Age and geographic heterogeneity in COVID-19 outcomes among young children and parental practices in China.

OBJECTIVES

This study examines age and geographic disparities in COVID-19 outcomes among Chinese children aged 0-6 years during China's rapid policy transition (December 2022-January 2023), and evaluates the protective role of parental caregiving practices.

METHODS

A cross-sectional online survey leveraging a natural experiment during China's COVID-19 policy shift. Data were collected from 48,332 households through randomized national sampling, stratified by urban/rural and North/South residency. Chi-square tests (SPSS 22.0) and latent class analysis (Mplus 7.0) assessed disparities in infection status, symptom severity, healthcare access, and medication use, alongside parental response patterns.

RESULTS

Age-mediated disparities: Significant gradients in infection rates (χ2 = 30.060, p < 0.001), symptom severity (χ2 = 20.626, p < 0.001), and healthcare access (χ2 = 90.876, p < 0.001), with children aged 3-6 experiencing milder outcomes than infants (0-1 years) and toddlers (1-3 years). Geospatial inequities: Urban-rural gaps in infections (χ2 = 58.713, p < 0.001) and North-South disparities in medication use (χ2 = 71.160, p < 0.001), with urban northern children most vulnerable. Parental buffering effects: Parents have exhibited a notably proactive stance and practices in response to the COVID-19 pandemic.

CONCLUSIONS

COVID-19 infections in children vary by age and region, with parents playing a crucial role in home-based care. Policy responses should prioritize (1) parent-led protection programs and (2) targeted medical resource allocation to high-risk regions to ensure equitable pandemic recovery.