Reported today in JAMA Paediatrics, the largest population study of COVID-19 in children to date suggests a link between ethnicity and COVID-19, with important implications for global public health strategies to combat the virus, such as access to tests.
In their study, a research team from the Universities of Oxford, Leicester, Nottingham, Cambridge and Southampton analysed a nationally-representative sample of 2,576,353 electronic healthcare records in children to understand whether the established link between ethnicity and COVID-19 in adults was similar in children.
Overall, 410,726 (15.9% of the total cohort) children in the analysis were tested for SARS-CoV-2, with 26,322 (6.4% of children tested) receiving a positive test and 343 (0.01% of the total cohort) admitted to hospital. The study found that COVID-19 testing in children varied across race and ethnicities - 17.1% of white children in the study were tested for SARS-CoV-2 compared with 13.6% of Asian children, 12.9% of children from mixed/other ethnicities, and 8.3% of Black children.
Compared with white children, the odds of a positive test were higher in children from Asian (1.8 times more likely), Black (1.12 times more likely) and mixed/other ethnicity (1.14 times more likely) backgrounds.
Asian children were 1.62 times more likely to be admitted to hospital with confirmed COVID-19 compared with white children, while Black, mixed race and children from other ethnicities were more likely to remain in hospital for 36 hours or longer compared with white children. There was one death in the study cohort.
Lead author Dr Defne Saatci, a DPhil student in the University of Oxford’s Nuffield Department of Primary Care Health Sciences, who conceived the project, said “This is the largest observational study yet of COVID-19 in children, and highlights disparities in testing, infection rates and hospitalisation linked to ethnic minority children, with important implications for families, doctors and policymakers.”
Co-author Professor Julia Hippisley-Cox, lead of the Primary Care Epidemiology Group at Oxford University’s Nuffield Department of Primary Care Health Sciences, said “While children are at a substantially lower risk from COVID-19 compared with adults, this study suggests that race and ethnicity play an important role in outcomes for COVID-19 across all age groups. Our findings reinforce the need for ethnicity-tailored approaches to diagnosing and managing COVID-19 in community settings, so those families at most risk of severe illness are better informed and have greater access to tests.”
The observed unequal testing across different races and ethnicities in this study supports similar findings from the US, providing a clearer picture of inequity in healthcare access across the two nations. In their analysis, the researchers accounted for key demographic factors such as age, sex, geography, deprivation and household size, in addition to underlying health conditions. They caution that due to the observational nature of the study certain biases could not be ruled out, which should be considered before drawing any further conclusions.
Data for the analysis was obtained between January and November 2020 from QResearch, a database of anonymised health records from 1,300 GP practices across England and linked to COVID-19 test results and hospital admissions data. The research was funded jointly by UK Research and Innovation and the National Institute for Health Research.
Association between race/ethnicity and COVID-19 outcomes in 2.6 million children in England.
Defne Saatci, Tom A Ranger, Cesar Garriga, Ash Kieran Clift, Francesco Zaccardi, Pui San Tan, Martina Patone, Carol Coupland, Anthony Harnden, Simon J Griffin, Kamlesh Khunti, Hajira Dambha-Miller, Julia Hippisley Cox.
JAMA Paediatrics 2021