COVID-19 found to be among the top 10 causes of mortality in children and youth in the United States

In a recent study posted to the medRxiv* pre-print server, coronavirus disease 2019 (COVID-19) emerged as the ninth leading cause of death among children and young people (CYP) in the age group of zero to 19 years in the United States (US) between March 1, 2020, and April 30, 2022. It also ranked as the number one infectious respiratory disease-causing death.

Background

The National Center for Health Statistics (NCHS) data confirmed 1,433 deaths in CYP aged zero to 19 years between March 2020 and April 2022 in the US, and the toll raised to one million by May 2022. Compared to other age groups in the US, the overall risk of death from COVID-19 in CYP was much less. The annualized death rate in US CYP was 0.8 per 100,000 population between March 2020 and April 2022, compared to a death rate of 89 per 100,000 in 50-54-year-olds during the same time. However, deaths from all causes are rare in US CYP.

Therefore, the researchers attempted to elucidate the COVID-19 mortality burden by comparing it to other causes of CYP deaths from a recent pre-COVID-19 period.

About the study

In the present study, researchers retrieved the US Centers for disease control and prevention (CDC) data for causes of death by age group for 2019 and compared it to the cumulative and annualized COVID-19 mortality between March 2020 and April 2022. The researchers estimated annual and cumulative deaths due to COVID-19 for children in the age groups of less than one year, one to four years, five to nine years, 10 to 14 years, and 15 to 19 years compared to COVID-19 deaths in the pre-pandemic year 2019.

Both cumulative and annualized mortalities are useful comparisons in the context of COVID-19. The former accounted for the first two pandemic years when non-pharmaceutical interventions (NPIs) were used whereas the latter represents a lower bound on the future COVID-19 burden in the absence of vaccination for CYP.

Next, they used 2020 population size estimates by single year of age from the US census bureau. The NCHS groups together many individual ICD codes to assess leading causes of death. However, it uses a single International Classification of Diseases (ICD) cause (U07.1) for COVID-19 deaths. Therefore, the current study compared the direct effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to groupings of multiple diseases although the rankings so obtained should be seen as conservative, especially looking at SARS-CoV-2's widespread transmission.

Although COVID-19 amplifies the impacts of other diseases, such as influenza and pneumonia, the researchers focused on COVID-19 as the direct cause of death and not as a contributing cause of death in the present study. Therefore, it is likely that the burden of COVID-19 was higher than the estimates of the current study.

Study findings

Like many other diseases, cumulative pediatric COVID-19 death rates followed a U-shape pattern in the US, with 7.2 deaths per 100,000, in infants under one year. It reduced to 1.2 and below one for one-year-old and children aged two to 12, respectively, gradually increasing to 3.9 per 100,000 in 18-year-olds. Overall, COVID-19 ranked as the seventh cumulative and ninth annualized cause of CYP deaths and consistently remained in the top 10 causes of death in all the pediatric age groups. As a respiratory infectious disease, COVID-19 ranked the number one cause of death in US CYP aged zero to 19. Other leading causes of pediatric deaths comprised perinatal conditions, congenital deformities, assault, heart diseases, neoplasms, suicide, and influenza and pneumonia.

Conclusion

To summarize, the study highlighted the variations in COVID-19 severity between age groups and thus could help appropriately allocate already limited resources to prioritize vaccination campaigns for the most vulnerable age groups. The study findings could also inform long-term public health planning and management in the US.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Neha Mathur

Neha is a digital marketing professional based in Gurugram, India. She has a Master’s degree from the University of Rajasthan with a specialization in Biotechnology in 2008. She has experience in pre-clinical research as part of her research project in The Department of Toxicology at the prestigious Central Drug Research Institute (CDRI), Lucknow, India. She also holds a certification in C++ programming.