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



Marwali, Eva Miranda, Kekalih, Aria, Yuliarto, Saptadi, Wati, Dyah Kanya, Rayhan, Muhammad, Valerie, Ivy Cerelia, Cho, Hwa Jin, Jassat, Waasila, Blumberg, Lucille, Masha, Maureen
et al (show 16 more authors) (2022) Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity. BMJ PAEDIATRICS OPEN, 6 (1). e001657-.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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)).<h4>Conclusion</h4>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.

Item Type: Article
Uncontrolled Keywords: Adolescent Health, COVID-19, Health services research, Mortality, Neonatology
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 10 Mar 2023 09:11
Last Modified: 10 Mar 2023 09:11
DOI: 10.1136/bmjpo-2022-001657
Open Access URL: http://dx.doi.org/10.1136/bmjpo-2022-001657
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3168918