US child COVID hospital rates vary widely by state, time

Rates of pediatric COVID-19 hospitalizations have varied dramatically across US states and more than tripled from May to November, raising concerns that specialized medical resources for children may not be available at the time and place they are needed, according to a research letter published yesterday in JAMA Pediatrics.

A team led by researchers from the University of Minnesota in Minneapolis used state-level hospitalization data and US Census information to assess COVID-19 hospitalization trends among patients 19 years and younger in 22 states.

From May 15 to Nov 15, 2020, a total of 301,102 Americans were hospitalized with COVID-19, 5,364 of them children. In mid-May, the average cumulative hospitalization rate per 100,000 children was 2.0, which increased to 7.2 by mid-November.

Pediatric coronavirus hospitalization rates varied widely over the study period. When the study started, Hawaii and Rhode Island had no pediatric cases, compared with New Jersey and Colorado, which had the highest rates, at 5.0 and 4.4 per 100,000 children, respectively.

By the end of the study, Hawaii still had a low rate (4.3 per 100,000 children), but New Hampshire had the lowest rate, at 3.4 per 100,000. South Dakota and Arizona had the highest rates (33.7 and 32.8 per 100,000, respectively).

From 42% to 5,067% change in 3 months

The degree of change from the beginning to the conclusion of the study period also varied substantially between states. While pediatric hospitalization rates in Hawaii and New Hampshire increased by 4.3 and 1.0 per 100,000, rates in Arizona and South Dakota jumped by 32.0 and 31.2 per 100,000, respectively.

Some states experienced a significant hike in pediatric hospitalizations over 3 months. Utah saw the largest increase (5,067%), from 0.3 to 15.5 per 100,000, and New Hampshire witnessed the lowest (42%), from 2.4 to 3.4 per 100,000.

Most of the 20 states observed at the end of the study period ranked similarly in adult and pediatric hospitalizations, except for New Jersey, which had the most adult hospitalizations by Nov 15 but ranked seventh in pediatric hospitalizations, and Indiana, which had the sixth-highest rate of adult hospitalizations but the 13th-highest in children. Colorado was 13th-highest in adult hospitalizations but sixth-highest for children. 

The authors remarked that the trends observed in pediatric hospitalizations were worrisome because, although adult—particularly geriatric—COVID-19 infections remain much more common than those in children, pediatric patients may require life-saving treatments that are in short supply or even unavailable in some regions of the country.

And while the study involved only 44% of the US states (those with available breakdown of cumulative hospitalizations by age), "the states included in our analyses are geographically representative and include more than 29 million children in the United States," the authors wrote.

"As conversations around in-person education continue, hospitalization growth may offer reasons for concern."

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