Association of Household Deprivation, Comorbidities, and COVID-19 Hospitalization in Children in Germany, January 2020 to July 2021

Dragano, Nico; Dortmann, Olga; Timm, Jörg; Mohrmann, M.; Wehner, Rosemarie; Rupprecht, Christoph; Scheider, Maria; Mayatepek, Ertan; Wahrendorf, Morten

doi:10.1001/jamanetworkopen.2022.34319

Cited by 5 publications

(5 citation statements)

References 52 publications

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“…Also, vaccinations were not generally available during the study period for this age group and therefore unlikely to account for these associations. The findings from this study by Dragano et al 2 suggest that there is a cost associated with social disadvantage, even in settings with established social systems.…”

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confidence: 44%

The Hidden Factors Associated With Poor Health Outcomes

Dobbs

Carson

2022

JAMA Netw Open

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Socioeconomic conditions are fundamental causes of health inequities, 1 including COVID-19. Given the long-term sequelae of COVID-19, it is important to understand how socioeconomic factors may be associated with COVID-19 diagnosis in early life. In the study by Dragano et al, 2 administrative health insurance data were used to investigate the association between socioeconomic conditions and COVID-19 hospitalization among 690 115 individuals aged 18 years or younger in Germany between January 1, 2020, and July 13, 2021. In this study, children within households with lower socioeconomic position, as determined by parental employment status, had significantly higher rates of hospitalization from COVID-19. After adjustment for age, sex, sociodemographic variables, and comorbidities, children with parents classified as long-term unemployed had higher odds of COVID-19 hospitalization (odds ratio [OR], 1.36; 95% CI, 1.22-1.51) than children with parents who were employed. In additional analyses that investigated area-level measures, children living in low household income districts had higher odds of COVID-19 hospitalization (OR, 3.10; 95% CI, than children living in districts with high median household income, even after accounting for individual-level socioeconomic position. While the administrative insurance database used in this study is comprehensive, several important factors could not be accounted for, such as differences in

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confidence: 44%

The Hidden Factors Associated With Poor Health Outcomes

Dobbs

Carson

2022

JAMA Netw Open

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“…However, relatively few studies examining changes in the incidence rate of pediatric diabetes since the onset of the COVID-19 pandemic have reported the socioeconomic status, race, or ethnicity of the study population. Such information would elucidate whether health disparities in the incidence rates of diabetes and DKA widened during the pandemic …”

Section: Discussionmentioning

confidence: 99%

“…Such information would elucidate whether health disparities in the incidence rates of diabetes and DKA widened during the pandemic. 80 , 81 …”

Section: Discussionmentioning

confidence: 99%

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

D’Souza,

Empringham,

Pechlivanoglou

et al. 2023

JAMA Netw Open

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ImportanceThere are reports of increasing incidence of pediatric diabetes since the onset of the COVID-19 pandemic. Given the limitations of individual studies that examine this association, it is important to synthesize estimates of changes in incidence rates.ObjectiveTo compare the incidence rates of pediatric diabetes during and before the COVID-19 pandemic.Data SourcesIn this systematic review and meta-analysis, electronic databases, including Medline, Embase, the Cochrane database, Scopus, and Web of Science, and the gray literature were searched between January 1, 2020, and March 28, 2023, using subject headings and text word terms related to COVID-19, diabetes, and diabetic ketoacidosis (DKA).Study SelectionStudies were independently assessed by 2 reviewers and included if they reported differences in incident diabetes cases during vs before the pandemic in youths younger than 19 years, had a minimum observation period of 12 months during and 12 months before the pandemic, and were published in English.Data Extraction and SynthesisFrom records that underwent full-text review, 2 reviewers independently abstracted data and assessed the risk of bias. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Eligible studies were included in the meta-analysis and analyzed with a common and random-effects analysis. Studies not included in the meta-analysis were summarized descriptively.Main Outcomes and MeasuresThe primary outcome was change in the incidence rate of pediatric diabetes during vs before the COVID-19 pandemic. The secondary outcome was change in the incidence rate of DKA among youths with new-onset diabetes during the pandemic.ResultsForty-two studies including 102 984 incident diabetes cases were included in the systematic review. The meta-analysis of type 1 diabetes incidence rates included 17 studies of 38 149 youths and showed a higher incidence rate during the first year of the pandemic compared with the prepandemic period (incidence rate ratio [IRR], 1.14; 95% CI, 1.08-1.21). There was an increased incidence of diabetes during months 13 to 24 of the pandemic compared with the prepandemic period (IRR, 1.27; 95% CI, 1.18-1.37). Ten studies (23.8%) reported incident type 2 diabetes cases in both periods. These studies did not report incidence rates, so results were not pooled. Fifteen studies (35.7%) reported DKA incidence and found a higher rate during the pandemic compared with before the pandemic (IRR, 1.26; 95% CI, 1.17-1.36).Conclusions and RelevanceThis study found that incidence rates of type 1 diabetes and DKA at diabetes onset in children and adolescents were higher after the start of the COVID-19 pandemic than before the pandemic. Increased resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to assess whether this trend persists and may help elucidate possible underlying mechanisms to explain temporal changes.

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“…[8][9][10][11][12] Socio-economic disparities in healthcare utilization, such as delayed diagnosis, suboptimal management, and higher rates of complications, contribute to the unequal burden of disease in vulnerable populations. [9,10,13] In a recent meta-analysis of 28 studies, Best et al showed that lower socio-economic status was associated with increased risk of short-term and long-term mortality at different ages (neonates, infants and children) of children with CHD. [14] There are national and regional data exploring disparities in outcomes based on race and socio-economic conditions in CHD populations [15,16] [17][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Socio-economic disparities in unplanned hospital admission and in- hospital outcomes among children with congenital heart disease

Ghimire,

Khanal,

Torabyan

et al. 2024

Preprint

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Unplanned/non-elective admissions have been associated with worse clinical outcomes and increased use of hospital resources. We hypothesize that children with congenital heart disease (CHD) from lower socio-economic status backgrounds have higher rates of unplanned hospital admissions and increased hospital resource utilization. We used Kids’ Inpatient Database (2016 and 2019). We included children < 21 years of age with CHD, and excluded newborn hospitalization. We further categorized CHD into simple lesions, complex bi-ventricular lesions, and single ventricle lesions. Admission types were further divided into surgical and non-surgical admissions. We used a logistic regression model to calculate the risk of unplanned hospital admission, mortality, and hospital resource utilization in children with different socio-economic status backgrounds. Out of 4,722,684 admitted children, excluding those with newborn hospitalization, 199,757 had CHD and met the study criteria. 121,626 had mild CHD, 61,639 complex bi-ventricular lesions, and 16,462 single ventricle lesions. Surgical admission comprised 20%(n = 39,694). In the CHD cohort, 27% had elective admissions, while 73% had non-elective admissions. Mortality was higher in unplanned admissions vs elective admissions, 3.0% vs 0.93%, P < 0.001. Unplanned admissions were more common in lowest income neighborhoods vs highest income neighborhoods, aOR = 1.4(1.3–1.5), P < 0.001 and were consistent at different age groups. There were higher rates of unplanned admissions in lowest income neighborhoods for each category of CHD and for both medical and surgical admission groups. Lengths of hospitalization were longer in the poorest neighborhood compared to their wealthiest counterparts, median of 7 days (IQR 3–21) vs 6 (3–17), P < 0.001. In conclusion, children with CHD who live in lowest income neighborhoods have increased odds of unplanned hospitalization for both surgical and non-surgical admissions and have higher mortality and resource utilization.

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Association of Household Deprivation, Comorbidities, and COVID-19 Hospitalization in Children in Germany, January 2020 to July 2021

Cited by 5 publications

References 52 publications

The Hidden Factors Associated With Poor Health Outcomes

The Hidden Factors Associated With Poor Health Outcomes

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

Socio-economic disparities in unplanned hospital admission and in- hospital outcomes among children with congenital heart disease

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