Where does COVID-19 rank as an underlying cause of death for children and young people in the US?

By Dr. Sanchari Sinha Dutta, Ph.D.Reviewed by Danielle Ellis, B.Sc.Feb 2 2023

A study published in JAMA Network Open ranks coronavirus disease 2019 (COVID-19) in 8^th position among all causes of death in children and young adults aged 0 to 19 years in the United States. This novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) accounts for 2% of all causes of death in this age group.    

Background

According to recent reports, COVID-19 is the underlying cause of death among 940,000 US residents, including at least 1289 children and young adults aged 0 to 19 years. At least 821 COVID-19 deaths have been reported among children and young adults over a period of one year (August 2021 – July 2022).

In the current study, scientists have explored whether COVID-19 is a leading cause of death among children and young adults aged 0 to 19 in the United States.

Study design

The scientists conducted a population-level epidemiological analysis from August 2021 to July 2022 using the data from the US Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on the underlying cause of death in the United States.

The main purpose of the analysis was to establish the ranking of COVID-19 among other rankable causes of death between August 2021 and July 2022 in the study population. They considered ten leading causes of death to identify the position of COVID-19 as an underlying cause of death.

For the sensitivity analysis, they considered COVID-19 deaths that occurred every 12 months between April 2020 and August 2022 and compared that with deaths from other (non-COVID-19) leading causes in 2019, 2020, and 2021.

Important observations

The scientists categorized the study population into five separate age groups and estimated COVID-19 mortality rates. According to their analyses, the mortality rate was 4.3 deaths per 100,000 population among infants younger than one year, 0.6 per 100,000 among children aged 1 to 4 years, 0.4 per 100,000 among children aged 5 to 9 years, 0.5 per 100,000 among children aged 10 to 14 years, and 1.8 per 100,000 among young adults aged 15 to 19 years.

Compared to other leading causes of death in the study period (August 2021 – July 2022), COVID-19 ranked 8^th among all causes of death in the study population, accounting for 2% of all causes of death.

A separate analysis conducted by excluding death causes that are not related to any diseases (unintentional injuries, assault, and suicide) ranked COVID-19 as the 5^th leading cause of death in the study population.

Considering only infectious and respiratory diseases, COVID-19 was identified as the top (first) leading cause of death, followed by influenza and pneumonia (2^nd leading cause of death).

Sensitivity analysis

Since the study period coincided with the Delta and Omicron waves, where substantial infections occurred, the scientists conducted a sensitivity analysis every 12 months between April 2020 and August 2022. Sensitivity analysis determines the changes in the target variable in response to changes in input variables.

The findings revealed that COVID-19 mortality rates were significantly lower in the pre-Delta period (before July 2021) than in the Delta and Omicron periods. Considering the pre-Delta period, COVID-19 was identified as the 9^th leading cause of death in the study population.

Notably, before the entry of COVID-19 in the list of leading causes of death, the top ten leading causes of death in the study population remained mostly unchanged from 2015 to 2021.

Study significance

The study identifies COVID-19 as the 8^th leading cause of death among children and young adults aged 0 to 19. Based on the study findings, the scientists recommend continuous execution of pharmaceutical and non-pharmaceutical interventions to control the spread of future SARS-CoV-2 variants and prevent severe COVID-19 in this age group.