Latania K. Logan

Background COVID‐19 disproportionately affects racial and ethnic minority populations, but comparatively few epidemiologic studies have been performed on children as compared to adults. Objectives To characterise factors associated with SARS‐CoV‐2 infections amongst children from Chicago, Illinois, USA. Methods A test‐negative case‐control study of children tested for SARS‐CoV‐2 (0–18 years) at three medical centres of the Rush University System for Health between 12 March and 7 December 2020 was conducted. Of 8462 children, 1,302 tested positive by real‐time PCR or rapid (NAAT) testing. Infection with SARS‐CoV‐2 was analysed as the outcome variable; effects of predictors were assessed by logistic regression analysis. A Paediatric Risk Score Index with a concordance index of 72% of accuracy was created to predict SARS‐CoV‐2 infection. Results The median age of cases was 13 years. On multivariable analysis, factors associated with SARS‐CoV‐2 infection were being Hispanic/Latinx (odds ratio [OR] 2.45, 95% CI 1.99, 3.03); Black/African‐American (OR 1.31, 95% CI 1.03, 1.66); overweight/obese (OR 1.27, 95% CI 1.02, 1.58); older age, 10–14 years (OR 1.70, 95% CI 1.39, 2.08), 15–18 years (OR 2.06, 95% CI 1.71, 2.47); from households with income <$50,000 (OR 1.36, 95% CI 1.17, 1.60); or residing in predominantly minority neighbourhoods (OR 1.45, 95% CI 1.17, 1.80). Infections were higher during the second “fall” wave (5 October 2020 onward) compared with the first “spring” wave (OR 2.30, 95% CI 2.01, 2.63). Within Chicago, racial/ethnic minority neighbourhoods had striking positivity rates, as high as 39% in majority Hispanic/Latinx West Lawn neighbourhood. In suburban Chicago, highest positivity rates (20%–28%) were in zip codes within Hispanic/Latinx communities. Conclusions Infection with SARS‐CoV‐2 is more likely amongst children of Hispanic/Latinx ethnicity, Black/African‐American race, aged 10–18 years, who are overweight/obese, from lower income households, and from minority neighbourhoods. Future studies should focus on the prevention of COVID‐19 infection in children of highest risk.