Impact of Ethnicity on COVID-19 Related Hospitalizations in Children During the First Pandemic Wave in Northern Italy.

Roberto Baronio,Lucia Savaré,Claudio Cavalli,Angelo Mazza,Icilio Dodi,Jessica Ruggiero,Richard Fabian Schumacher,Beatrice Crotti,Gian Luigi Marseglia

doi:10.3389/fped.2021.625398

Abstract

There is increasing evidence that black people and other minorities have a higher incidence of severe COVID-19 disease, but little is known about the situation of children, especially in Europe. In general children are less infected and if so, frequently show mild or asymptomatic disease, making conclusions difficult. We collected data on SARS-CoV-2 associated hospitalizations in a well-defined population of 550,180 children up to 15 years in five hub-centers during the “first wave” at the heart of the pandemic in Northern Italy. Among the 451,053 Italian citizens 80 were hospitalized as compared to 31 out of 99,127 foreign citizens, giving a significantly higher risk (odds ratio 1.76; 95% CI: 1.16–2.66) for the foreign children. The risk was highest for children of African ethnicity as compared to Italians with an odds ratio of 2.76 (95% CI: 1.56–4.87). None of the patients deceased. There was no significant difference in age (thou infants regardless of ethnicity had a 10-fold higher risk), sex, length of hospitalization or comorbidities, namely overweight. As bureaucratic, cultural and information barriers mostly affect preventive and adult services and considering that in contrast to other countries, in Italy pediatric care is guaranteed free of (out-of-pocket) charge to all people <16 years, and hospitals are densely spaced, access to health care seems to be a minor problem. Thus, other possible root causes are discussed. We believe that this is an unbiased starting point to understand and overcome the reasons for the higher risk those children experience.

Highlights

We identified a total of 111 inpatients (51 females, 60 males) of whom 40 were hospitalized in Bergamo, 30 in Brescia, 15 in Pavia, 15 in Parma, and 11 in Cremona
When analyzing the different ethnicities, we found patients from Africa to be the most affected: 0.49% of the pediatric African population were hospitalized with COVID-19, as compared to 0.47% of the American, 0.22% of foreigners from other European countries than Italy, 0.19% of the Asian and 0.17% of the Italian pediatric population
To our knowledge the most numerous to provide ethnic, demographic, and epidemiological data from a purely pediatric population hospitalized for COVID-19 during the first wave of the pandemic, we analyze data from five provincial HUB Centers in the heart of the first epidemic wave in Northern Italy

Summary

Introduction

Since the outbreak of the COVID-19 pandemic, more than 44 million cases and 1 million fatalities have been reported worldwide up to the end of October 2020 [1].The dynamic of spread and the severity of COVID-19 remarkably vary among different geographical regions: the Americas account for almost 50% of cases and more than 50% of deaths, followed by Europe (23% of cases, 24% of deaths) and South-East Asia (20% of cases, 12% of deaths), while Africa has seen only 1 million of cases (3%) and 29,491 deaths (2.5%) [1].Ethnicity and Pediatric COVID19 HospitalizationsInterestingly, an opposite trend is reported within the most affected countries (namely the USA), where people of non-white ethnicity – and especially those of African American ethnicity - have a much higher incidence and mortality from COVID-19 than that observed in the population of Caucasian ethnicity. The explanation is probably related to the socio-economic differences aggravated by a health system that does not offer equal care and services to all members of the society [2] This theory is supported by a recent analysis conducted in Brazil that reported an increased mortality in regions with lower levels of socioeconomic development and especially among black Brazilians and those of mixed ethnicity [3]. Some reports highlight a possible role of biological factors such as Vitamin D deficiency [7], ACE1 gene I/D polymorphisms and higher thrombotic risk in Black people [8], even if this is in contrast with the lower disease burden in sub-Saharan Africa [9] Whether this heterogeneity in COVID-19 burden is entirely due to genetic susceptibility, socioeconomic or environmental factors is not completely clear yet

Methods

Results

Conclusion