Prior medical history could exacerbate coronavirus disease 2019 (COVID-19) symptoms among children, suggests new research.
The prevalence of medical conditions such as type 1 diabetes, cardiac and circulatory congenital anomalies, and obesity increased the severity of COVID-19 – caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection – among patients under 18 years old.
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Risk of hospitalization from severe COVID-19 increases nearly 3-fold in patients with chronic and complex chronic disease
In a new study investigating whether underlying medical conditions and medical complexity (i.e., presence of complex or non-complex chronic disease) is associated with hospitalization from COVID-19, researchers found chronic diseases increased the risk of severe infection.
The team of scientists led by first author Lyudmyla Kompaniyets, PhD, from the US Centers for Disease Control and Prevention, used data of more than 800 hospitals across the US from the Premier Healthcare Database Special COVID-19 Release to investigate the outcome of COVID-19 in under 18 years old with underlying medical conditions.
Among the 43,465 patients considered with COVID-19 aged 18 years or younger, the median age was 12 (4-16) years; 22,943 (52.8%) were female patients; and 12,491 (28.7%) had underlying medical conditions. The most common conditions reported were asthma, anxiety, neurodevelopmental disorders, depressive disorders, and obesity.
Such conditions are particularly likely to increase the severity of COVID-19 due to the overlap in symptom type. Upper respiratory symptoms and metabolic disruptions, as well as alterations in neurological processes, are established to be common symptoms of COVID-19 and were the most commonly reported chronic disorders in this study. This supports the likelihood of synergistic effects and the potential exacerbation of COVID-19 symptoms.
Results from the analysis showed that the strongest risk factors for hospitalization were type 1 diabetes and obesity, and the strongest risk factors for severe COVID-19 illness were type as well as cardiac and circulatory congenital.
In children under 2 years old, prematurity increased the risk factor for severe COVID-19 illness. Moreover, chronic and complex chronic disease were risk factors for hospitalization, with adjusted risk ratio (aRR) of 2.91 and 7.86, respectively, as well as for severe COVID-19 illness, with aRRs of 1. and 2.86, respectively.
A need for more cautious clinical management for high-risk patients
The findings of this study indicate that the variation in COVID-19 severity is affected by the medical history of individuals. This is particularly true among children with medical complexity and certain underlying conditions, such as type 1 diabetes, cardiac and circulatory congenital anomalies, and obesity.
Such an increase in risk of developing severe COVID-19 symptoms makes children with chronic medical conditions particularly susceptible to hospitalization. In response, health care practitioners could implement closer observation and more cautious clinical management of children with these conditions that are infected with COVID-19.
In this study, the risk ratios of hospitalization were based upon the combined outcome of intensive care unit admission, invasive mechanical ventilation, or death, of patients. This encompasses the most severe cases of COVID-19, and further research could include the response of weak or mild SARS-CoV-2 infections to compare the responses. Future studies could therefore compare the proportionate responses of children with chronic medical conditions to COVID-19 on a nationwide scale.
Importantly, the study encompassed an extensive dataset comprising of male and female patients, examining responses in nearly 13,000 cases in a cross-sectional study. Such study designs could be replicated across different countries that are accumulating useful data. Findings would then be able to elaborate on how patients at high risk of severe COVID-19 are distributed among and between countries.
The authors conclude by discussing the limitations of the dataset, including the lack of BMI data, potential flaws in diagnosis, the use of only chronic but not acute conditions, and only hospitalized patients being used. Nevertheless, such factors could be incorporated into future study designs to better represent the range of outcomes for children with COVID-19.
Ultimately, although the causal mechanisms are not yet identified fully, this study provides key indications on the association between chronic medical conditions and COVID-19.