In a recently published study medRxiv* Pre-print server, Coronavirus disease 2019 (COVID-19) spread in the United States (USA) between April 1, 2020 and April 30, 2022. It has also been ranked as the number one killer of infectious respiratory diseases.
Data from the National Center for Health Statistics (NCHS) confirmed 1,433 deaths from CYP ages zero to 19 between March 2020 and April 2022 in the United States, and the number of deaths rose 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 lower. The annualized mortality rate in US-CYP from March 2020 to April 2022 was 0.8 per 100,000 population, compared to a mortality rate of 89 per 100,000 for 50- to 54-year-olds during the same period. However, deaths from all causes are rare in US-CYP.
Therefore, the researchers sought to elucidate the mortality burden from COVID-19 by comparing it to other causes of CYP deaths from a more recent time, before COVID-19.
About the study
In the present study, researchers retrieved 2019 data from the US Centers for Disease Control and Prevention (CDC) on causes of death by age group and compared them to 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 under 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 mortality are useful comparisons in the context of COVID-19. The former accounted for the first two years of the pandemic using non-pharmaceutical interventions (NPIs), while the latter provides a lower bound for future COVID-19 burden without vaccination against CYP.
Next, they used 2020 population size estimates by individual years of age from the US Census Bureau. The NCHS summarizes many individual ICD codes to assess the 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 multiple disease groupings, although the ranking thus obtained should be considered conservative, particularly given the widespread transmission of SARS-CoV -2.
Although COVID-19 amplifies the effects of other diseases such as influenza and pneumonia, in the present study, researchers focused on COVID-19 as a direct cause of death rather than a contributory cause of death. Therefore, it is likely that the burden of COVID-19 was higher than the current study’s estimates.
As with many other diseases, cumulative U.S. pediatric COVID-19 death rates followed a U-shaped pattern with 7.2 deaths per 100,000 in infants under one year old. It fell to 1.2 and below one for one-year-olds and children aged two to 12, and gradually increased to 3.9 per 100,000 among 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 across all pediatric age groups. As a respiratory infectious disease, COVID-19 was the number one cause of death in US CYP aged zero to 19 years. Other leading causes of pediatric deaths included perinatal disease, congenital malformations, assault, heart disease, neoplasms, suicide, and influenza and pneumonia.
In summary, the study highlighted differences in the severity of COVID-19 across age groups and thus could help appropriately allocate already limited resources to prioritize vaccination campaigns for the most vulnerable age groups. Study results could also inform long-term public health planning and management in the United States.
medRxiv publishes preliminary scientific reports that have not been peer-reviewed and therefore should not be relied upon as conclusive, guide clinical practice/health behavior or be treated as established information.
- Seth Flaxman, Charles Whittaker, Elizaveta Semenova, Theo Rashid, Robbie Parks, Alexandra Blenkinsop, H Juliette T Unwin, Swapnil Mishra, Samir Bhatt, Deepti Gurdasani, Oliver Ratmann. (2022). Covid-19 is a leading cause of death among children and adolescents ages 0 to 19 in the United States. medRxiv. doi: https://doi.org/10.1101/2022.05.23.22275458 https://www.medrxiv.org/content/10.1101/2022.05.23.22275458v1