
  • SARS-CoV-2
  • Severity of Illness Index*
  • United States / epidemiology