Children at highest risk for COVID-19 are tested less often
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Despite having a “markedly increased chance” of testing positive for COVID-19, Black, Hispanic and Asian children and young adults are less likely than white patients to be tested, findings in JAMA Pediatrics showed.
L. Charles Bailey, MD, PhD, attending physician in the cancer center at the Children’s Hospital of Philadelphia, and colleagues assessed data on 135,794 pediatric patients aged 25 years or younger who were tested for SARS-CoV-2. The data were from PEDSnet, a network of seven pediatric health systems. The patients had a mean age of 8.8 years.
Of the patients, 53% were male, 59% were white, 15% were Black, 11% were Hispanic, 3% were Asian or Pacific Islander, and 3% were multiracial. Nine percent of individuals were not categorized.
Overall, 5,374 patients (4%) tested positive for SARS-CoV-2. Recurring patients — those who had at least two visits in the 3 years before the time of inclusion — had an overall positivity of 4%, whereas those who were nonrecurring had a positivity rate of 6%. Eighty-seven percent of patients received one test, whereas 9% received two, 2% received three and 2% received four or more tests.
Black (OR = 0.70; 95% CI, 0.68-0.72), Hispanic (OR = 0.65; 95% CI, 0.63-0.67) and Asian (OR = 0.60; 95% CI, 0.57-0.63) patients were less likely to undergo testing compared with white patients despite being at a higher risk for receiving a positive test: Black (OR = 2.66; 95% CI, 2.43-2.90), Hispanic (OR = 3.75; 95% CI, 3.39-4.15) and Asian (OR, 2.04 (95% CI, 1.69-2.48).
“It happens that children with minority ethnicity get sick more [often]; we need to take care of these patients,” Bailey told Healio. “These are the groups that are most likely to have limited access to health care, whether for acute symptoms or longer term effects of COVID-19, so in the middle of the pandemic we need to work on improving access.”
According to the results, patients with public insurance had a lower likelihood of undergoing testing compared with those with commercial coverage (OR = 0.95; 95% CI, 0.93-0.97), whereas the likelihood of a positive test result was increased (OR = 1.43; 95% CI, 1.31-1.57).
The authors also analyzed COVID-19 severity across racial groups, and found that Black race/ethnicity was significantly associated with severe illness among patients with SARS-CoV-2 (OR = 1.44; 95% CI, 1.02-2.04), as was age less than 1 year (OR = 2.96; 95% CI, 1.85-4.73); age 12 to 17 years (OR = 1.85; 95% CI, 1.22-2.81); age 18 to 24 years (OR = 1.63; 1.02-2.61), those with public insurance (OR = 1.91; 95% CI, 1.27-2.87) and those with a progressive condition (OR = 5.99; 95% CI, 4.51-7.96).
“We may be seeing evidence that the details of viral infection are different in different ethnic groups, or that the immune response to the virus, which is a factor in severity of COVID-19, may differ,” Bailey said. “Or we may be seeing in children that their parents are more likely to get infected because they are less able to stay home and isolate, and that flows down to children at home. We don’t know that, but these are things we need to look at.”