Household deprivation, comorbidities and COVID-19 hospitalization in 690,115 children/adolescents

Abstract Background Studies document that adults in disadvantaged socio-economic positions have elevated risks of a severe course of COVID-19, but it is unclear if this holds true for children. We investigate in this population-based study whether young people from socio-economically disadvantaged households in Germany had a higher risk of COVID-19 hospitalization compared with more affluent counterparts. We also examined if differences were related to comorbidities that predict severe courses in children. Methods We included data from all 690,115 children and adolescents (0-18 years) enrolled in a statutory health insurance carrier. Daily hospital diagnoses of COVID-19 were recorded from 1.1.2020 to 13.7.2021. Logistic regressions were used to compare children from households with an indication of poverty (e.g. long- or short-term unemployed) with children from households with insurance holders in regular employment. We also assessed socio-economic characteristics of the area of residence. We controlled for age, sex, days under observation, nationality, and comorbidities (e.g. obesity). Findings A COVID-19 hospital diagnosis was a rare event (n = 1637). Children of long-term unemployed parents had a 1·36 times (95% CI 1·21-1·51) higher adjusted odds of hospitalization compared with those of employed parents. Elevated odds were also found for short-term unemployed or low-wage employment. Those living in poor areas had a 3·02 (1·81-5·22) higher odds of hospitalization than those in less deprived areas. Comorbidities were strongly related to hospitalization, but their adjustment did not change main estimates for household deprivation. Discussion Results suggest that children from poor households are at higher risk of severe courses of COVID-19 than their affluent counterparts. This underlies the need to implement effective Public Health strategies to protect deprived children from COVID-19 and other infectious disease even in high income countries such as Germany. Key messages • Children and adolescents from poor families seem to be at higer risk for sever courses of COVID-19. • Comorbidities were no key mediating factor in this study.


Introduction:
The screening and management of obesity, metabolic chronic conditions conditions and genetic predisposition, before and during pregnancy, improve the effects of therapies and reduce the rate congenital diseases, metabolic fetal disorders and early chronic diseases during first 1000days. The maternal child health promotion program 'Future in Pediatrics' is dedicated to women in preconception and in early pregnancy, with three steps: 1) a specific survey, 2) a personalisated plan 3) the management of chronic conditions (diabetes, hypertension, overweight, metabolic disorders) and surveillance during the first maternal child 1000 days. Encouraged results

Methods:
In 2019-2021, FUTURA project involved 460 women (before,during and after pregnancy) into 2 groups: group 1 of 280 women, with overweight/ obesity, metabolic conditions, malnutrition, and hypovitaminosis, group 2 of 180 women without chronic conditions, but physical inactivity, high level of homocysteine (60 to 100 mmol/L) and with predisposition for cardiovascular diseases. We have involved the patients in a survey of 100 questions about health, lifestyle, habits, sleep and in a daily diary. In the second time we have realized a personalised and educational program for diet, supplementations sleep, physical activities, health routine.

Results:
The 2 groups of women improved the quality of their health and the management of weight, chronic and metabolic conditions, with impact on reproductive and perinatal health, reduction of inflammatory status and metabolic parameters.We have observed a great influence on cardiovascular health in both groups and decreased of homocysteine levels in the 2nd group. During first 1000 days 393 women, involved into the program, continued with the healthy and preventive routine with zero cases of weight and metabolic chronic disorder in their children.

Conclusions:
This research that the prevention in perinatal health influences the children's health.

Key messages:
The origins of chronic and metabolic conditions are in uterine life before the conception. The unhealthy lifestyle influenced fertility, cardiovascular health and child health.
The cardiovascular health and metabolic chronic conditions are influenced by first 1000 days health and habits.

Background:
Studies document that adults in disadvantaged socio-economic positions have elevated risks of a severe course of COVID-19, but it is unclear if this holds true for children. We investigate in this population-based study whether young people from socio-economically disadvantaged households in Germany had a higher risk of COVID-19 hospitalization compared with more affluent counterparts. We also examined if differences were related to comorbidities that predict severe courses in children.

Methods:
We included data from all 690,115 children and adolescents (0-18 years) enrolled in a statutory health insurance carrier. Daily hospital diagnoses of COVID-19 were recorded from 1.1.2020 to 13.7.2021. Logistic regressions were used to compare children from households with an indication of poverty (e.g. long-or short-term unemployed) with children from households with insurance holders in regular employment. We also assessed socio-economic characteristics of the area of residence. We controlled for age, sex, days under observation, nationality, and comorbidities (e.g. obesity).

Findings:
A COVID-19 hospital diagnosis was a rare event (n = 1637). Children of long-term unemployed parents had a 1Á36 times (95% CI 1Á21-1Á51) higher adjusted odds of hospitalization compared with those of employed parents. Elevated odds were also found for short-term unemployed or low-wage employment. Those living in poor areas had a 3Á02 (1Á81-5Á22) higher Research from across the globe has consistently shown that young sexual and gender minority individuals (e.g., those identifying as lesbian, gay, bisexual, and/or transgender [LGBT+]) are at a higher risk for depression, anxiety, and suicidal thoughts and behaviors when compared to heterosexual youth, including during early childhood and later adolescence. A sizeable body of research has attributed the elevated risk to increased exposure to specific social stressors related to navigating a stigmatized minority identity, including stressors such as victimization and other interpersonal and social difficulties in, for example, the school environment. Yet, relatively less is known about the early developmental timing of such disparities in childhood and how LGBT+ youth navigate school climates. As a sensitive developmental period, childhood and adolescence may be a particularly challenging time for sexual and gender minority youth to navigate cisnormative and heteronormative school contexts. Exposure to oppressive norms, particularly in school environments, has only recently become the subject of research. Additionally, research has been limited on how supportive school climates may be protective but stigmatizing school environments may drive LGBT+ trajectories towards suicidal behaviors and shape how they may navigate self-disclosure of cooccurring identities and mental health status in school settings, particularly when such stigmas may prevalently intersect. This workshop aims to further explore these novel aspects around developmental and school-based risk and protective factors shaping the mental health of sexual and gender minority children and adolescents. This workshop includes five empirical presentations that span from examining the developmental timing of mental health disparities, the role school-based experiences play in shaping and driving these disparities, to how sexual and gender minority youth may navigate their school context and how supportive climates may be protective for mental health. First, Arjan van der Star will present longitudinal evidence on how sexual identity formation precedes the onset of sexual orientation-based mental health disparities and the role that peer difficulties play in driving these as early as pre-teen years. Next, Niolyne Jasmin Bomolo will present findings from a qualitative study that unravel how school-based experiences shape individual trajectories toward suicidal attempts among LGBT+ adolescents. Third, Wouter Kiekens will explore how normative cultures in school environments may drive sexual attraction-based mental health disparities among a large sample of adolescents. Fourth, Lourdes Cantarero Arévalo will present findings on how LGBT+ adolescents living with mental conditions navigate self-disclosure in school environments. Finally, Sandra Sevic will present results on how supportive school environments may be protective for gender minority mental health.

Key messages:
Negative school-based experiences put sexual and gender minority youth at elevated risk for adverse mental health as early as middle childhood.
Intersecting stigmas around minority identities and mental health problems may further complicate how sexual and gender minority children and adolescents navigate their school environments.

Background:
Sexual minority children are at increased risk for psychopathology compared to their heterosexual peers, but longitudinal studies are needed to determine whether sexual minority identification precedes (rather than co-occurs with) mental health disparities and what may drive these disparities during childhood. The current study examined the longitudinal associations between sexual orientation and mental health over two years in a cohort of U.S. pre-teens with two potential mediators (increased social problems and decreased perceived school safety).

Methods:
We used data from Waves 1-3 (2016-2020) of the U.S. Adolescent Brain Cognitive Development study. Multiple linear regression and auto-regressive cross-lagged mediation models were used to examine longitudinal associations and mediation. Analyses accounted for customized sampling weights to correct for attrition and missing data.

Results:
The analytic sample included 5,574 children (46.0% assigned female at birth, 55.1% non-Hispanic White). Across waves, beginning to identify as gay/bisexual (0.6-2.7% of sample) was associated with increased internalizing and externalizing problems, and consistently identifying as gay/bisexual (3.4-5.0% of sample) with increased internalizing problems, compared to consistently identifying as heterosexual. For