While early evidence and experience with coronavirus disease 2019 (COVID-19) suggests that children are less susceptible to infection and have a lower risk for symptomatic and severe disease, pediatric patients are not immune from the virus. We examined pediatric COVID-19 hospitalization trends in 22 states for indications of both severity among this population and spread of the virus.
Using data extracted from the University of Minnesota COVID-19 Hospitalization Tracking Project,1 we identified the 22 states that reported cumulative COVID-19 hospitalizations overall and for patients 19 years and younger (in some states younger than 17 or 14 years) between May 15, 2020, and November 15, 2020. The University of Minnesota institutional review board reviewed the study data and determined that it was not human subject research. We combined state-level hospitalization data with population estimates from the US Census.2 Cumulative pediatric COVID-19 hospitalizations per 100 000 children were calculated at regular time intervals, and growth rates were calculated on the changes in per capita hospitalizations. Cross-sectional analyses done include tabulations by state over time.
There were a total of 301 102 COVID-19 hospitalizations and 5364 pediatric COVID-19 hospitalizations in 22 states during the study period (Table). At the beginning of the study, the average cumulative hospitalization rate per 100 000 children was 2.0, increasing to 17.2 by the end of the study. There were large variations across states at the beginning and end of the study and in the extent of change in rates. For example, at the start of the study, Hawaii and Rhode Island had the lowest pediatric hospitalization rates at 0.0 per 100 000 children, whereas New Jersey and Colorado had the highest at 5.0 and 4.4 per 100 000 children. At the end of the study, Hawaii and New Hampshire had the lowest rates at 4.3 and 3.4 per 100 000 respectively and South Dakota and Arizona had the highest rates at 33.7 and 32.8 per 100 000. There was also significant variance between states in the magnitude of change from the beginning to the end of the study period, with rates in Hawaii and New Hampshire increasing by 4.3 and 1.0 per 100 000 compared with much larger growth in the rates in Arizona and South Dakota (32.0 and 31.2 per 100 000 respectively). Several states saw significant growth in 3 months, with Utah experiencing a 5067% increase from 0.3 hospitalizations to 15.5 per 100 000 at the high end, compared with 42% increase from 2.4 to 3.4 per 100 000 in New Hampshire. The Figure shows the percentage of cumulative COVID-19–related hospitalizations attributable to pediatric patients during the study period for each state.
Pediatric hospitalization rates for COVID-19 exhibit significant variation across states and over the course of the pandemic. When ordering the 20 states observed at the end of the study period, most ranked similarly for adult and pediatric hospitalization rates, with some notable exceptions: New Jersey ranked highest for adult hospitalizations in the sample by November 15 but only seventh highest for pediatric hospitalizations. Indiana also had a significant difference, ranking sixth highest for adult hospitalizations but only thirteenth highest for pediatrics. Similarly, Colorado was thirteenth highest for adult but sixth highest for pediatric hospitalizations.
Our results present concerning trends in pediatric hospitalizations. Adult, and especially geriatric, incidence of COVID-19 continues to dominate the national picture, but pediatric populations may require resources that are not readily available across the country. Our study is limited by including only states where breakdown of cumulative hospitalizations by age is available, leaving approximately 56% of states out of the analysis. Still, the states included in our analyses are geographically representative and include more than 29 million children in the United States. As conversations around in-person education continue, hospitalization growth may offer reasons for concern.
Corresponding Author: Pinar Karaca-Mandic, PhD, Carlson School of Management, 321 19th Ave S, Minneapolis, MN 55455 (pkmandic@umn.edu).
Accepted for Publication: September 23, 2020.
Published Online: January 11, 2021. doi:10.1001/jamapediatrics.2020.5535
Author Contributions: Dr Karaca-Mandic had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Levin, Choyke, Georgiou, Karaca-Mandic.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Levin, Choyke, Sen, Karaca-Mandic.
Obtained funding: Karaca-Mandic.
Administrative, technical, or material support: Choyke, Sen.
Supervision: Georgiou, Karaca-Mandic.
Conflict of Interest Disclosures: Dr Karaca-Mandic reports funding from the University of Minnesota, Office of Academic Clinical Affairs, and grants from United Health Foundation during the conduct of the study; personal fees from Tactile Medical, Precision Health Economics, and Sempre Health; and grants from Agency for Healthcare Research and Quality, the American Cancer Society, the National Institute for Health Care Management, the National Institute on Drug Abuse, and the National Institutes of Health outside the submitted work. Dr Georgiou reports personal fees from HealthGrades outside the submitted work. No other disclosures were reported.
Funding/Support: This research uses publicly available data from the University of Minnesota COVID-19 Hospitalization Project, which is partially funded by the University of Minnesota Office of Academic Clinical Affairs and United Health Foundation. Although the age breakdown of hospitalizations are not reported on the project website, data can be requested from the project team.
Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Yi Zhu, MA, doctoral student at the Carlson School of Management, University of Minnesota, contributed to this project by helping launch the University of Minnesota COVID-19 Hospitalization Project website. Yi Zhu did not receive compensation. Khoa Vu, doctoral student in Applied Economics, University of Minnesota, provided research assistance with data collection. Mr Vu was compensated as a research assistant.