Minority and socioeconomically disadvantaged
children have significantly higher rates of COVID-19 infection, a new study led by
Children's National Hospital researchers shows. These findings, reported online August
5 in Pediatrics, parallel similar health disparities for the novel coronavirus that have been
found in adults, the authors state.
COVID-19, an infection caused by the novel coronavirus SARS-CoV-2 that emerged in
late 2019, has infected more than 4.5 million Americans, including tens of thousands of
children. Early in the pandemic, studies highlighted significant disparities in the rates of
infection in the U.S., with minorities and socioeconomically disadvantaged adults bearing
much higher burdens of infection. However, says Monika Goyal, M.D., M.S.C.E, a
pediatric emergency medicine specialist and associate division chief in the Division of
Emergency Medicine at Children's National whose research focuses on health
disparities, it's been unclear whether these disproportionate rates of infection also
extend to youth.
To investigate this question, she and her colleagues looked to data collected between
March 21, 2020, and April 28, 2020, from a drive-through/walk-up COVID-19 testing site
affiliated with Children's National -- one of the first exclusively pediatric testing sites for
the 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: mild
symptoms and either known exposure, high-risk status, family member with high-risk
status or required testing for work. Physicians referred patients through an online portal
that collected basic demographic information, reported symptoms and the reason for
referral.
When Dr. Goyal and her colleagues analyzed the data from the first 1,000 patients
tested at this site, they found that infection rates differed dramatically among different
racial and ethnic groups. While about 7% of non-Hispanic white children were positive
for COVID-19, about 30% of non-Hispanic Black and 46% of Hispanic children were
positive.
"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 estimates
derived from home address to estimate median family income, the researchers
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 9%, about 38% of those in the lowest
quartile were infected.
There were additional disparities in exposure status, Dr. Goyal adds. Of the 10% of
patients 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 authors
are 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," says
Dr. Goyal.
She adds that Children's National is working to address those factors that might increase
risk 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 when
patients 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," says Denice Cora-Bramble, M.D., M.B.A., 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."
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.