Social Determinants of Health and Pediatric Long COVID in the US.
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Rhee Kyung E, Thaweethai Tanayott, Pant Deepti B, Stein Cheryl R, Salisbury Amy L, Kinser Patricia A, Kleinman Lawrence C, Gallagher Richard, Warburton David, Mohandas Sindhu, Snowden Jessica N, Stockwell Melissa S, Tantisira Kelan G, Flaherman Valerie J, Teufel Ronald J, Castro Leah, Chung Alicia, Espinoza Esparza Jocelyn, Hockett Christine W, Isidoro-Chino Maria, Krishnan Anita, McCormack Lacey A, Nabower Aleisha M, Nahin Erica R, Rosas Johana M, Siddiqui Sarwat, Szmuszkovicz Jacqueline R, Vangeepuram Nita, Zimmerman Emily, Brown Heather-Elizabeth, Carmilani Megan, Coombs K, Fisher Liza, Witvliet Margot Gage, Wood John C, Milner Joshua D, Rosenzweig Erika B, Irby Katherine, Karlson Elizabeth W, Qian Zihan, Lamendola-Essel Michelle F, Hasson Denise C, Katz Stuart D, Yin H Shonna, Foulkes Andrea S, Gross Rachel S, RECOVER-Pediatrics Group; and the ABCD-RECOVER Group; for the RECOVER-Pediatrics Consortium, Aschner Judy L, Atz Andrew M, Banerjee Dithi, Bogie Amanda, Bukulmez Hulya, Clouser Katharine, Cottrell Lesley A, Cowan Kelly, D'Sa Viren A, Dozor Allen J, Elliott Amy J, Faustino E Vince S, Fiks Alexander G, Gaur Sunanda, Gennaro Maria L, Gordon Stewart T, Hasan Uzma N, Hester Christina M, Hogan Alexander H, Hsia Daniel S, Kaelber David C, Kosut Jessica S, Krishnan Sankaran, McCulloh Russell J, Michelow Ian C, Nolan Sheila M, Oliveira Carlos R, Pace Wilson D, Palumbo Paul, Raissy Hengameh, Reyes Andy, Ross Judith L, Salazar Juan C, Selvarangan Rangaraj, Stevenson Michelle D, Werzberger Alan, Westfall John M, Zani Kathleen, Zempsky William T, Chan James, Metz Torri D, Newburger Jane W, Truong Dongngan T, Feldman Candace H, Aupperle Robin, Baker Fiona C, Banich Marie T, Barch Deanna M, Baskin-Sommers Arielle, Bjork James M, Dapretto Mirella, Brown Sandra A, Casey B J, Chang Linda, Clark Duncan B, Dale Anders M, Ernst Thomas M, Fair Damien A, Feldstein Ewing Sarah W, Foxe John J, Freedman Edward G, Friedman Naomi P, Garavan Hugh, Gee Dylan G, Gonzalez Raul, Gray Kevin M, Heitzeg Mary M, Herting Megan M, Jacobus Joanna, Laird Angela R, Larson Christine L, Lisdahl Krista M, Luciana Monica, Luna Beatriz, Madden Pamela A F, McGlade Erin C, Müller-Oehring Eva M, Nagel Bonnie J, Neale Michael C, Paulus Martin P, Potter Alexandra S, Renshaw Perry F, Sowell Elizabeth R, Squeglia Lindsay M, Uddin Lucina Q, Wilson Sylia, Yurgelun-Todd Deborah A
Аннотация
OBJECTIVE: To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n = 903) and adolescents (12-17 years; n = 3681) with SARS-CoV-2 infection history were included. Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded. Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024.
EXPOSURE: Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality. Latent classes were created within each domain and used in regression models.
MAIN OUTCOMES AND MEASURES: Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices.
RESULTS: The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male. The number of latent classes varied by domain; the reference group was the class with the least adversity. In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID. After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23). Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results.
CONCLUSIONS AND RELEVANCE: In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID. Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID. Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.