Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States

Dazheng Zhang, Bingyu Zhang, Qiong Wu, Ting Zhou, Jiayi Tong, Yiwen Lu, Jiajie Chen, Huiyuan Wang, Deena J. Chisolm, Ravi Jhaveri, Rachel C. Kenney, Russell L. Rothman, Suchitra Rao, David A. Williams, Mady Hornig, Linbo Wang, Jeffrey S. Morris, Christopher B. Forrest and Yong Chen ()
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Dazheng Zhang: University of Pennsylvania
Bingyu Zhang: University of Pennsylvania
Qiong Wu: University of Pennsylvania
Ting Zhou: University of Pennsylvania
Jiayi Tong: University of Pennsylvania
Yiwen Lu: University of Pennsylvania
Jiajie Chen: University of Pennsylvania
Huiyuan Wang: University of Pennsylvania
Deena J. Chisolm: Abigail Wexner Research Institute Nationwide Children’s Hospital
Ravi Jhaveri: Ann & Robert H. Lurie Children’s Hospital of Chicago
Rachel C. Kenney: New York University Grossman School of Medicine
Russell L. Rothman: Vanderbilt University Medical Center
Suchitra Rao: University of Colorado School of Medicine and Children’s Hospital Colorado
David A. Williams: University of Michigan
Mady Hornig: Columbia University Mailman School of Public Health
Linbo Wang: University of Toronto
Jeffrey S. Morris: University of Pennsylvania
Christopher B. Forrest: Children’s Hospital of Philadelphia
Yong Chen: University of Pennsylvania

Nature Communications, 2025, vol. 16, issue 1, 1-11

Abstract: Abstract Racial/ethnic differences are associated with the symptoms and conditions of post-acute sequelae SARS-CoV-2 infection (PASC) in adults. These differences may exist among children and warrant further exploration. We conducted a retrospective cohort study with difference-in-differences analyzes to assess these differences in children and adolescents under the age of 21. The study utilized data from the RECOVER Initiative in the United States, which aims to learn about the long-term effects of COVID-19. The cohort included 225,723 patients with SARS-CoV-2 infection or COVID-19 diagnosis between March 2020 and October 2022. The study compared minority racial/ethnic groups to Non-Hispanic White (NHW) individuals, stratified by severity during the acute phase of COVID-19. Within the severe group, Asian American/Pacific Islanders (AAPI) had a higher prevalence of fever/chills and respiratory signs and symptoms, Hispanic patients showed greater hair loss prevalence in severe COVID-19 cases, while Non-Hispanic Black (NHB) patients had fewer skin symptoms in comparison to NHW patients. Within the non-severe group, AAPI patients had increased POTS/dysautonomia and respiratory symptoms, and NHB patients showed more cognitive symptoms than NHW patients. In conclusion, racial/ethnic differences related to COVID-19 exist among PASC symptoms and conditions in pediatrics, and these differences are associated with the severity of illness during acute COVID-19.

Date: 2025
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DOI: 10.1038/s41467-024-55273-z

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