Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm

Abstract

ImportanceLimited data exist on pediatric health care utilization during the COVID-19 pandemic among children and young adults born preterm.ObjectiveTo investigate differences in health care use related to COVID-19 concerns during the pandemic among children and young adults born preterm vs those born at term.Design, Setting, and ParticipantsIn this cohort study, questionnaires regarding COVID-19 and health care utilization were completed by 1691 mother-offspring pairs from 42 pediatric cohorts in the National Institutes of Health Environmental Influences on Child Health Outcomes Program. Children and young adults (ages 1-18 years) in these analyses were born between 2003 and 2021. Data were recorded by the August 31, 2021, data-lock date and were analyzed between October 2021 and October 2022.ExposuresPremature birth (<37 weeks’ gestation).Main Outcomes and MeasuresThe main outcome was health care utilization related to COVID-19 concerns (hospitalization, in-person clinic or emergency department visit, phone or telehealth evaluations). Individuals born preterm vs term (≥37 weeks’ gestation) and differences among preterm subgroups of individuals (<28 weeks’, 28-36 weeks’ vs ≥37 weeks’ gestation) were assessed. Generalized estimating equations assessed population odds for health care used and related symptoms, controlling for maternal age, education, and psychiatric disorder; offspring history of bronchopulmonary dysplasia (BPD) or asthma; and timing and age at COVID-19 questionnaire completion.ResultsData from 1691 children and young adults were analyzed; among 270 individuals born preterm, the mean (SD) age at survey completion was 8.8 (4.4) years, 151 (55.9%) were male, and 193 (71.5%) had a history of BPD or asthma diagnosis. Among 1421 comparison individuals with term birth, the mean (SD) age at survey completion was 8.4 (2.4) years, 749 (52.7%) were male, and 233 (16.4%) had a history of BPD or asthma. Preterm subgroups included 159 individuals (58.5%) born at less than 28 weeks’ gestation. In adjusted analyses, individuals born preterm had a significantly higher odds of health care utilization related to COVID-19 concerns (adjusted odds ratio [aOR], 1.70; 95% CI, 1.21-2.38) compared with term-born individuals; similar differences were also seen for the subgroup of individuals born at less than 28 weeks’ gestation (aOR, 2.15; 95% CI, 1.40-3.29). Maternal history of a psychiatric disorder was a significant covariate associated with health care utilization for all individuals (aOR, 1.44; 95% CI, 1.17-1.78).Conclusions and RelevanceThese findings suggest that during the COVID-19 pandemic, children and young adults born preterm were more likely to have used health care related to COVID-19 concerns compared with their term-born peers, independent of a history of BPD or asthma. Further exploration of factors associated with COVID-19–related health care use may facilitate refinement of care models.

Quality of life and healthcare utilization during the COVID-19 pandemic are more restricted in chronically ill than in healthy children: a tertiary care children’s hospital experience

“…Although first studies are available analyzing the access to and utilization of healthcare for adult patients with and without chronic diseases [ 23 – 25 ], data on children and adolescents is limited [ 16 , 26 , 27 ] while no study compared between healthy and chronically ill children, so far. Of all caregivers assessed in our study, 91.3% reported their children having regular medical appointments (Fig.…”

Opportunities for understanding the COVID-19 pandemic and child health in the United States: the Environmental influences on Child Health Outcomes (ECHO) program

“…(6) Describe geographic variation in environmental exposures and health outcomes during the pandemic using geocoded data, and describe how geographic location may modify the association between pandemic-related exposures and child health; (7) Identify early life factors associated with health outcomes during the pandemic, and related indicators of resilience and susceptibility, using a life course approach and harmonized extant data; and (8) Characterize the prevalence, disparities, and risk factors for SARS-CoV-2 infection among children. The ECHO Program has already begun leveraging these data to describe families' experiences during the COVID-19 pandemic, and the impact of the pandemic on the health (34)(35)(36)(37)(38)(39)(40)(41)(42), but many innovative research questions remain to be answered.…”