Ethnic and racial differences in children and young people with respiratory and neurological post-acute sequelae of SARS-CoV-2: an electronic health record-based cohort study from the RECOVER Initiative

RECOVER EHR and; RECOVER Pediatric Cohorts

doi:10.1016/j.eclinm.2024.103042

Ethnic and racial differences in children and young people with respiratory and neurological post-acute sequelae of SARS-CoV-2: an electronic health record-based cohort study from the RECOVER Initiative

RECOVER EHR and, RECOVER Pediatric Cohorts

School of Medicine

Hackensack Meridian School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health. Methods: We conducted a retrospective cohort study of individuals <21 years seeking care at 24 health systems across the U.S, using electronic health record (EHR) data. Our cohort included those with a positive SARS-CoV-2 molecular, serology or antigen test, or with a COVID-19, multisystem inflammatory disease in children, or PASC diagnosis from February 29, 2020 to August 1, 2022. We identified children/youth with at least 2 codes associated with respiratory and neurologic PASC. We measured associations between sociodemographic and clinical characteristics and respiratory and neurologic PASC using odds ratios and 95% confidence intervals estimated from multivariable logistic regression models adjusted for other sociodemographic characteristics, social vulnerability index or area deprivation index, time period of cohort entry, presence and complexity of chronic respiratory (respectively, neurologic) condition and healthcare utilization. Findings: Among 771,725 children in the cohort, 203,365 (26.3%) had SARS-CoV-2 infection. Among children with documented infection, 3217 children had respiratory PASC and 2009 children/youth had neurologic PASC. In logistic regression models, children <5 years (Odds Ratio [OR] 1.78, 95% CI 1.62–1.97), and of Hispanic White descent (OR 1.19, 95% CI 1.05–1.35) had higher odds of having respiratory PASC. Children/youth living in regions with higher area deprivation indices (OR 1.25, 95% CI 1.10–1.420 for 60–79th percentile) and with chronic complex respiratory conditions (OR 3.28, 95% CI 2.91–3.70) also had higher odds of respiratory PASC. In contrast, older (OR 1.57, 95% CI 1.40–1.77 for those aged 12–17 years), non-Hispanic White individuals and those with chronic pre-existing neurologic conditions (OR 2.04, 95% CI 1.78–2.35) were more likely to have a neurologic PASC diagnosis. Interpretation: Racial and ethnic differences in healthcare utilization for neurologic and respiratory PASC may reflect social drivers of health and inequities in access to care. Funding: National Institutes of Health.

Original language	English
Article number	103042
Journal	EClinicalMedicine
Volume	80
DOIs	https://doi.org/10.1016/j.eclinm.2024.103042
State	Published - Feb 2025

ASJC Scopus subject areas

General Medicine

Keywords

Chronic COVID-19 syndrome
Ethnicity
Late sequelae of COVID-19
Long COVID
Long-haul COVID
Long-term COVID-19
PCORnet
PEDSnet
Post-COVID condition
Post-COVID syndrome
Post-acute COVID-19
Post-acute sequelae of SARS-CoV-2 infection
Race
Social determinants of health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.eclinm.2024.103042

Cite this

@article{bc4ac3b392be448a8023eea25eb0a0f8,

title = "Ethnic and racial differences in children and young people with respiratory and neurological post-acute sequelae of SARS-CoV-2: an electronic health record-based cohort study from the RECOVER Initiative",

abstract = "Background: Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health. Methods: We conducted a retrospective cohort study of individuals <21 years seeking care at 24 health systems across the U.S, using electronic health record (EHR) data. Our cohort included those with a positive SARS-CoV-2 molecular, serology or antigen test, or with a COVID-19, multisystem inflammatory disease in children, or PASC diagnosis from February 29, 2020 to August 1, 2022. We identified children/youth with at least 2 codes associated with respiratory and neurologic PASC. We measured associations between sociodemographic and clinical characteristics and respiratory and neurologic PASC using odds ratios and 95% confidence intervals estimated from multivariable logistic regression models adjusted for other sociodemographic characteristics, social vulnerability index or area deprivation index, time period of cohort entry, presence and complexity of chronic respiratory (respectively, neurologic) condition and healthcare utilization. Findings: Among 771,725 children in the cohort, 203,365 (26.3%) had SARS-CoV-2 infection. Among children with documented infection, 3217 children had respiratory PASC and 2009 children/youth had neurologic PASC. In logistic regression models, children <5 years (Odds Ratio [OR] 1.78, 95% CI 1.62–1.97), and of Hispanic White descent (OR 1.19, 95% CI 1.05–1.35) had higher odds of having respiratory PASC. Children/youth living in regions with higher area deprivation indices (OR 1.25, 95% CI 1.10–1.420 for 60–79th percentile) and with chronic complex respiratory conditions (OR 3.28, 95% CI 2.91–3.70) also had higher odds of respiratory PASC. In contrast, older (OR 1.57, 95% CI 1.40–1.77 for those aged 12–17 years), non-Hispanic White individuals and those with chronic pre-existing neurologic conditions (OR 2.04, 95% CI 1.78–2.35) were more likely to have a neurologic PASC diagnosis. Interpretation: Racial and ethnic differences in healthcare utilization for neurologic and respiratory PASC may reflect social drivers of health and inequities in access to care. Funding: National Institutes of Health.",

keywords = "Chronic COVID-19 syndrome, Ethnicity, Late sequelae of COVID-19, Long COVID, Long-haul COVID, Long-term COVID-19, PCORnet, PEDSnet, Post-COVID condition, Post-COVID syndrome, Post-acute COVID-19, Post-acute sequelae of SARS-CoV-2 infection, Race, Social determinants of health",

author = "{RECOVER EHR and} and {RECOVER Pediatric Cohorts} and Suchitra Rao and Rodrigo Azuero-Dajud and Vitaly Lorman and Jeremy Landeo-Gutierrez and Rhee, {Kyung E.} and Julie Ryu and C. Kim and Megan Carmilani and Gross, {Rachel S.} and Sindhu Mohandas and Srinivasan Suresh and Bailey, {L. Charles} and Victor Castro and Yalini Senathirajah and Shari Esquenazi-Karonika and Shawn Murphy and Steve Caddle and Kleinman, {Lawrence C.} and Leah Castro-Baucom and Oliveira, {Carlos R.} and Klein, {Jonathan D.} and Alicia Chung and Cowell, {Lindsay G.} and Charisse Madlock-Brown and Geary, {Carol Reynolds} and Sills, {Marion R.} and Thorpe, {Lorna E.} and Jacqueline Szmuszkovicz and Tantisira, {Kelan G.} and Jessica Snowden and Katherine Irby and Paul Darden and Lexie Dixon and Danielle Evans and Connor Garbe and Laura Hobart-Porter and Lee Howard and Kathy Hummel and Hannah Krehbiel and Haley Spradlin and Phaedra Yount and Amy Elliott and Grace Adam and Jyoti Angal and Maria Barber and Katelynne Clark and {Dos Reis}, Clayton and Mandy Freesemann and Judy Aschner and Katharine Clouser",

note = "Publisher Copyright: {\textcopyright} 2024",

year = "2025",

month = feb,

doi = "10.1016/j.eclinm.2024.103042",

language = "English",

volume = "80",

journal = "EClinicalMedicine",

issn = "2589-5370",

publisher = "Elsevier Ltd",

}

TY - JOUR

T1 - Ethnic and racial differences in children and young people with respiratory and neurological post-acute sequelae of SARS-CoV-2

T2 - an electronic health record-based cohort study from the RECOVER Initiative

AU - RECOVER EHR and

AU - RECOVER Pediatric Cohorts

AU - Rao, Suchitra

AU - Azuero-Dajud, Rodrigo

AU - Lorman, Vitaly

AU - Landeo-Gutierrez, Jeremy

AU - Rhee, Kyung E.

AU - Ryu, Julie

AU - Kim, C.

AU - Carmilani, Megan

AU - Gross, Rachel S.

AU - Mohandas, Sindhu

AU - Suresh, Srinivasan

AU - Bailey, L. Charles

AU - Castro, Victor

AU - Senathirajah, Yalini

AU - Esquenazi-Karonika, Shari

AU - Murphy, Shawn

AU - Caddle, Steve

AU - Kleinman, Lawrence C.

AU - Castro-Baucom, Leah

AU - Oliveira, Carlos R.

AU - Klein, Jonathan D.

AU - Chung, Alicia

AU - Cowell, Lindsay G.

AU - Madlock-Brown, Charisse

AU - Geary, Carol Reynolds

AU - Sills, Marion R.

AU - Thorpe, Lorna E.

AU - Szmuszkovicz, Jacqueline

AU - Tantisira, Kelan G.

AU - Snowden, Jessica

AU - Irby, Katherine

AU - Darden, Paul

AU - Dixon, Lexie

AU - Evans, Danielle

AU - Garbe, Connor

AU - Hobart-Porter, Laura

AU - Howard, Lee

AU - Hummel, Kathy

AU - Krehbiel, Hannah

AU - Spradlin, Haley

AU - Yount, Phaedra

AU - Elliott, Amy

AU - Adam, Grace

AU - Angal, Jyoti

AU - Barber, Maria

AU - Clark, Katelynne

AU - Dos Reis, Clayton

AU - Freesemann, Mandy

AU - Aschner, Judy

AU - Clouser, Katharine

PY - 2025/2

Y1 - 2025/2

N2 - Background: Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health. Methods: We conducted a retrospective cohort study of individuals <21 years seeking care at 24 health systems across the U.S, using electronic health record (EHR) data. Our cohort included those with a positive SARS-CoV-2 molecular, serology or antigen test, or with a COVID-19, multisystem inflammatory disease in children, or PASC diagnosis from February 29, 2020 to August 1, 2022. We identified children/youth with at least 2 codes associated with respiratory and neurologic PASC. We measured associations between sociodemographic and clinical characteristics and respiratory and neurologic PASC using odds ratios and 95% confidence intervals estimated from multivariable logistic regression models adjusted for other sociodemographic characteristics, social vulnerability index or area deprivation index, time period of cohort entry, presence and complexity of chronic respiratory (respectively, neurologic) condition and healthcare utilization. Findings: Among 771,725 children in the cohort, 203,365 (26.3%) had SARS-CoV-2 infection. Among children with documented infection, 3217 children had respiratory PASC and 2009 children/youth had neurologic PASC. In logistic regression models, children <5 years (Odds Ratio [OR] 1.78, 95% CI 1.62–1.97), and of Hispanic White descent (OR 1.19, 95% CI 1.05–1.35) had higher odds of having respiratory PASC. Children/youth living in regions with higher area deprivation indices (OR 1.25, 95% CI 1.10–1.420 for 60–79th percentile) and with chronic complex respiratory conditions (OR 3.28, 95% CI 2.91–3.70) also had higher odds of respiratory PASC. In contrast, older (OR 1.57, 95% CI 1.40–1.77 for those aged 12–17 years), non-Hispanic White individuals and those with chronic pre-existing neurologic conditions (OR 2.04, 95% CI 1.78–2.35) were more likely to have a neurologic PASC diagnosis. Interpretation: Racial and ethnic differences in healthcare utilization for neurologic and respiratory PASC may reflect social drivers of health and inequities in access to care. Funding: National Institutes of Health.

AB - Background: Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health. Methods: We conducted a retrospective cohort study of individuals <21 years seeking care at 24 health systems across the U.S, using electronic health record (EHR) data. Our cohort included those with a positive SARS-CoV-2 molecular, serology or antigen test, or with a COVID-19, multisystem inflammatory disease in children, or PASC diagnosis from February 29, 2020 to August 1, 2022. We identified children/youth with at least 2 codes associated with respiratory and neurologic PASC. We measured associations between sociodemographic and clinical characteristics and respiratory and neurologic PASC using odds ratios and 95% confidence intervals estimated from multivariable logistic regression models adjusted for other sociodemographic characteristics, social vulnerability index or area deprivation index, time period of cohort entry, presence and complexity of chronic respiratory (respectively, neurologic) condition and healthcare utilization. Findings: Among 771,725 children in the cohort, 203,365 (26.3%) had SARS-CoV-2 infection. Among children with documented infection, 3217 children had respiratory PASC and 2009 children/youth had neurologic PASC. In logistic regression models, children <5 years (Odds Ratio [OR] 1.78, 95% CI 1.62–1.97), and of Hispanic White descent (OR 1.19, 95% CI 1.05–1.35) had higher odds of having respiratory PASC. Children/youth living in regions with higher area deprivation indices (OR 1.25, 95% CI 1.10–1.420 for 60–79th percentile) and with chronic complex respiratory conditions (OR 3.28, 95% CI 2.91–3.70) also had higher odds of respiratory PASC. In contrast, older (OR 1.57, 95% CI 1.40–1.77 for those aged 12–17 years), non-Hispanic White individuals and those with chronic pre-existing neurologic conditions (OR 2.04, 95% CI 1.78–2.35) were more likely to have a neurologic PASC diagnosis. Interpretation: Racial and ethnic differences in healthcare utilization for neurologic and respiratory PASC may reflect social drivers of health and inequities in access to care. Funding: National Institutes of Health.

KW - Chronic COVID-19 syndrome

KW - Ethnicity

KW - Late sequelae of COVID-19

KW - Long COVID

KW - Long-haul COVID

KW - Long-term COVID-19

KW - PCORnet

KW - PEDSnet

KW - Post-COVID condition

KW - Post-COVID syndrome

KW - Post-acute COVID-19

KW - Post-acute sequelae of SARS-CoV-2 infection

KW - Race

KW - Social determinants of health

UR - http://www.scopus.com/inward/record.url?scp=85214267549&partnerID=8YFLogxK

U2 - 10.1016/j.eclinm.2024.103042

DO - 10.1016/j.eclinm.2024.103042

M3 - Article

SN - 2589-5370

VL - 80

JO - EClinicalMedicine

JF - EClinicalMedicine

M1 - 103042

ER -

Ethnic and racial differences in children and young people with respiratory and neurological post-acute sequelae of SARS-CoV-2: an electronic health record-based cohort study from the RECOVER Initiative

Abstract

ASJC Scopus subject areas

Keywords

UN SDGs

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