COVID-19 Data Reveals Pediatric Racial and Ethnic Disparities

August 05, 2020 - An analysis of COVID-19 data showed that infection rates are higher among minority and socioeconomically disadvantaged children, indicating that racial and ethnic disparities persist even in pediatric populations, a study published in Pediatrics revealed.

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COVID-19 has infected more than 4.5 million Americans, including tens of thousands of children, researchers noted. Throughout the pandemic, studies have highlighted significant disparities in the rates of infection in the US, with minority and underserved populations bearing significantly higher burdens of infection.

A recent study from the Commonwealth Fund showed that COVID-19 is more prevalent among black and Hispanic populations, highlighting major gaps in care that have unfortunately existed long before the pandemic.

However, so far it has been unclear whether disparities in COVID-19 infection rates extend to children.

Researchers at Children’s National Hospital examined data collected between March 21, 2020 and April 28, 2020 from a COVID-19 testing site affiliated with Children’s National. In order to access this free testing site, patients had to meet specific criteria: mild symptoms and either known exposure, high-risk status, family member with high-risk status, or required testing for work.

Physicians referred patients to the site through an online portal that collected basic demographic information, reported symptoms, and the reason for referral.

When researchers analyzed the data from the first 1,000 patients tested at this site, they found that infection rates differed significantly among different racial and ethnic groups. While only about seven percent of non-Hispanic white children tested positive for COVID-19, about 30 percent of non-Hispanic black and 46 percent of Hispanic children were positive.

"You're going from about one in ten non-Hispanic white children to one in three non-Hispanic Black children and one in two Hispanic children. It's striking," said Monika Goyal, MD, MSCE, a pediatric emergency medicine specialist and associate division chief in the Division of Emergency Medicine at Children's National. 

The team then used data from the American Families Survey, which uses five-year census estimates derived from home address to estimate median family income, and separated the group of 1,000 patients into estimated family income quartiles. They found marked disparities in COVID-19 positivity rates by income levels: while those in the highest quartile had infection rates of about nine percent, those in the lowest quartile had infection rates of about 38 percent.

Researchers uncovered disparities in exposure rates as well. Of the ten percent of patients who reported known exposure to COVID-19, about 11 percent of those were non-Hispanic white, but non-Hispanic black children were triple this number.

Researchers are now trying to understand why these disparities are occurring, and how they can mitigate the impact of these gaps in COVID-19 care.

"Some possible reasons may be socioeconomic factors that increase exposure, differences in access to healthcare and resources, as well as structural racism," said Goyal.

Going forward, research should aim to uncover the reasons behind these disparities to improve outcomes for COVID-19 and other conditions.

“Future research should confirm and extend this work by focusing on the modifiable reasons for these observed disparities as well as their differential impact in terms of SARS-CoV-2-related morbidity and mortality outcomes to mitigate the spread of infection and its health effects,” the research team concluded.

Children’s National is working to address the factors that might increase risk for COVID-19 infection and poor outcomes by helping to meet unmet needs, like food or housing insecurity, and offer patients resources when they receive their test results.

“As clinicians and researchers at Children's National, we pride ourselves on not only being a top-tier research institution that provides cutting-edge care to children, but by being a hospital that cares about the community we serve," said Denice Cora-Bramble, MD, MBA, chief medical officer of Ambulatory and Community Health Services at Children's National and the research study's senior author.

"There's still so much work to be done to achieve health equity for children."