Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm
Authors: McGowan Elisabeth C. , McGrath Monica , Law Andrew , O’Shea T. Michael , Aschner Judy L. , Blackwell Courtney K. , Fry Rebecca C. , Ganiban Jody M. , Higgins Rosemary , Margolis Amy , Sathyanarayana Sheela , Taylor Genevieve , Alshawabkeh Akram N. , Cordero José F. , Spillane Nicole T. , Hudak Mark L. , Camargo Carlos A. , Dabelea Dana , Dunlop Anne L. , Elliott Amy J. , Ferrara Assiamira M. , Talavera-Barber Maria , Singh Anne Marie , Karagas Margaret R. , Karr Catherine , O’Connor Thomas G. , Paneth Nigel , Wright Rosalind J. , Wright Robert O. , Cowell Whitney , Stanford Joseph B. , Bendixsen Casper , Lester Barry M. ,   program collaborators for Environmental Influences on Child Health Outcomes (ECHO), Smith Phillip B , Newby Laura K , Jacobson Lisa P , Catellier Diane J , Gershon Richard C , Cella David , Teitelbaum Susan L , Stroustrup Annemarie , Lampland Andrea L , Mayock Dennis E , Washburn Lisa K , Duarte Cristiane , Canino Glorisa J , Mason Alex , Marsit Carmen J , Pastyrnak Steven L , Neal Charles , Helderman Jennifer B , Simhan Hyagriv , Kerver Jean , Barone Charles , McKane Patricia , Elliott Michael R , Schantz Susan L , Silver Robert M , Bosquet-Enlow Michelle , Merhar Stephanie L , Pryhuber Gloria S , Moore Paul E , Wadhawan Rajan , Wagner Carol L , Croen Lisa A , Smith Lynne M , McEvoy Cindy , Tepper Robert S , Trasande Leonardo , Ren Clement L , Reynolds Anne Marie , Keller Roberta , Duncan Andrea J , Mansbach Jonathan M , Spergel Jonathan M , Stevenson Michelle D , Bauer Cindy S , Deoni Sean CL , Gern James E , Zoratti Edward M , Bacharier Leonard B , O’Connor George T , Rivera-Spoljaric Katherine , Hartert Tina V , Johnson Christine C , Hertz-Picciotto Irva , Weiss Scott T , Zeiger Robert , Lyall Kristen , Landa Rebecca , Ozonoff Sally J , Dager Stephen R , Schultz Robert T , Piven Joseph , Volk Heather , Vaidya Ruben , Obeid Rawad , Rollins Caitlin , Bear Kelly A , Lenski Madeleine , Msall Michael E , Montgomery Angela M , Woodruff Tracey J , Porucznik Christy A , Conradt Elisabeth , Keller R , Breton Carrie , Bastain Theresa , Farzan Shohreh , Habre Rima , Schmidt Rebecca , Frazier Jean , Herbstman Julie 
Published: April 2023

Importance

Limited data exist on pediatric health care utilization during the COVID-19 pandemic among children and young adults born preterm.

Objective

To investigate differences in health care use related to COVID-19 concerns during the pandemic among children and young adults born preterm vs those born at term.

Design, Setting, and Participants

In this cohort study, questionnaires regarding COVID-19 and health care utilization were completed by 1691 mother-offspring pairs from 42 pediatric cohorts in the National Institutes of Health Environmental Influences on Child Health Outcomes Program. Children and young adults (ages 1-18 years) in these analyses were born between 2003 and 2021. Data were recorded by the August 31, 2021, data-lock date and were analyzed between October 2021 and October 2022.

Exposures

Premature birth (&amp;lt;37 weeks’ gestation).

Main Outcomes and Measures

The main outcome was health care utilization related to COVID-19 concerns (hospitalization, in-person clinic or emergency department visit, phone or telehealth evaluations). Individuals born preterm vs term (≥37 weeks’ gestation) and differences among preterm subgroups of individuals (&amp;lt;28 weeks’, 28-36 weeks’ vs ≥37 weeks’ gestation) were assessed. Generalized estimating equations assessed population odds for health care used and related symptoms, controlling for maternal age, education, and psychiatric disorder; offspring history of bronchopulmonary dysplasia (BPD) or asthma; and timing and age at COVID-19 questionnaire completion.

Results

Data from 1691 children and young adults were analyzed; among 270 individuals born preterm, the mean (SD) age at survey completion was 8.8 (4.4) years, 151 (55.9%) were male, and 193 (71.5%) had a history of BPD or asthma diagnosis. Among 1421 comparison individuals with term birth, the mean (SD) age at survey completion was 8.4 (2.4) years, 749 (52.7%) were male, and 233 (16.4%) had a history of BPD or asthma. Preterm subgroups included 159 individuals (58.5%) born at less than 28 weeks’ gestation. In adjusted analyses, individuals born preterm had a significantly higher odds of health care utilization related to COVID-19 concerns (adjusted odds ratio [aOR], 1.70; 95% CI, 1.21-2.38) compared with term-born individuals; similar differences were also seen for the subgroup of individuals born at less than 28 weeks’ gestation (aOR, 2.15; 95% CI, 1.40-3.29). Maternal history of a psychiatric disorder was a significant covariate associated with health care utilization for all individuals (aOR, 1.44; 95% CI, 1.17-1.78).

Conclusions and Relevance

These findings suggest that during the COVID-19 pandemic, children and young adults born preterm were more likely to have used health care related to COVID-19 concerns compared with their term-born peers, independent of a history of BPD or asthma. Further exploration of factors associated with COVID-19–related health care use may facilitate refinement of care models.