Poverty increases risk of hospitalization for COVID-19 in children

According to a recent study, children from low-income families are at greater risk of severe COVID-19.

The risk of severe COVID-19 has been noted to be lower in young children than in adults, but critical cases have occurred. Research into the causes of severe COVID-19 in children is ongoing, but socioeconomic factors have been hypothesized to play a role in the risk of severity.

Previous studies have linked low income to severe COVID-19 in adults, but not in children. In Germany, investigators studied the association between socioeconomic factors on severe COVID-19 in children.

The data comes from the Allgemeine Ortskrankenkasse Rhineland/Hamburg–Die Gesundheitskasse, which insures individuals in certain regions of Germany. A total of 688,075 children insured for at least 1 day during the observation period were included in the study.

COVID-19 was diagnosed based on World Health Organization guidelines. If there were multiple COVID-19 hospitalizations in an individual, only the first was included in the study.

Socioeconomic characteristics included the degree of urbanization of the community of residence, the average living space per capita in the neighborhood of residence, and the median income in the neighborhood of residence. The postal code was used to separate the areas.

Comorbidities were identified using ICD-10-GM 2019 diagnosis codes and were considered present if at least 1 diagnosis was made between 2019 and 2021.

The average age of the participants was 8.3 years. In this age group, hospitalizations related to COVID-19 were rare. Of these cases, a large proportion came from families suffering from long-term unemployment. An increased risk was also observed in children whose parents had low-paying jobs.

Households where the insurance owner was gainfully employed had the lowest raw incidence rates.

Low area-level income, smaller average living space, and higher degree of urbanization all increased the risk of hospitalization for COVID-19. These incidence rates increased with comorbidity.

Children living in the area with the lowest median income were 3 times more likely to be hospitalized due to COVID-19 than those in the area with the highest median income. The results were equally drastic depending on the living space. Children who used immunosuppressants or had diabetes saw an even higher risk of hospitalization for COVID-19.

The researchers initially hypothesized that predisposing diseases more common in socioeconomically disadvantaged families, such as asthma and obesity, would be mediating risk factors. However, no data from the study supported this hypothesis.

The results were consistent with studies of adults and indicated that socioeconomic depravity increased children’s risk of contracting severe COVID-19. The investigators concluded that more research should be conducted on social inequalities during the pandemic, especially among children.


Dragano N, Dortmann O, Timm J, Mohrmann M, Wehner R, Rupprect CJ, et al. Association of household deprivation, comorbidities and COVID-19 hospitalization among children in Germany, January 2020 to July 2021. JAMA Netw Open. 2022;5(10):e2234319. doi:10.1001/jamanetworkopen.2022.34319

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