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

Marwali EM 1 , Kekalih A 2 , Yuliarto S 3 , Wati DK 4 , Rayhan M 5 , Valerie IC 4 Show all authors , Cho HJ 6 , Jassat W 7 , Blumberg L 7 , Masha M 7 , Semple C 8 , Swann OV 9 , Kohns Vasconcelos M 10 , Popielska J 11 , Murthy S 12 , Fowler RA 13 , Guerguerian AM 14 , Streinu-Cercel A 15 , Pathmanathan MD 16 , Rojek A 8 , Kartsonaki C 8 , Gonçalves BP 8 , Citarella BW 8 , Merson L 8 , Olliaro PL 8 , Dalton HJ 17 , International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Clinical Characterization Group Investigators

Affiliations 

  • 1 Department of Pediatric Cardiac Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia [email protected]
  • 2 Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • 3 Department of Pediatrics, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar Hospital, Malang, Jawa Timur, Indonesia
  • 4 Department of Pediatrics, Faculty of Medicine, Universitas Udayana, Sanglah Hospital, Denpasar, Bali, Indonesia
  • 5 Department of Pediatric Cardiac Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
  • 6 Division of Pediatric Cardiology and Pediatric Intensive Care, Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea (the Republic of)
  • 7 National Institute for Communicable Diseases, Johannesburg, South Africa
  • 8 International Severe Acute Respiratory and emerging Infection Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
  • 9 Centre for Medical Informatics, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
  • 10 Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
  • 11 Warsaw's Hospital for Infectious Diseases, Medical University of Warsaw, Warszawa, Mazowieckie, Poland
  • 12 Department of Pediatrics, Division of Critical Care, The University of British Columbia, Vancouver, British Columbia, Canada
  • 13 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
  • 14 Department of Critical Care Medicine, Neurosciences and Mental Health Program, Faculty of Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 15 National Institute of Infectious Diseases Prof Dr Matei Bals, Bucuresti, Romania
  • 16 National Institutes of Health, Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
  • 17 Inova Fairfax Medical Center, Inova, Falls Church, Arizona, USA
BMJ Paediatr Open, 2022 Oct;6(1).
PMID: 36645791 DOI: 10.1136/bmjpo-2022-001657

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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)).

CONCLUSION: 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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