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

International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Clinical Characterization Group Investigators; Eva Miranda Marwali; Aria Kekalih; Saptadi Yuliarto; Dyah Kanya Wati; Muhammad Rayhan; Ivy Cerelia Valerie; Hwa Jin Cho; Waasila Jassat; Lucille Blumberg; Maureen Masha; Calum Semple; Olivia V Swann; Malte Kohns Vasconcelos; Jolanta Popielska; Srinivas Murthy; Robert A Fowler; Anne-Marie Guerguerian; Anca Streinu-Cercel; Mohan Dass Pathmanathan; Amanda Rojek; Christiana Kartsonaki; Bronner P Gonçalves; Barbara Wanjiru Citarella; Laura Merson; Piero L Olliaro; Heidi Jean Dalton

doi:10.1136/bmjpo-2022-001657

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

International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Clinical Characterization Group Investigators
, Eva Miranda Marwali^*
, Aria Kekalih
, Saptadi Yuliarto
, Dyah Kanya Wati
, Muhammad Rayhan
, Ivy Cerelia Valerie
, Hwa Jin Cho
, Waasila Jassat
, Lucille Blumberg
, Maureen Masha
, Calum Semple
, Olivia V Swann
, Malte Kohns Vasconcelos
, Jolanta Popielska
, Srinivas Murthy
, Robert A Fowler
, Anne-Marie Guerguerian
, Anca Streinu-Cercel
, Mohan Dass Pathmanathan

Amanda Rojek, Christiana Kartsonaki, Bronner P Gonçalves, Barbara Wanjiru Citarella, Laura Merson, Piero L Olliaro, Heidi Jean Dalton

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

81 Downloads (Pure)

Abstract

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.

Original language	English
Article number	e001657
Number of pages	11
Journal	BMJ Paediatrics Open
Volume	6
Issue number	1
DOIs	https://doi.org/10.1136/bmjpo-2022-001657
Publication status	Published - 27 Oct 2022

Bibliographical note

Acknowledgments:
This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z and 220757/Z/20/Z]; the Bill & Melinda Gates Foundation [OPP1209135]; the philanthropic support of the donors to the University of Oxford’s COVID-19 Research Response Fund (0009109); CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and the coordination in Canada by Sunnybrook Research Institute; endorsement of the Irish Critical Care- Clinical Trials Group, co-ordination in Ireland by the Irish Critical Care- Clinical Trials Network at University College Dublin and funding by the Health Research Board of Ireland [CTN-2014-12]; the COVID clinical management team, AIIMS, Rishikesh, India; the COVID-19 Clinical Management team, Manipal Hospital Whitefield, Bengaluru, India; Cambridge NIHR Biomedical Research Centre; the dedication and hard work of the Groote Schuur Hospital Covid ICU Team and supported by the Groote Schuur nursing and University of Cape Town registrar bodies coordinated by the Division of Critical Care at the University of Cape Town; the Liverpool School of Tropical Medicine and the University of Oxford; the dedication and hard work of the Norwegian SARS-CoV-2 study team and the Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; Imperial NIHR Biomedical Research Centre; the Comprehensive Local Research Networks (CLRNs) of which PJMO is an NIHR Senior Investigator (NIHR201385); Innovative Medicines Initiative Joint Undertaking under Grant Agreement No. 115523 COMBACTE, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007- 2013) and EFPIA companies, in-kind contribution; Stiftungsfonds zur Förderung der Bekämpfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, Project Number: APCOV22BGM; Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), the Prince Charles Hospital Foundation, Australia; grants from Instituto de Salud Carlos III, Ministerio de Ciencia, Spain; Brazil, National Council for Scientific and Technological Development Scholarship number 303953/2018- 7; the Firland Foundation, Shoreline, Washington, USA; the French COVID cohort (NCT04262921) is sponsored by INSERM and is funded by the REACTing (REsearch & ACtion emergING infectious diseases) consortium and by a grant of the French Ministry of Health (PHRC n°20-0424); a grant from foundation Bevordering Onderzoek Franciscus; the South Eastern Norway Health Authority and the Research Council of Norway; Institute for Clinical Research (ICR), National Institutes of Health (NIH) supported by the Ministry of Health Malaysia; preparedness work conducted by the Short Period Incidence Study of Severe Acute Respiratory Infection; the U.S. DoD Armed Forces Health Surveillance Division, Global Emerging Infectious Diseases Branch to the U.S Naval Medical Research Unit No. TWO (NAMRU-2) (Work Unit #: P0153_21_N2). These authors would like to thank Vysnova Partners, Inc. for the management of this research project. The Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit is funded by the Wellcome Trust. This work uses data provided by patients and collected by the NHS as part of their care and support #DataSavesLives. The data used for this research were obtained from ISARIC4C. We are extremely grateful to the 2648 frontline NHS clinical and research staff and volunteer medical students who collected these data in challenging circumstances; and the generosity of the patients and their families for their individual contributions in these difficult times. The COVID-19 Clinical Information Network (CO-CIN) data was collated by ISARIC4C Investigators. Data and Material provision was supported by grants from: the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award ISBRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. We also acknowledge the support of Jeremy J Farrar and Nahoko Shindo.

Access to Document

10.1136/bmjpo-2022-001657Licence: Creative Commons: Attribution (CC BY)

MarwaliE2022PaediatricFinal published version, 533 KBLicence: Creative Commons: Attribution (CC BY)

Cite this

International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Clinical Characterization Group Investigators, Marwali, E. M., Kekalih, A., Yuliarto, S., Wati, D. K., Rayhan, M., Valerie, I. C., Cho, H. J., Jassat, W., Blumberg, L., Masha, M., Semple, C., Swann, O. V., Vasconcelos, M. K., Popielska, J., Murthy, S., Fowler, R. A., Guerguerian, A.-M., Streinu-Cercel, A., ... Dalton, H. J. (2022). Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity. BMJ Paediatrics Open, 6(1), Article e001657. https://doi.org/10.1136/bmjpo-2022-001657

@article{ac56a79a8cda4edebd4d0d7381aa9de6,

title = "Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity",

abstract = "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.",

author = "\{International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Clinical Characterization Group Investigators\} and Marwali, \{Eva Miranda\} and Aria Kekalih and Saptadi Yuliarto and Wati, \{Dyah Kanya\} and Muhammad Rayhan and Valerie, \{Ivy Cerelia\} and Cho, \{Hwa Jin\} and Waasila Jassat and Lucille Blumberg and Maureen Masha and Calum Semple and Swann, \{Olivia V\} and Vasconcelos, \{Malte Kohns\} and Jolanta Popielska and Srinivas Murthy and Fowler, \{Robert A\} and Anne-Marie Guerguerian and Anca Streinu-Cercel and Pathmanathan, \{Mohan Dass\} and Amanda Rojek and Christiana Kartsonaki and Gon{\c c}alves, \{Bronner P\} and Citarella, \{Barbara Wanjiru\} and Laura Merson and Olliaro, \{Piero L\} and Dalton, \{Heidi Jean\} and Christopher Green",

note = "Acknowledgments: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z and 220757/Z/20/Z]; the Bill \& Melinda Gates Foundation [OPP1209135]; the philanthropic support of the donors to the University of Oxford{\textquoteright}s COVID-19 Research Response Fund (0009109); CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and the coordination in Canada by Sunnybrook Research Institute; endorsement of the Irish Critical Care- Clinical Trials Group, co-ordination in Ireland by the Irish Critical Care- Clinical Trials Network at University College Dublin and funding by the Health Research Board of Ireland [CTN-2014-12]; the COVID clinical management team, AIIMS, Rishikesh, India; the COVID-19 Clinical Management team, Manipal Hospital Whitefield, Bengaluru, India; Cambridge NIHR Biomedical Research Centre; the dedication and hard work of the Groote Schuur Hospital Covid ICU Team and supported by the Groote Schuur nursing and University of Cape Town registrar bodies coordinated by the Division of Critical Care at the University of Cape Town; the Liverpool School of Tropical Medicine and the University of Oxford; the dedication and hard work of the Norwegian SARS-CoV-2 study team and the Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; Imperial NIHR Biomedical Research Centre; the Comprehensive Local Research Networks (CLRNs) of which PJMO is an NIHR Senior Investigator (NIHR201385); Innovative Medicines Initiative Joint Undertaking under Grant Agreement No. 115523 COMBACTE, resources of which are composed of financial contribution from the European Union{\textquoteright}s Seventh Framework Programme (FP7/2007- 2013) and EFPIA companies, in-kind contribution; Stiftungsfonds zur F{\"o}rderung der Bek{\"a}mpfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, Project Number: APCOV22BGM; Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), the Prince Charles Hospital Foundation, Australia; grants from Instituto de Salud Carlos III, Ministerio de Ciencia, Spain; Brazil, National Council for Scientific and Technological Development Scholarship number 303953/2018- 7; the Firland Foundation, Shoreline, Washington, USA; the French COVID cohort (NCT04262921) is sponsored by INSERM and is funded by the REACTing (REsearch \& ACtion emergING infectious diseases) consortium and by a grant of the French Ministry of Health (PHRC n°20-0424); a grant from foundation Bevordering Onderzoek Franciscus; the South Eastern Norway Health Authority and the Research Council of Norway; Institute for Clinical Research (ICR), National Institutes of Health (NIH) supported by the Ministry of Health Malaysia; preparedness work conducted by the Short Period Incidence Study of Severe Acute Respiratory Infection; the U.S. DoD Armed Forces Health Surveillance Division, Global Emerging Infectious Diseases Branch to the U.S Naval Medical Research Unit No. TWO (NAMRU-2) (Work Unit \#: P0153\_21\_N2). These authors would like to thank Vysnova Partners, Inc. for the management of this research project. The Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit is funded by the Wellcome Trust. This work uses data provided by patients and collected by the NHS as part of their care and support \#DataSavesLives. The data used for this research were obtained from ISARIC4C. We are extremely grateful to the 2648 frontline NHS clinical and research staff and volunteer medical students who collected these data in challenging circumstances; and the generosity of the patients and their families for their individual contributions in these difficult times. The COVID-19 Clinical Information Network (CO-CIN) data was collated by ISARIC4C Investigators. Data and Material provision was supported by grants from: the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC\_PC\_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award ISBRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. We also acknowledge the support of Jeremy J Farrar and Nahoko Shindo.",

year = "2022",

month = oct,

day = "27",

doi = "10.1136/bmjpo-2022-001657",

language = "English",

volume = "6",

journal = "BMJ Paediatrics Open",

issn = "2399-9772",

publisher = "BMJ Publishing Group",

number = "1",

}

International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Clinical Characterization Group Investigators, Marwali, EM, Kekalih, A, Yuliarto, S, Wati, DK, Rayhan, M, Valerie, IC, Cho, HJ, Jassat, W, Blumberg, L, Masha, M, Semple, C, Swann, OV, Vasconcelos, MK, Popielska, J, Murthy, S, Fowler, RA, Guerguerian, A-M, Streinu-Cercel, A, Pathmanathan, MD, Rojek, A, Kartsonaki, C, Gonçalves, BP, Citarella, BW, Merson, L, Olliaro, PL & Dalton, HJ 2022, 'Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity', BMJ Paediatrics Open, vol. 6, no. 1, e001657. https://doi.org/10.1136/bmjpo-2022-001657

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity. / International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Clinical Characterization Group Investigators; Marwali, Eva Miranda; Kekalih, Aria et al.
In: BMJ Paediatrics Open, Vol. 6, No. 1, e001657, 27.10.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Paediatric COVID-19 mortality

T2 - a database analysis of the impact of health resource disparity

AU - International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Clinical Characterization Group Investigators

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 - Vasconcelos, Malte Kohns

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 - Green, Christopher

N1 - Acknowledgments: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z and 220757/Z/20/Z]; the Bill & Melinda Gates Foundation [OPP1209135]; the philanthropic support of the donors to the University of Oxford’s COVID-19 Research Response Fund (0009109); CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and the coordination in Canada by Sunnybrook Research Institute; endorsement of the Irish Critical Care- Clinical Trials Group, co-ordination in Ireland by the Irish Critical Care- Clinical Trials Network at University College Dublin and funding by the Health Research Board of Ireland [CTN-2014-12]; the COVID clinical management team, AIIMS, Rishikesh, India; the COVID-19 Clinical Management team, Manipal Hospital Whitefield, Bengaluru, India; Cambridge NIHR Biomedical Research Centre; the dedication and hard work of the Groote Schuur Hospital Covid ICU Team and supported by the Groote Schuur nursing and University of Cape Town registrar bodies coordinated by the Division of Critical Care at the University of Cape Town; the Liverpool School of Tropical Medicine and the University of Oxford; the dedication and hard work of the Norwegian SARS-CoV-2 study team and the Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; Imperial NIHR Biomedical Research Centre; the Comprehensive Local Research Networks (CLRNs) of which PJMO is an NIHR Senior Investigator (NIHR201385); Innovative Medicines Initiative Joint Undertaking under Grant Agreement No. 115523 COMBACTE, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007- 2013) and EFPIA companies, in-kind contribution; Stiftungsfonds zur Förderung der Bekämpfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, Project Number: APCOV22BGM; Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), the Prince Charles Hospital Foundation, Australia; grants from Instituto de Salud Carlos III, Ministerio de Ciencia, Spain; Brazil, National Council for Scientific and Technological Development Scholarship number 303953/2018- 7; the Firland Foundation, Shoreline, Washington, USA; the French COVID cohort (NCT04262921) is sponsored by INSERM and is funded by the REACTing (REsearch & ACtion emergING infectious diseases) consortium and by a grant of the French Ministry of Health (PHRC n°20-0424); a grant from foundation Bevordering Onderzoek Franciscus; the South Eastern Norway Health Authority and the Research Council of Norway; Institute for Clinical Research (ICR), National Institutes of Health (NIH) supported by the Ministry of Health Malaysia; preparedness work conducted by the Short Period Incidence Study of Severe Acute Respiratory Infection; the U.S. DoD Armed Forces Health Surveillance Division, Global Emerging Infectious Diseases Branch to the U.S Naval Medical Research Unit No. TWO (NAMRU-2) (Work Unit #: P0153_21_N2). These authors would like to thank Vysnova Partners, Inc. for the management of this research project. The Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit is funded by the Wellcome Trust. This work uses data provided by patients and collected by the NHS as part of their care and support #DataSavesLives. The data used for this research were obtained from ISARIC4C. We are extremely grateful to the 2648 frontline NHS clinical and research staff and volunteer medical students who collected these data in challenging circumstances; and the generosity of the patients and their families for their individual contributions in these difficult times. The COVID-19 Clinical Information Network (CO-CIN) data was collated by ISARIC4C Investigators. Data and Material provision was supported by grants from: the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award ISBRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. We also acknowledge the support of Jeremy J Farrar and Nahoko Shindo.

PY - 2022/10/27

Y1 - 2022/10/27

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.

U2 - 10.1136/bmjpo-2022-001657

DO - 10.1136/bmjpo-2022-001657

M3 - Article

SN - 2399-9772

VL - 6

JO - BMJ Paediatrics Open

JF - BMJ Paediatrics Open

IS - 1

M1 - e001657

ER -

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

Abstract

Bibliographical note

Access to Document

Fingerprint

Cite this