A study conducted in United Kingdom study found a high prevalence of poor mental health and wellbeing among all children and adolescents aged 11–17 years during the pandemic, but no difference among those with positive and negative SARS-CoV-2 test results. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00022-0/fulltext
The study findings were published in the U.S. CDC’s journal: Morbidity and Mortality Weekly Report (MMWR)
https://www.cdc.gov/mmwr/volumes/71/wr/mm7131a3.htm
Post–COVID-19 (post-COVID) symptoms and conditions* are new, recurring, or ongoing health problems that occur 4 or more weeks after infection with SARS-CoV-2 (the virus that causes COVID-19). Previous studies have characterized and estimated the incidence of post-COVID conditions among adults (1,2), but data among children and adolescents are limited (3–8). Using a large medical claims database, CDC assessed nine potential post-COVID signs and symptoms (symptoms) and 15 potential post-COVID conditions among 781,419 U.S. children and adolescents aged 0–17 years with laboratory-confirmed COVID-19 (patients with COVID-19) compared with 2,344,257 U.S. children and adolescents without recognized COVID-19 (patients without COVID-19) during March 1, 2020–January 31, 2022. The analysis identified several symptoms and conditions with elevated adjusted hazard ratios among patients with COVID-19 (compared with those without).
The highest hazard ratios were recorded for acute pulmonary embolism (adjusted hazard ratio [aHR] = 2.01), myocarditis and cardiomyopathy (1.99), venous thromboembolic event (1.87), acute and unspecified renal failure (1.32), and type 1 diabetes (1.23), all of which were rare or uncommon in this study population. Conversely, symptoms and conditions that were most common in this study population had lower aHRs (near or below 1.0).
CDC analyzed linked medical claims and commercial laboratory data for persons with a health care encounter possibly related to COVID-19.† Analyses were restricted to children and adolescents aged 0–17 years who were continuously enrolled in a health insurance plan during March 1, 2019–January 31, 2022. Children and adolescents aged 0–17 years with laboratory-confirmed COVID-19 and those without recognized COVID-19§ were matched 1:3 based on age at encounter, sex, and month of index date.
Patients were followed for a minimum of 60 days and a maximum of 365 days or until January 31, 2022, whichever occurred first. Scientific literature on symptoms and conditions associated with post-COVID illness among children or adults was reviewed (1–5). Symptoms and conditions were identified by the first occurrence and classified based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes documented 31–365 days after the index date but not during the 7–365 days preceding the index date.**
The incidences (occurrence per 100,000 person-years) of nine potential post-COVID symptoms and 15 potential post-COVID conditions among children and adolescents aged 0–17 years were calculated. Separate Cox proportional hazards models were used to estimate aHRs for each symptom and condition, after excluding persons with that particular symptom or condition during the 7–365 days preceding the index date. All models were adjusted for age, sex, race, U.S. Census Bureau region, payor type, previous medical complexity (10), and previous hospitalization.
The same models were estimated separately for three age groups (2–4, 5–11, and 12–17 years).¶¶ A sensitivity analysis was performed to assess the incidences of potential post-COVID symptoms and conditions among children and adolescents aged 0–17 years who had not experienced any of the 24 assessed symptoms or conditions before the index date.*** Finally, incidence of each symptom and condition among patients with COVID-19 was plotted against aHRs from the main analysis. Analyses were conducted using R software (version 4.1.0; R Foundation); p-values <0.05 were considered statistically significant. This activity was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.
During March 1, 2020–January 31, 2022, a total of 781,419 patients aged 0–17 years with COVID-19 and 2,344,257 patients aged 0–17 years without COVID-19 were identified (Table 1). The median age of both patients with and without COVID-19 was 12 years, and 50.0% in both groups were female; 72.2% of patients with COVID-19 were enrolled in Medicaid managed care, compared with 70.6% of patients without COVID-19. Patients without COVID-19 had a higher prevalence of previous hospitalization (4.5%) and complex chronic disease (15.6%), than did patients with COVID-19 (3.6% and 11.7%, respectively).
Patients with COVID-19 were significantly more likely than were those without to develop the following assessed post-COVID symptoms: smell and taste disturbances (aHR = 1.17), circulatory signs and symptoms (1.07), malaise and fatigue (1.05), and musculoskeletal pain (1.02) (Table 2). Patients with COVID-19 were also more likely than were those without to develop the following assessed post-COVID conditions: acute pulmonary embolism (2.01), myocarditis and cardiomyopathy (1.99), venous thromboembolic event (1.87), acute and unspecified renal failure (1.32), type 1 diabetes (1.23), coagulation and hemorrhagic disorders (1.18), type 2 diabetes (1.17), and cardiac dysrhythmias (1.16). Patients with COVID-19 were less likely than were those without to experience respiratory signs and symptoms (0.91), symptoms of mental conditions (0.91), sleeping disorders (0.91), neurological conditions (0.94), anxiety and fear-related disorders (0.85), mood disorders (0.78), and muscle disorders (0.94); no significant associations were found for the remaining five symptoms and conditions.
In age-stratified analysis of three age groups (2–4, 5–11, and 12–17 years), the unadjusted incidences of symptoms and conditions differed by age group (Supplementary Table, https://stacks.cdc.gov/view/cdc/118760). Among children aged 2–4 years, the highest aHRs for patients with COVID-19 compared with patients without COVID-19 were for myocarditis and cardiomyopathy (aHR = 2.39), acute and unspecified renal failure (1.52), and coagulation and hemorrhagic disorders (1.47) (Table 3). Unlike other age groups, children aged 2–4 years had higher rates of asthma diagnosis (1.12) and respiratory signs and symptoms (1.07) after COVID-19. Among children aged 5–11 years, the highest aHRs for patients with COVID-19 compared with those without were for myocarditis and cardiomyopathy (2.84), venous thromboembolic event (2.69), and acute and unspecified renal failure (1.38). Among patients aged 12–17 years, the highest aHRs for those with COVID-19 compared with those without were for acute pulmonary embolism (2.03), myocarditis and cardiomyopathy (1.66), and venous thromboembolic event (1.52).
The sensitivity analysis of 396,336 patients with COVID-19 and 792,672 matched patients without COVID-19 (without previous symptoms or conditions of interest) found that patients in both groups were healthier at baseline than their counterparts in the main cohort; 84.2% of persons with COVID-19 and 84.8% patients without COVID-19 had no previous documentation of chronic disease, compared with 64.8% and 56.7%, respectively in the main cohort (Table 1). Higher rates of five symptoms and six conditions among patients with COVID-19 compared with those without were found in the sensitivity analysis, whereas the main analysis found higher rates of four symptoms and eight conditions. In the sensitivity analysis, aHRs for type 1 diabetes and venous thromboembolic event were not statistically significant, and the aHR for respiratory signs and symptoms was elevated (1.16) (Table 2).
Analysis of the relationship between incidence rates among patients with COVID-19 and aHRs found that five post-COVID conditions with the highest aHRs had low incidence rates, ranging from 23 (acute pulmonary embolism) to 140 (type 1 diabetes) per 100,000 person-years (Supplementary Figure, https://stacks.cdc.gov/view/cdc/118761). Conversely, this analysis found that five symptoms and conditions with the highest incidence rates among patients with COVID-19 had lower aHRs (near or below 1.0): respiratory signs and symptoms (0.91), musculoskeletal pain (1.02), anxiety and fear-related disorders (0.85), gastrointestinal and esophageal disorders (1.01), and asthma (1.00).
