Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States
Authors: LeWinn Kaja Z. , Trasande Leonardo , Law Andrew , Blackwell Courtney K. , Bekelman Traci A. , Arizaga Jessica A. , Sullivan Alexis A. , Bastain Theresa M. , Breton Carrie V. , Karagas Margaret R. , Elliott Amy J. , Karr Catherine J. , Carroll Kecia N. , Dunlop Anne L. , Croen Lisa A. , Margolis Amy E. , Alshawabkeh Akram N. , Cordero Jose F. , Singh Anne Marie , Seroogy Christine M. , Jackson Daniel J. , Wood Robert A. , Hartert Tina V. , Kim Young Shin , Duarte Cristiane S. , Schweitzer Julie B. , Lester Barry M. , McEvoy Cynthia T. , O’Connor Thomas G. , Oken Emily , Bornkamp Nicole , Brown Eric D. , Porucznik Christina A. , Ferrara Assiamira , Camargo Carlos A. , Zhao Qi , Ganiban Jody M. , Jacobson Lisa P. ,   Environmental influences on Child Health Outcomes Consortium, Smith P B , Newby K L , Jacobson Lisa P , Parker C B , Gershon Richard C , Cella David , Teitelbaum Susan L , Stroustrup Annemarie , Lampland Andrea L , Hudak Mark L , Washburn Lisa K , Canino Glorisa J , Pastyrnak Steven L , Neal Charles , Carter Brian S , Helderman Jennifer B , Simhan Hyagriv , Kerver Jean , Barone Charles , Paneth Nigel , Elliott Michael R , Schantz Susan L , Silver Robert M , Wright Rosalind J , Bosquet-Enlow Michelle , Mason Alex , Tylavsky Frances , Zhao Qi , Sathyanarayana Sheela , Fussman Chris , Farzan Shohreh F , Habre Rima , Tepper Robert S , Gern James , Miller Rachel L , Nguyen Ruby HN , Aschner Judy L , Merhar Stephanie L , Moore Paul E , Pryhuber Gloria S , Smith Lynne M , Barrett Emily S , Reynolds Anne Marie , Gatzke-Kopp Lisa , Swingler Margaret M , Mansbach Jonathan M , Spergel Jonathan M , Zoratti Edward M , Bendixsen Casper G , Bacharier Leonard B , O’Connor George T , Kattan Meyer , Rivera-Spoljaric Katherine , Johnson Christine C , Hertz-Picciotto Irva , Koinis Mitchell Daphne , D’Sa Viren , Dabelea Dana , Deoni Sean CL , Hipwell Alison E , Leve Leslie D , Weiss Scott T , Lyall Kristen , Volk Heather , Dager Stephen R , Schultz Robert T , Obeid Rawad , Rollins Caitlin , Msall Michael E , O'Shea Michael , Vaidya Ruben , Meeker John , Laham Federico , Wu Susan , Celedón Juan C , Puls Henry T , Teach Stephen J , Porter Stephen C , Waynik Ilana Y , Iyer Sujit , Samuels-Kalow Margaret E , Thompson Amy D , Stevenson Michelle D , Bauer Cindy S , Inhofe Nancy R , Boos Markus , Macias Charles G , Monk Catherine , Posner Jonathan , Hershey Gurjit , Keenan Kathryn , Neiderhiser Jenae , Litonjua Augusto , Zeiger Robert , Bacharier Leonard , Landa Rebecca , Ozonoff Sally , Schmidt Rebecca , Piven Joseph , Bear Kelly , Lenski Madeleine , Singh Rachana , Frazier Jean A , Gogcu Semsa , Montgomery Angela , Kuban Karl C , Douglass Laurie M , Jara Hernan , Joseph Robert , Ruden Douglas , Herbstman Julie , Woodruff Tracey , Giardino Angelo P , Stanford Joseph , Innocenti Mark , Conradt Elizabeth , Huddleston Kathi , Swan Shanna 
Published: August 2023

Importance

Few population-based studies in the US collected individual-level data from families during the COVID-19 pandemic.

Objective

To examine differences in COVID-19 pandemic–related experiences in a large sociodemographically diverse sample of children and caregivers.

Design, Setting, and Participants

The Environmental influences on Child Health Outcomes (ECHO) multi-cohort consortium is an ongoing study that brings together 64 individual cohorts with participants (24 757 children and 31 700 caregivers in this study) in all 50 US states and Puerto Rico. Participants who completed the ECHO COVID-19 survey between April 2020 and March 2022 were included in this cross-sectional analysis. Data were analyzed from July 2021 to September 2022.

Main Outcomes and Measures

Exposures of interest were caregiver education level, child life stage (infant, preschool, middle childhood, and adolescent), and urban or rural (population &amp;lt;50 000) residence. Dependent variables included COVID-19 infection status and testing; disruptions to school, child care, and health care; financial hardships; and remote work. Outcomes were examined separately in logistic regression models mutually adjusted for exposures of interest and race, ethnicity, US Census division, sex, and survey administration date.

Results

Analyses included 14 646 children (mean [SD] age, 7.1 [4.4] years; 7120 [49%] female) and 13 644 caregivers (mean [SD] age, 37.6 [7.2] years; 13 381 [98%] female). Caregivers were racially (3% Asian; 16% Black; 12% multiple race; 63% White) and ethnically (19% Hispanic) diverse and comparable with the US population. Less than high school education (vs master’s degree or more) was associated with more challenges accessing COVID-19 tests (adjusted odds ratio [aOR], 1.88; 95% CI, 1.06-1.58), lower odds of working remotely (aOR, 0.04; 95% CI, 0.03-0.07), and more food access concerns (aOR, 4.14; 95% CI, 3.20-5.36). Compared with other age groups, young children (age 1 to 5 years) were least likely to receive support from schools during school closures, and their caregivers were most likely to have challenges arranging childcare and concerns about work impacts. Rural caregivers were less likely to rank health concerns (aOR, 0.77; 95% CI, 0.69-0.86) and social distancing (aOR, 0.82; 95% CI, 0.73-0.91) as top stressors compared with urban caregivers.

Conclusions

Findings in this cohort study of US families highlighted pandemic-related burdens faced by families with lower socioeconomic status and young children. Populations more vulnerable to public health crises should be prioritized in recovery efforts and future planning.