Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

TY - JOUR

T1 - Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

AU - Marwali, Eva Miranda

AU - Kekalih, Aria

AU - Yuliarto, Saptadi

AU - Wati, Dyah Kanya

AU - Rayhan, Muhammad

AU - Valerie, Ivy Cerelia

AU - Cho, Hwa Jin

AU - Jassat, Waasila

AU - Blumberg, Lucille

AU - Masha, Maureen

AU - Semple, Calum

AU - Swann, Olivia V

AU - Kohns Vasconcelos, Malte

AU - Popielska, Jolanta

AU - Murthy, Srinivas

AU - Fowler, Robert A

AU - Guerguerian, Anne-Marie

AU - Streinu-Cercel, Anca

AU - Pathmanathan, Mohan Dass

AU - Rojek, Amanda

AU - Kartsonaki, Christiana

AU - Gonçalves, Bronner P

AU - Citarella, Barbara Wanjiru

AU - Merson, Laura

AU - Olliaro, Piero L

AU - Dalton, Heidi Jean

AU - ISARIC Characterization Group

AU - Kobbe, Robin

N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

PY - 2022/10

Y1 - 2022/10

N2 - BACKGROUND: The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.METHODS: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.RESULTS: A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).CONCLUSION: Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities.

AB - BACKGROUND: The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.METHODS: The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.RESULTS: A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).CONCLUSION: Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities.

KW - Adolescent

KW - Humans

KW - Child

KW - COVID-19 Testing

KW - Pandemics

KW - COVID-19/epidemiology

KW - Tuberculosis

KW - Health Resources

U2 - 10.1136/bmjpo-2022-001657

DO - 10.1136/bmjpo-2022-001657

M3 - SCORING: Journal article

C2 - 36645791

VL - 6

JO - BMJ PAEDIATR OPEN

JF - BMJ PAEDIATR OPEN

SN - 2399-9772

IS - 1

M1 - e001657

ER -