Racial disparities in children tested for SARS-CoV-2 at pediatric emergency departments: A prospective cohort study

Objectives To evaluate the association between race and SARS-CoV-2 test positivity and outcomes in children. Study Design Secondary analysis of a prospective cohort study recruiting children < 18 years, tested for SARS-CoV-2 between August 2020 and February 2022, in Canadian pediatric emergency departments. Race was self-reported by participants. The primary outcome was SARS-CoV-2 test positivity. Secondary outcomes were medical interventions and hospitalization within 14 days of index visit, and post-COVID condition (PCC) at 90-day follow-up. Associations were evaluated using multi-level logistic regression models. Results Seven thousand and two-thirty three children underwent SARS-CoV-2 testing; median age was 2.0 years (IQR: 1.0–5.0), and 3366 (46.5%) were female. 1440 (19.9%) children tested positive for SARS-CoV-2, 776 (10.7%) were hospitalized, and 153 (13.2%) test-positive children experienced PCC. Compared to White children, most racial minority groups were more likely to test positive for SARS-CoV-2 (Middle Eastern aOR [95% CI] 2.62 [2.07, 3.32], Black aOR 2.36 [1.85, 3.03], Latin American aOR 2.23 [1.58, 3.15], South Asian aOR 2.17 [1.67, 2.82], Indigenous aOR 2.09 [1.29, 3.37], Southeast Asian aOR 1.82 [1.27, 2.62], Multiracial aOR 1.35 [1.07, 1.69], and had lower odds of medical interventions. Only Indigenous children were at higher odds of hospitalization than White children (aOR [95% CI]: 2.48 [1.03, 5.95]). Black children were less likely to report PCCs than White children (aOR 0.44 [0.22–0.86]). Conclusions Racial disparities exist in SARS-CoV-2 test positivity and outcomes among Canadian children seeking emergency care. A better understanding of the factors contributing to these differences is needed to promote equitable health across the population.