COVID-19 Pandemic
COVID-19 hospitalizations and hospitalization outcomes among children with immunocompromising conditions, MarketScan Commercial Database, 2020-2022 Regina M. Simeone* Regina Simeone Emilia H. Koumans Angela P. Campbell
People who are immunocompromised are at increased risk for infections compared with those who are not. Our objectives were to assess the association between presence of immunocompromising conditions (IC) in children and COVID-19 hospitalization, and whether hospitalization outcomes occurred more frequently in children with IC compared to those without. Using the MarketScan® Commercial Databases from January 1, 2020–December 31, 2022, eligible children were 0–17 years, continuously enrolled in participating insurance plans for ≥2 years, with ≥1 outpatient encounter. We identified children with IC as having ≥1 IC ICD-10-CM code(s) during a hospitalization, or ≥2 outpatient encounters with IC ICD-10-CM codes. Age, sex, and geographic region of residence were included in all models. We used Poisson regression with robust standard errors, additionally adjusted for non-COVID-19 hospitalizations to estimate the risk ratio (RR) and 95% confidence interval (CI) for any COVID-19 hospitalization. For models of COVID-19 hospitalization outcomes, we additionally adjusted for year and non-COVID-19 hospitalizations before first COVID-19 hospitalization. A negative binomial distribution was used to model hospital length of stay. We included 3,116,239 children; 90,043 (2.9%) had IC and 78,855 (2.5%) had ≥1 hospitalization. Among 3,193 COVID-19 hospitalizations, 1,000 (31.3%) had an IC diagnosis. Compared to those without, children with IC were 5.8 times more likely to have a COVID-19 hospitalization (CI: 5.2, 6.4); among children with ≥1 hospitalization, those with IC were 1.3 times more likely to have a hospitalization with COVID-19 (CI: 1.2, 1.4). Among children with a COVID-19 hospitalization, those with IC were more likely to be admitted to the intensive care unit and be re-admitted within 30 days of COVID-19 hospitalization (RRs=1.2) (Figure). Future work should assess drivers of COVID-19 hospitalization, specific IC, and hospitalization outcomes among children with IC.
