Multilevel Analysis of Racial and Ethnic Disparities in COVID-19 Hospitalization among Children with Allergies.
Multilevel Analysis of Racial and Ethnic Disparities in COVID-19 Hospitalization among Children with Allergies.
复制标题
DOI：
10.1513/annalsats.202207-580oc
复制
发表时间：
2023-06
影响因子：
8.3
通讯作者：
中科院分区：
文献类型：
--
作者：
先前的研究已经确定了儿童冠状病毒病（COVID-19）住院的风险因素。然而，这些研究在区分种族差异、过敏性合并症和环境暴露对过敏高危儿童严重COVID-19发展的影响方面能力有限。研究COVID-19住院治疗中的种族和民族差异及其与过敏儿童潜在的潜在过敏性合并症以及个体和地方因素的联系。这是一项2020年基于电子健康档案的儿童回顾性研究。结果是COVID-19住院治疗，分类为无症状/轻度疾病患者无需住院治疗，24小时内入院和出院的患者短期住院，需要额外时间出院的患者延长住院时间（超过24小时）。使用混合效应和中介模型来确定自变量、中介因子和COVID-19住院之间的关系。在5，258名COVID-19检测或诊断呈阳性的儿童中，10%需要短期逗留，3. 7%需要长期逗留。黑人和西班牙裔儿童比非西班牙裔白色儿童住院时间更长（均P < 0.001）。肥胖和嗜酸粒细胞性食管炎的儿童短期和长期住院的几率更高（均P < 0.05）。区域水平剥夺与短期停留（校正比值比[AOR]，15.49; 95%置信区间[CI]，每增加0.1个单位，5.16-45.47）和长期停留（AOR，11.82; 95% CI，每增加0.1个单位，2.25-62.01）相关。种族/民族与COVID-19住院之间的关联主要由保险和地区水平的剥夺介导，共占COVID-19住院差异的99%。过敏儿童存在种族和民族差异，与COVID-19住院相关的个体和地点因素也存在差异。差异主要是由保险和地区水平的剥夺介导的，共占COVID-19住院变化的99%。更好地了解儿童中与COVID相关的发病率及其与基于地点的因素的联系，是制定能够公平改善结果的预防战略的关键。
Previous studies have identified risk factors for coronavirus disease (COVID-19) hospitalization in children. However, these studies have been limited in their ability to disentangle the contribution of racial disparities, allergic comorbidities, and environmental exposures to the development of severe COVID-19 in at-risk children with allergies. To examine racial and ethnic disparities in COVID-19 hospitalization and their links to potentially underlying allergic comorbidities and individual and place-based factors in children with allergies. This is an electronic health record-based retrospective study of children in 2020. The outcome was COVID-19 hospitalization categorized as no hospital care for patients with asymptomatic/mild illness, short stay for patients admitted and discharged within 24 hours, and prolonged stay for patients requiring additional time to discharge (more than 24 h). Mixed-effects and mediation models were used to determine relationships among independent variables, mediators, and COVID-19 hospitalization. Among the 5,258 children with COVID-19 positive test or diagnosis, 10% required a short stay, and 3.7% required a prolonged stay. Black and Hispanic children had higher odds of longer stays than non-Hispanic White children (both P < 0.001). Children with obesity and eosinophilic esophagitis diagnoses had higher odds of short and prolonged stay (all P < 0.05). Area-level deprivation was associated with short stay (adjusted odds ratio [AOR], 15.49; 95% confidence interval [CI], 5.16–45.47 for every 0.1-unit increase) and prolonged stay (AOR, 11.82; 95% CI, 2.25–62.01 for every 0.1-unit increase). Associations between race/ethnicity and COVID-19 hospitalization were primarily mediated by insurance and area-level deprivation, altogether accounting for 99% of the variation in COVID-19 hospitalization. There were racial and ethnic differences in children with allergies and individual and place-based factors related to COVID-19 hospitalization. Differences were primarily mediated by insurance and area-level deprivation, altogether accounting for 99% of the variation in COVID-19 hospitalization. A better understanding of COVID-related morbidity in children and the link to place-based factors is key to developing prevention strategies capable of equitably improving outcomes.