COVID-19 rates higher among minority, socioeconomically disadvantaged children
Minority and socioeconomically disadvantagedchildren have significantly higher rates of COVID-19 infection, a new study led byChildren's National Hospital researchers shows. These findings, reported online August5 in Pediatrics, parallel similar health disparities for the novel coronavirus that have beenfound in adults, the authors state.
COVID-19, an infection caused by the novel coronavirus SARS-CoV-2 that emerged inlate 2019, has infected more than 4.5 million Americans, including tens of thousands ofchildren. Early in the pandemic, studies highlighted significant disparities in the rates ofinfection in the U.S., with minorities and socioeconomically disadvantaged adults bearingmuch higher burdens of infection. However, says Monika Goyal, M.D., M.S.C.E, apediatric emergency medicine specialist and associate division chief in the Division ofEmergency Medicine at Children's National whose research focuses on healthdisparities, it's been unclear whether these disproportionate rates of infection alsoextend to youth.
To investigate this question, she and her colleagues looked to data collected betweenMarch 21, 2020, and April 28, 2020, from a drive-through/walk-up COVID-19 testing siteaffiliated with Children's National—one of the first exclusively pediatric testing sites forthe virus in the U.S. To access this free testing site, funded by philanthropic support,patients between the ages of 0 and 22 years needed to meet specific criteria: mildsymptoms and either known exposure, high-risk status, family member with high-riskstatus or required testing for work. Physicians referred patients through an online portalthat collected basic demographic information, reported symptoms and the reason forreferral.
When Dr. Goyal and her colleagues analyzed the data from the first 1,000 patientstested at this site, they found that infection rates differed dramatically among differentracial and ethnic groups. While about 7% of non-Hispanic white children were positivefor COVID-19, about 30% of non-Hispanic Black and 46% of Hispanic children werepositive.
"You're going from about one in 10 non-Hispanic white children to one in three nonHispanic Black children and one in two Hispanic children. It's striking," says Dr. Goyal.Using data from the American Families Survey, which uses five-year census estimatesderived from home address to estimate median family income, the researchersseparated the group of 1,000 patients into estimated family income quartiles. They foundmarked disparities in COVID-19 positivity rates by income levels: while those in thehighest quartile had infection rates of about 9%, about 38% of those in the lowestquartile were infected.
There were additional disparities in exposure status, Dr. Goyal adds. Of the 10% ofpatients who reported known exposure to COVID-19, about 11% of these were nonHispanic white. However, non-Hispanic Black children were triple this number.
Although these numbers show clear disparities in COVID-19 infection rates, the authorsare now trying to understand why these disparities occur and how they can be mitigated.
"Some possible reasons may be socioeconomic factors that increase exposure,differences in access to health care and resources, as well as structural racism," saysDr. Goyal.
She adds that Children's National is working to address those factors that might increaserisk for COVID-19 infection and poor outcomes by helping to identify unmet needs —such as food and/or housing insecurity—and steer patients toward resources whenpatients receive their test results.
"As clinicians and researchers at Children's National, we pride ourselves on not onlybeing a top-tier research institution that provides cutting-edge care to children, but bybeing a hospital that cares about the community we serve," says Denice Cora-Bramble, M.D., M.B.A., chief medical officer of Ambulatory and Community Health Services atChildren's National and the research study's senior author. "There's still so much work tobe done to achieve health equity for children."
Other Children's National researchers who contributed to this study include Joelle N. Simpson, M.D.; Meleah D. Boyle, M.P.H, Gia M. Badolato, M.P.H; Meghan Delaney, D.O,. M.P.H.; and Robert McCarter Jr., Sc.D.