Social Determinants of Health Patterns in Children with Severe Disease Due to SARS-CoV-2 Infection—An Exploratory Approach

TL;DR

This study found that social factors like caregiver drug/alcohol use and lack of support are linked to severe pediatric COVID-19.

Contribution

Identified specific social determinants of health patterns associated with severe pediatric SARS-CoV-2 outcomes.

Findings

Caregiver drug/alcohol use was strongly linked to severe pediatric COVID-19 (OR: 5.92).

Social discrimination and lack of support were also associated with severe disease (OR: 1.74).

Combinations of social risk factors may have a greater impact on disease severity than individual factors.

Abstract

What are the main findings?
Families with children with SARS-CoV-2 infection reported a high level of adverse social determinants of health. Two adverse social determinants of health patterns (caregiver use of drugs/alcohol and social discrimination/lack of support) were associated with severe pediatric COVID-19.

Families with children with SARS-CoV-2 infection reported a high level of adverse social determinants of health. Two adverse social determinants of health patterns (caregiver use of drugs/alcohol and social discrimination/lack of support) were associated with severe pediatric COVID-19.

What are the implications of the main findings?
Combinations of adverse social determinants of health in children may have a higher impact on disease severity than in isolation. Our results can inform future studies and the development of tailored interventions to address these patterns of social risk factors.

Combinations of adverse social determinants of health in children may have a higher impact on disease severity than in isolation. Our results can inform future studies and the development of tailored interventions to address these patterns of social risk factors.

Background/Objectives: Research on the association of adverse social determinants of health (SDOH) with severe pediatric coronavirus disease (COVID-19) is limited. We examined associations between SDOH patterns and COVID-19 severity in children. Methods: We conducted a prospective, observational study of children (<18 years) with symptomatic SARS-CoV-2 infection evaluated in an urban pediatric emergency department (March 2021–April 2022) in Detroit, Michigan. Caregivers completed a 34-item survey based on the Healthy People 2030 framework. Severe disease was defined as the occurrence of respiratory/cardiac failure or death within four weeks of diagnosis. Continuous and categorical variables were described using medians and percentages, respectively. Associations between disease severity and risk factors were determined using chi-square tests. Association rule mining was used for feature selection, followed by multivariate logistic regression. Results: We analyzed data from 354 children [6–12 years: 31.1%, Female: 51.1%, Black: 59%, not Hispanic: 84.7%, public insurance: 77.1%, chronic condition: 27.4%]. Of the total, 113 children had severe disease. Most caregivers were 30–44 years old (53.1%), had less than a college degree (70.4%), and income < USD 50,000 (75.2%). Adverse SDOH reported included food/housing insecurity (24.6%), no support (64.7%), unmet childcare needs (35.9%), and lack of transportation (12.7%). After controlling for age, sex, medical history, income, and obesity, severe disease was associated with caregiver use of drugs/alcohol (OR:5.92, p < 0.001) and social discrimination/lack of support (OR: 1.74, p = 0.030). Conclusions: Two SDOH patterns (caregiver use of drugs/alcohol and social discrimination/lack of support) were associated with severe COVID-19. Further studies are needed to confirm findings and develop interventions.

Figures