Rebecca C Woodruff1,2, Angela P Campbell1, Christopher A Taylor1, Shua J Chai2,3,4, Breanna Kawasaki5, James Meek6, Evan J Anderson7,8,9, Andy Weigel10, Maya L Monroe11, Libby Reeg12, Erica Bye13, Daniel M Sosin14,15, Alison Muse16, Nancy M Bennett17, Laurie M Billing18, Melissa Sutton19, H Keipp Talbot20, Keegan McCaffrey21, Huong Pham1, Kadam Patel1,22, Michael Whitaker1, Meredith L McMorrow1,2, Fiona P Havers1,2. 1. CDC COVID-19 Response Team. 2. US Public Health Service Commissioned Corps, Rockville, Maryland. 3. Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia. 4. California Emerging Infections Program, Oakland, California. 5. Colorado Department of Public Health and Environment, Denver, Colorado. 6. Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut. 7. Departments of Medicine and Pediatrics, Emory School of Medicine, Atlanta, Georgia. 8. Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia. 9. Atlanta Veterans Affairs Medical Center, Atlanta, Georgia. 10. Iowa Department of Public Health, Des Moines, Iowa. 11. Maryland Department of Health, Baltimore, Maryland. 12. Michigan Department of Health and Human Services, Lansing, Michigan. 13. Minnesota Department of Health, St Paul, Minnesota. 14. New Mexico Emerging Infections Program, Santa Fe, New Mexico. 15. New Mexico Department of Health, Santa Fe, New Mexico. 16. New York State Department of Health, Albany, New York. 17. University of Rochester School of Medicine and Dentistry, Rochester, New York. 18. Ohio Department of Health, Columbus, Ohio. 19. Public Health Division, Oregon Health Authority, Portland, Oregon. 20. Vanderbilt University Medical Center, Nashville, Tennesee. 21. Utah Department of Health, Salt Lake City, Utah. 22. General Dynamics Information Technology, Atlanta, Georgia.
Abstract
OBJECTIVES: Describe population-based rates and risk factors for severe coronavirus disease 2019 (COVID-19) (ie, ICU admission, invasive mechanical ventilation, or death) among hospitalized children. METHODS: During March 2020 to May 2021, the COVID-19-Associated Hospitalization Surveillance Network identified 3106 children hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection in 14 states. Among 2293 children primarily admitted for COVID-19, multivariable generalized estimating equations generated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of the associations between demographic and medical characteristics abstracted from medical records and severe COVID-19. We calculated age-adjusted cumulative population-based rates of severe COVID-19 among all children. RESULTS: Approximately 30% of hospitalized children had severe COVID-19; 0.5% died during hospitalization. Among hospitalized children aged <2 years, chronic lung disease (aRR: 2.2; 95% CI: 1.1-4.3), neurologic disorders (aRR: 2.0; 95% CI: 1.5‒2.6), cardiovascular disease (aRR: 1.7; 95% CI: 1.2‒2.3), prematurity (aRR: 1.6; 95% CI: 1.1‒2.2), and airway abnormality (aRR: 1.6; 95% CI: 1.1‒2.2) were associated with severe COVID-19. Among hospitalized children aged 2 to 17 years, feeding tube dependence (aRR: 2.0; 95% CI: 1.5‒2.5), diabetes mellitus (aRR: 1.9; 95% CI: 1.6‒2.3) and obesity (aRR: 1.2; 95% CI: 1.0‒1.4) were associated with severe COVID-19. Severe COVID-19 occurred among 12.0 per 100 000 children overall and was highest among infants, Hispanic children, and non-Hispanic Black children. CONCLUSIONS: Results identify children at potentially higher risk of severe COVID-19 who may benefit from prevention efforts, including vaccination. Rates establish a baseline for monitoring changes in pediatric illness severity after increased availability of COVID-19 vaccines and the emergence of new variants.
OBJECTIVES: Describe population-based rates and risk factors for severe coronavirus disease 2019 (COVID-19) (ie, ICU admission, invasive mechanical ventilation, or death) among hospitalized children. METHODS: During March 2020 to May 2021, the COVID-19-Associated Hospitalization Surveillance Network identified 3106 children hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection in 14 states. Among 2293 children primarily admitted for COVID-19, multivariable generalized estimating equations generated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of the associations between demographic and medical characteristics abstracted from medical records and severe COVID-19. We calculated age-adjusted cumulative population-based rates of severe COVID-19 among all children. RESULTS: Approximately 30% of hospitalized children had severe COVID-19; 0.5% died during hospitalization. Among hospitalized children aged <2 years, chronic lung disease (aRR: 2.2; 95% CI: 1.1-4.3), neurologic disorders (aRR: 2.0; 95% CI: 1.5‒2.6), cardiovascular disease (aRR: 1.7; 95% CI: 1.2‒2.3), prematurity (aRR: 1.6; 95% CI: 1.1‒2.2), and airway abnormality (aRR: 1.6; 95% CI: 1.1‒2.2) were associated with severe COVID-19. Among hospitalized children aged 2 to 17 years, feeding tube dependence (aRR: 2.0; 95% CI: 1.5‒2.5), diabetes mellitus (aRR: 1.9; 95% CI: 1.6‒2.3) and obesity (aRR: 1.2; 95% CI: 1.0‒1.4) were associated with severe COVID-19. Severe COVID-19 occurred among 12.0 per 100 000 children overall and was highest among infants, Hispanic children, and non-Hispanic Black children. CONCLUSIONS: Results identify children at potentially higher risk of severe COVID-19 who may benefit from prevention efforts, including vaccination. Rates establish a baseline for monitoring changes in pediatric illness severity after increased availability of COVID-19 vaccines and the emergence of new variants.
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