Impact of underlying conditions on COVID-19 severity


In adults, certain health conditions were linked to a greater risk of hospitalization and severe COVID-19 infection. A report examines whether this is true in the pediatric population.

Although adult COVID-19 cases have declined dramatically, with nationwide numbers hitting lows not seen since before the pandemic’s beginning in March 2020, the number of cases and hospitalizations for the disease in children continues to climb. This outbreak makes understanding what conditions are linked to severe illness more important than ever. A report in JAMA Network Open offers essential insight.1

Investigators collected data from the Premier Healthcare Database Special COVID-19 Release, which had data from over 800 hospitals in the United States. They included patients aged 18 years and younger who had International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes of either U07.1 (COVID-19) or B97.29 (other coronavirus) at an emergency department or inpatient encounter from March 2020 to January 2021.

There were 43,655 patients aged 18 years and younger who had COVID-19; 12,491 of those patients had an underlying medical condition. Among the patients with an underlying medical condition, the most common diagnoses included were asthma (4416 [10.2%]), neurodevelopmental disorders (1690 [3.9%]), anxiety and fear-related disorders (1374 [3.2%]), depressive disorders (1209 [2.8%]), and obesity (1071 [2.5%]). The strongest risk factors for hospitalization were found with obesity (adjusted risk ratio [aRR], 3.07; 95% CI, 2.66-3.54) and type 1 diabetes (aRR, 4.60; 95% CI, 3.91-5.42). For severe illness, the strongest risk factors found were cardiac and circulatory congenital anomalies (aRR, 1.72; 95% CI, 1.48-1.99) as well as type 1 diabetes (aRR, 2.38; 95% CI, 2.06-2.76). In children aged younger than 2 years, prematurity was a noted risk factor for severe illness (aRR, 1.83; 95% CI, 1.47-2.29). Having a chronic or a complex chronic disease were also risk factors for severe illness , with aRRs of 1.95 (95% CI, 1.69-2.26) and 2.86 (95% CI, 2.47-3.32), respectively, and hospitalization, with aRRs of 2.91 (95% CI, 2.63-3.23) and 7.86 (95% CI, 6.91-8.95), respectively.

The investigators concluded that children with medical complexity as well as certain conditions such as obesity or cardiac and circulatory congenital anomalies had a higher risk of having severe COVID-19. For patients who have medically complex conditions or these underlying conditions, clinicians should consider cautious management and close observation when COVID-19 is suspected.


1. Kompaniyets L, Agathis N, Nelson J, et al. Underlying medical conditions associated with severe COVID-19 illness among children. JAMA Netw Open. 2021;4(6):e2111182. doi:10.1001/jamanetworkopen.2021.11182

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Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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