O'Neill Liam, Chumbler Neale R
Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA.
Department of Diagnostic and Health Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN, USA.
Health Serv Res Manag Epidemiol. 2022 Jun 9;9:23333928221104677. doi: 10.1177/23333928221104677. eCollection 2022 Jan-Dec.
With the recent emergence of the Omicron variant, there has been a rapid and alarming increase in the number of COVID-19 cases among pediatric populations. Yet few US pediatric cohort studies have characterized the clinical features of children with severe COVID-19. The objective of this study was to identify those chronic comorbidities that increase the risk of hospitalization for pediatric populations with severe COVID-19.
A retrospective cohort study that utilized the Texas Inpatient Public Use Data file was conducted. The study included 1187 patients (ages 5 to 19) from 164 acute-care Texas hospitals with the primary or secondary ICD-10CM diagnosis code U07.1 (COVID-19, virus identified). The baseline comparison group included 38 838 pediatric patients who were hospitalized in 2020. Multivariable binary logistic regression, controlling for patient characteristics, sociodemographic factors, and health insurance, was used to estimate the adjusted risk of hospitalization for COVID-19.
Obesity and type 1 diabetes increased the risk of hospitalization with COVID-19 among both children (5-12 years) and adolescents (13-19 years). Adolescents with morbid obesity were 10 times more likely to have severe COVID-19 (p < 0.001). Regardless of age, single-parent households (%) for the patient's zip code was associated with an increased risk of hospitalization with COVID-19 (AOR = 1.02, CI: 1.01-1.03, p < 0.01). Other risk factors included chronic kidney disease (p < 0.05), male gender (p < 0.001), Medicaid (p < 0.001), and charity care (p < 0.001).
Pediatric providers and public health officials should consider the need to tailor clinical management and mitigation efforts for pediatric populations with identifiable risk factors for severe COVID-19. These findings can be used to improve risk communication with families of children with underlying medical conditions and to prioritize prevention measures, including vaccinations.
随着奥密克戎变异株的近期出现，儿科人群中新冠病毒病（COVID-19）病例数迅速且惊人地增加。然而，美国很少有儿科队列研究描述重症COVID-19患儿的临床特征。本研究的目的是确定那些会增加重症COVID-19儿科人群住院风险的慢性合并症。
进行了一项回顾性队列研究，利用德克萨斯州住院患者公共使用数据文件。该研究纳入了来自德克萨斯州164家急性护理医院的1187名患者（5至19岁），其主要或次要国际疾病分类第十次修订本临床修正版（ICD-10CM）诊断代码为U07.1（COVID-19，病毒已识别）。基线比较组包括2020年住院的38838名儿科患者。使用多变量二元逻辑回归，控制患者特征、社会人口学因素和医疗保险，来估计COVID-19住院的调整风险。
肥胖和1型糖尿病增加了儿童（5至12岁）和青少年（13至19岁）因COVID-19住院的风险。患有重度肥胖的青少年患重症COVID-19的可能性高10倍（p<0.001）。无论年龄如何，患者邮政编码所在地区的单亲家庭比例与因COVID-19住院的风险增加相关（比值比[AOR]=1.02，置信区间[CI]：1.01-1.03，p<0.01）。其他风险因素包括慢性肾病（p<0.05）、男性（p<0.001）、医疗补助（p<0.001）和慈善医疗（p<0.001）。
儿科医疗服务提供者和公共卫生官员应考虑是否需要为有重症COVID-19可识别风险因素的儿科人群量身定制临床管理和缓解措施。这些发现可用于改善与患有基础疾病儿童家庭的风险沟通，并确定预防措施的优先次序，包括接种疫苗。
