Non-communicable diseases, sociodemographic vulnerability and the risk of mortality in hospitalised children and adolescents with COVID-19 in Brazil: a cross-sectional observational study

Abstract

ObjectivesTo analyse how previous comorbidities, ethnicity, regionality and socioeconomic development are associated with COVID-19 mortality in hospitalised children and adolescents.DesignCross-sectional observational study using publicly available data from the Brazilian Ministry of Health.SettingNationwide.Participants5857 patients younger than 20 years old, all of them hospitalised with laboratory-confirmed COVID-19, from 1 January 2020 to 7 December 2020.Main outcome measureWe used multilevel mixed-effects generalised linear models to study in-hospital mortality, stratifying the analysis by age, region of the country, presence of non-communicable diseases, ethnicity and socioeconomic development.ResultsIndividually, most of the included comorbidities were risk factors for mortality. Notably, asthma was a protective factor (OR 0.4, 95% CI 0.24 to 0.67). Having more than one comorbidity increased almost tenfold the odds of death (OR 9.67, 95% CI 6.89 to 13.57). Compared with white children, Indigenous, Pardo (mixed) and East Asian had significantly higher odds of mortality (OR 5.83, 95% CI 2.43 to 14.02; OR 1.93, 95% CI 1.48 to 2.51; OR 2.98, 95% CI 1.02 to 8.71, respectively). We also found a regional influence (higher mortality in the North—OR 3.4, 95% CI 2.48 to 4.65) and a socioeconomic association (lower mortality among children from more socioeconomically developed municipalities—OR 0.26, 95% CI 0.17 to 0.38)ConclusionsBesides the association with comorbidities, we found ethnic, regional and socioeconomic factors shaping the mortality of children hospitalised with COVID-19 in Brazil. Our findings identify risk groups among children that should be prioritised for public health measures, such as vaccination.

Sex-differences in incidence of hospitalizations and in hospital mortality of community-acquired pneumonia among children in Spain: a population-based study

“…Interestingly, asthma was a protective factor for IHM among girls, in line with previous studies in patients with other respiratory infections [ 35 ]. However, it cannot be ruled out that asthmatic children are admitted to the hospital with less severe infections, resulting in an apparent protective effect [ 14 ].…”

Risk factors for severe COVID-19 infection in Brazilian children

“… 16 , 17 , 22 , 23 Furthermore, Brazilian studies have shown even higher mortality rates in children from the North and Northeast (mortality values of up to 15% in hospitalized children). 29 , 30 Knowing the local particularities, deficiencies and fragilities of each region is essential to plan the necessary measures to reduce mortality. For example, knowing the age group that mostly needs ICU beds and providing bed adjustments, adequately managing patients' chronic diseases, and improving access to healthcare seem to be fundamental measures to reduce deaths and improve outcomes.…”

Spatial clusters, social determinants of health and risk of COVID-19 mortality in Brazilian children and adolescents: A nationwide population-based ecological study

“… 6 , 30 The limited and precarious child health care network in these areas is linked to unfavourable outcomes, especially among the youngest. 7 , 13 , 31 …”

“… 12 Previous reports indicated that children in the North and Northeast regions (the least developed regions of the country) or belonging to indigenous populations have a higher risk of death, independently of age and the presence of comorbidities. 7 , 13 As the country has marked social inequalities, millions of people and children live in precarious living conditions. 14 However, data regarding COVID-19 in children and adolescents are scarce, with a paucity on the risk factors for poor outcomes and their association with social determinants.…”