Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm
Creators: name: Margolis, A.
name: Mcgrath, M.
name: Wright, R.J.
name: Singh, A.M.
name: Law, A.
name: Hudak, M.L.
name: Karagas, M.R.
name: Cowell, W.
name: Lester, B.M.
name: O'connor, T.G.
name: Wright, R.O.
name: Ferrara, A.M.
name: Talavera-Barber, M.
name: Mcgowan, E.C.
name: Elliott, A.J.
name: Dabelea, D.
name: Sathyanarayana, S.
name: Cordero, J.F.
name: Spillane, N.T.
name: Dunlop, A.L.
name: Camargo, C.A., Jr
name: Aschner, J.L.
name: Taylor, G.
name: Alshawabkeh, A.N.
name: Ganiban, J.M.
name: Higgins, R.
name: Paneth, N.
name: O'shea, T.M.
name: Bendixsen, C..
name: Blackwell, C.K.
name: Karr, C.
name: Fry, R.C.
name: Stanford, J.B.
Publisher: name: American Medical Association
Year: 2023

description: 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 (<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 (<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.