Associations between area-level health-related social factor indices and risk of acute COVID-19: An EHR-based cohort study from the RECOVER program

Abstract

Background: Research demonstrates that SARS-CoV-2 infection (COVID-19) among adults disproportionately impacts racial and ethnic minorities and those living in lower-income communities. Similar research in children is limited due, in part, to the relatively low incidence in children compared to adults. This analysis, conducted as part of the RECOVER Initiative, explores this question. Methods: Electronic health record (EHR) data from PEDSnet, a multi-institutional research network of pediatric healthcare organizations, were geocoded and linked to two indices of contextual social deprivation: the Area Deprivation Index and the Child Opportunity Index. Univariate statistics were employed to test the association between each index and COVID19 positivity among children ages 0-20 tested at one of six Childrens hospitals. Multivariate logistic regression was used to explore the relationship between these social context indices and racial disparities in positivity, controlling co-variates. Results: Both ADI and COI were significantly associated with COVID-19 positivity in univariate and adjusted models, particularly in the pre-delta and delta variant waves. ADI showed a stronger association. Higher rates of positivity were found for non-Hispanic Black, Hispanic, and multi-racial children compared to non-Hispanic White children. These racial disparities remained significant after control for either index and other variables. Conclusion: ADI and COI are significantly associated with COVID-19 test positivity in a population of children and adolescents tested in childrens hospital settings. These social contextual variables do not fully explain racial disparities arguing that racial disparities are not solely a reflection of socioeconomic status. Future disparities research should consider both race and social context.

Racial/Ethnic Differences in Long-COVID-Associated Symptoms among Pediatrics Population: Findings from Difference-in-differences Analyses in RECOVER Program

“…First, socioeconomic differences due to race/ethnicity may exacerbate racial/ethnic differences in potential PASC symptoms and conditions, thereby acting as a mediator effect in the causal pathway between race/ethnicity and clinical outcomes. Such in uences have been suggested as risk factors for acute COVID-19 by Chisolm and colleagues in a RECOVER EHR study 32 . Future research on PASC outcomes is of interest to study such mediation effects.…”

“…Concurrently, research indicates children's likelihood of testing positive for COVID-19 correlates with their race/ethnicity [19][20][21][22][23] . NHB, Hispanic, and multi-racial children exhibited higher rates of COVID-19 positivity compared to their NHW counterparts, indicating differences in infection rates across different racial/ethnic groups 24 . However, limited research to date has addressed potential racial/ethnic differences in PASC among children and adolescents, making it a pressing area of study.…”