Poverty increases risk of COVID-19 hospitalization in children


In a recent study, investigators found that children from socioeconomically depraved families were more likely to be hospitalized from COVID-19.

Children from low-income families are at a greater risk of severe COVID-19, according to a recent study.

Risk of severe COVID-19 has been notes as lower in younger children compares to adults, but critical cases have occurred. Research on the causes of severe COVID-19 in children is ongoing, but socioeconomic factors have been hypothesized to play a role in risk of severity.

Prior studies linked low-income to severe COVID-19 in adults, but not children. In Germany, investigators studied the association between socioeconomic factors on severe COVID-19 in children.

Data was taken from the Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, which insured individuals in certain regions of Germany. A total of 688,075 children insured for at least 1 day within the observation period were included in the study.

COVID-19 was diagnosed based on guidelines from the World Health Organization. In cases of multiple COVID-19 hospitalizations in an individual, only the first was included in the study.

Socioeconomic characteristics included degree of urbanization of the community of residence, mean living space per inhabitant in the district of residence, and median income in the district of residence. Postal code was used to separate areas.

Comorbidities were identified using the ICD-10-GM 2019 diagnostic codes and were considered present if at least 1 diagnosis was given from 2019 to 2021.

The mean age of participants was 8.3 years. In this age group, COVID-19 hospitalization was uncommon. Of these cases, a major proportion were from families suffering from long-term unemployment. Increased risk was also seen in children whose parents had low-wage employment.

Households where the insurance owner had gainful employment saw the lowest rates of crude incidence.

Low area-level income, smaller mean living space, and higher degree of urbanization all increased the risk of COVID-19 hospitalization. These incidence rates increased in cases of comorbidity.

Children living in the area with the lowest median income were 3 times more likely to be hospitalized from COVID-19 than those in the area with the highest median income. Outcomes were similarly drastic based on living space. Children who used immunosuppressants or had diabetes saw an even higher risk of COVID-19 hospitalization.

Investigators initially hypothesized that predisposing diseases more frequent in socioeconomically deprived families, such as asthma and obesity, would mediate risk factors. However, no data from the study supported this hypothesis.

Findings were consistent with those from studies which focused on adults, and indicated that socioeconomic depravation increases risk of children contracting severe COVID-19. Investigators concluded that further research should be conducted on social inequality during the pandemic, especially among children.


Dragano N, Dortmann O, Timm J, Mohrmann M, Wehner R, Rupprect CJ, et al. Association of household deprivation, comorbidities, and COVID-19 hospitalization in children in germany, January 2020 to July 2021. JAMA Netw Open. 2022;5(10):e2234319. doi:10.1001/jamanetworkopen.2022.34319

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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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