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  • Population Study Article
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Clinical and healthcare utilization outcomes during the 6 months following COVID infection in children

Pediatric Research volume 95, pages 342–349 (2024)Cite this article

Abstract

Background

We aimed to identify the impact of COVID infection in children in the US prior to vaccine availability on clinical and healthcare utilization outcomes within 6 months of infection.

Methods

Using claims data from a large national insurer, we identified 223,842 children with a COVID diagnosis in May 2020–March 2021 and matched them to 223,842 children with a COVID test and no diagnosis. We compared the two cohorts’ outcomes during the 6 months after infection/test.

Results

Uncommon acute adverse events occurring in <0.5% of cases, including MIS-C (relative risk (RR) = 45.2), myocarditis (RR = 10.3), acute heart failure (RR = 2.14), sepsis (RR = 2.02), and viral pneumonia (RR = 2.43) were more frequent in the COVID cohort (all p < 0.001). Development of arrhythmias (RR = 1.24, p < 0.001) and atherosclerotic cardiovascular disease (RR = 1.41, p = 0.007) were more common in the COVID group, while behavioral health disorders were less common (RR = 0.94, p < 0.001). Lab testing and imaging were slightly higher in the COVID group (RR ranging 1.05–1.11 depending on the service and timeframe), though medical costs did not increase.

Conclusion

Severe disease and diagnoses of new conditions are rare in children following COVID infection. We observed an increase in cardiac complications, though they may not last long term.

Impact

  • Few studies have analyzed the association between COVID infection and medium-term outcomes in children.

  • Our study of >447,000 geographically and socioeconomically diverse children in the US found that uncommon acute adverse events, including myocarditis, MIS-C, and acute heart failure, were more frequent in children with COVID than matched controls, and development of arrhythmias and cardiovascular disease were 1.2 and 1.4 times more common, respectively.

  • Six-month healthcare utilization was similar between cohorts.

  • We provide data on the risks of COVID in children, particularly with respect to cardiac complications, that decision makers may find useful when weighing the benefits and harms of preventive measures.

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Fig. 1: Healthcare utilization outcomes.
Fig. 2: Healthcare cost outcomes.

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Data availability

The data used for this study included proprietary health claims and clinical data. Further information concerning access to a limited dataset would be provided upon reasonable request to the corresponding author.

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Acknowledgements

The authors would like to acknowledge Kerrin Gallagher for her assistance in variable creation.

Funding

The authors all are (or were at the time the study was conducted) employees of Elevance Health, Inc., or its subsidiary, Carelon Research. This study was conducted as part of employment duties and the authors did not receive additional funding for this research.

Author information

Authors and Affiliations

  1. Public Policy Institute, Elevance Health, Inc., Indianapolis, IN, 46204, USA

    Aliza S. Gordon & Sonali Shambhu

  2. Carelon Research, Wilmington, DE, 19801, USA

    Yaoxuan Xia

  3. Population Health Management Support, Elevance Health, Inc., Indianapolis, IN, 46204, USA

    Peter N. Bowers

  4. Health Economics, Elevance Health, Inc., Indianapolis, IN, 46204, USA

    Sue Sloop

  5. Medicare Clinical Operations, Elevance Health, Inc., Indianapolis, IN, 46204, USA

    Eugene Hsu

  6. Stanford University School of Medicine, Stanford, CA, 94305, USA

    Eugene Hsu

Authors
  1. Aliza S. Gordon
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  4. Peter N. Bowers
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Contributions

A.S.G. designed the study and the analytic strategy. S. Shambhu and Y.X. obtained and analyzed the data. S. Shambhu and A.S.G. prepared the tables and figure. A.S.G., S. Shambhu, E.H., P.N.B., and S. Sloop interpreted the data. A.S.G. and Y.X. conducted the literature search. S. Shambhu and A.S.G. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. A.S.G. wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the version to be published.

Corresponding author

Correspondence to Aliza S. Gordon.

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Competing interests

The authors all are (or were at the time the study was conducted) employees of Elevance Health, or its subsidiary, Carelon Research. As employees of Elevance Health, A.S.G., E.H. P.N.B., S. Shambhu, and S. Sloop hold Elevance Health stocks. E.H. is an advisor with stock options and a shareholder in Hello Pediatrics, a general pediatric telehealth company not specifically focused in COVID management.

Ethics approval

This observational study, conducted under the Research Exception provisions of Privacy Rule 45 CFR 164.514(e), was approved under Exempt Category by the WCB Institutional Board Review.

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Gordon, A.S., Shambhu, S., Xia, Y. et al. Clinical and healthcare utilization outcomes during the 6 months following COVID infection in children. Pediatr Res 95, 342–349 (2024). https://doi.org/10.1038/s41390-023-02762-4

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