Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States

Dazheng Zhang; Bingyu Zhang; Qiong Wu; Ting Zhou; Jiayi Tong; Yiwen Lu; Jiajie Chen; Huiyuan Wang; Deena J Chisolm; Ravi Jhaveri; Rachel C Kenney; Russell L Rothman; Suchitra Rao; David A Williams; Mady Hornig; Linbo Wang; Jeffrey S Morris; Christopher B Forrest; Yong Chen

doi:10.1038/s41467-024-55273-z

Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States

Nat Commun. 2025 Jan 21;16(1):878. doi: 10.1038/s41467-024-55273-z.

Authors

Dazheng Zhang^#^{1

2}, Bingyu Zhang^#^{1

3}, Qiong Wu^{1

2

4}, Ting Zhou^{1

2}, Jiayi Tong^{1

2

5}, Yiwen Lu^{1

3}, Jiajie Chen^{1

2}, Huiyuan Wang^{1

2}, Deena J Chisolm⁶, Ravi Jhaveri⁷, Rachel C Kenney^{8

9}, Russell L Rothman¹⁰, Suchitra Rao¹¹, David A Williams¹², Mady Hornig¹³, Linbo Wang¹⁴, Jeffrey S Morris², Christopher B Forrest¹⁵, Yong Chen^{16

17

18

19

20

21}

Affiliations

¹ The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA.
² Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³ The Graduate Group in Applied Mathematics and Computational Science, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Biostatistics and Health Data Science, University of Pittsburgh, Pittsburgh, PA, USA.
⁵ Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Abigail Wexner Research Institute Nationwide Children's Hospital, Columbus, OH, USA.
⁷ Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
⁸ Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
⁹ Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
¹⁰ Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
¹² Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
¹³ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
¹⁴ Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada.
¹⁵ Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁶ The Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA. [email protected].
¹⁷ Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. [email protected].
¹⁸ The Graduate Group in Applied Mathematics and Computational Science, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA. [email protected].
¹⁹ Leonard Davis Institute of Health Economics, Philadelphia, PA, USA. [email protected].
²⁰ Penn Medicine Center for Evidence-based Practice (CEP), Philadelphia, PA, USA. [email protected].
²¹ Penn Institute for Biomedical Informatics (IBI), Philadelphia, PA, USA. [email protected].

^# Contributed equally.

PMID: 39837828
DOI: 10.1038/s41467-024-55273-z

Abstract

Racial/ethnic differences are associated with the symptoms and conditions of post-acute sequelae SARS-CoV-2 infection (PASC) in adults. These differences may exist among children and warrant further exploration. We conducted a retrospective cohort study with difference-in-differences analyzes to assess these differences in children and adolescents under the age of 21. The study utilized data from the RECOVER Initiative in the United States, which aims to learn about the long-term effects of COVID-19. The cohort included 225,723 patients with SARS-CoV-2 infection or COVID-19 diagnosis between March 2020 and October 2022. The study compared minority racial/ethnic groups to Non-Hispanic White (NHW) individuals, stratified by severity during the acute phase of COVID-19. Within the severe group, Asian American/Pacific Islanders (AAPI) had a higher prevalence of fever/chills and respiratory signs and symptoms, Hispanic patients showed greater hair loss prevalence in severe COVID-19 cases, while Non-Hispanic Black (NHB) patients had fewer skin symptoms in comparison to NHW patients. Within the non-severe group, AAPI patients had increased POTS/dysautonomia and respiratory symptoms, and NHB patients showed more cognitive symptoms than NHW patients. In conclusion, racial/ethnic differences related to COVID-19 exist among PASC symptoms and conditions in pediatrics, and these differences are associated with the severity of illness during acute COVID-19.

MeSH terms

Adolescent
Black or African American / statistics & numerical data
COVID-19* / epidemiology
COVID-19* / ethnology
Child
Child, Preschool
Ethnic and Racial Minorities / statistics & numerical data
Ethnicity / statistics & numerical data
Female
Hispanic or Latino / statistics & numerical data
Humans
Infant
Male
Post-Acute COVID-19 Syndrome*
Prevalence
Retrospective Studies
SARS-CoV-2* / isolation & purification
Severity of Illness Index
United States / epidemiology
White
White People / statistics & numerical data
Young Adult

Abstract

MeSH terms

Grants and funding