Does Race & Economic Class Determine Risk Levels Associated with Children’s COVID-19 Infection Rates?

Does Race & Economic Class Determine Risk Levels Associated with Children’s COVID-19 Infection Rates

Apparently, if a new study led by Children’s National Hospital accurately represents the broader world, then the answer is yes. Published in Pediatrics, in a parallel dynamic unfolding with adults, children from minority and socioeconomically disadvantaged background face significantly higher rates of COVID-19 infection. In fact, at least in the Washington DC area, Black kids are infected at 4 times the rates of white kids; Hispanic children face even higher risk of COVID-19 infection at nearly 6 times the rates of whites.

With over 4.5 million Americans now infected, including tens of thousands of children, it was already known from previous studies that minorities and socioeconomically disadvantaged adults bear a high burden of infection. But it wasn’t clear if the disparities observed among adults existed with children. Hence, Monika Goyal, MD, MSCE, a pediatric emergency medicine specialist at Children’s National, embarked on a study to find the answer.

The Study

The Children’s National team reviewed data collected between March 21, 2020 and April 28, 2020 from a drive-through/walk-up COVID-19 testing site affiliated with Children’s National—one of the first exclusively pediatric testing sites for the virus in the U.S.  Access to the testing required disclosure of data, including demographics, which the study team used for this analysis.

The Results

Based on the first 1,000 patients tested at this site, the team found dramatically differences among different racial and ethnic groups as well as income.

First a look at race and ethnicity. For example, while about 7% of non-Hispanic white children were positive for COVID-19, about 30% of non-Hispanic Black and 46% of Hispanic children were positive.

Dr. Goyal was stunned with the findings; while 1 in 10 white kids were infected with COVID, 1 in 3 Black children were infected and one in two Hispanic children infected.

When it comes to known exposure to COVID-19 11% are white (non-Hispanic) while Blacks were triple this number.

In regards to economic class (socioeconomic level), the team, leveraging data from the American Families Survey, found marked disparities in COVID-19 positivity rates by income levels: while those in the highest quartile had infection rates of about 9%, about 38% of those in the lowest quartile were infected.


The researchers don’t know why these stark differences exist but Dr. Goyal speculates it could be because of “socioeconomic factors that increase exposure, differences in access to health care and resources, as well as structural racism.”

Social Determinants of Health

Now Children’s National, based on this new data, is working to address those factors that could possibly increase risk for COVID-19 infection and poor outcomes by helping to identify unmet needs. These could include what are known as social determinants of health, such as food and housing, in an effort to direct patients toward resources when they receive their test results.

Community Focus

Children’s National is not just about delivering care to the patient, but also to the community at large as this top-tier research institution grapples with an unprecedented public health crisis. Denice Cora-Bramble, MD, MBA, chief medical officer of Ambulatory and Community Health Services, is also the senior author of this study. Mr. Cora-Bramble emphasizes the importance of working with the community, saying, “There is still so much work to be done to achieve health equity for children.”

About Children National Hospital, Washington DC

Children’s National Hospital, based in Washington, D.C., celebrates 150 years of pediatric care, research and commitment to community. Volunteers opened the hospital in 1870 with 12 beds for children displaced after the Civil War. Today, 150 years stronger, it is among the nation’s top 10 children’s hospitals. It is ranked No. 1 for newborn care for the fourth straight year and ranked in all specialties evaluated by U.S. News & World Report. Children’s National is transforming pediatric medicine for all children. In 2020, construction will be complete on the Children’s National Research & Innovation Campus, the first in the nation dedicated to pediatric research. Children’s National has been designated twice as a Magnet® hospital, demonstrating the highest standards of nursing and patient care delivery. This pediatric academic health system offers expert care through a convenient, community-based primary care network and specialty outpatient centers in the D.C., metropolitan area, including the Maryland and Northern Virginia suburbs. Children’s National is home to the Children’s National Research Institute and Sheikh Zayed Institute for Pediatric Surgical Innovation and is the nation’s seventh-highest NIH-funded children’s hospital. It is recognized for its expertise and innovation in pediatric care and as a strong voice for children through advocacy at the local, regional and national levels.

Lead Research/Investigator

Monika Goyal, MD, MSCE, a pediatric emergency medicine specialist at Children’s National

Denice Cora-Bramble, MD, MBA, chief medical officer of Ambulatory and Community Health Services

Joelle N. Simpson, MD

Meleah D. Boyle, MPH

Gia M. Badolato, MPH

Meghan Delaney, DO, MPH

Robert McCarter Jr. 

Call to Action: A key dynamic underlying health equity are factors associated with the social determinants of health. The more that providers understand and incorporate an integrated approach, including implementing closed-loop referral management to social and community providers, the better the progression toward health equity. Appropriate investment in infrastructure that addresses key social determinants of health may have an impact but this is a longer term solution.