Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm

Elisabeth C. Mcgowan; Monica Mcgrath; Andrew Law; T. Michael O'shea; Judy L. Aschner; Courtney K. Blackwell; Rebecca C. Fry; Jody M. Ganiban; Rosemary Higgins; Amy Margolis; Sheela Sathyanarayana; Genevieve Taylor; Akram N. Alshawabkeh; José F. Cordero; Nicole T. Spillane; Mark L. Hudak; Carlos A. Camargo; Dana Dabelea; Anne L. Dunlop; Amy J. Elliott; Assiamira M. Ferrara; Maria Talavera-Barber; Anne Marie Singh; Margaret R. Karagas; Catherine Karr; Thomas G. O'connor; Nigel Paneth; Rosalind J. Wright; Robert O. Wright; Whitney Cowell; Joseph B. Stanford; Casper Bendixsen; Barry M. Lester

doi:10.1001/jamanetworkopen.2023.10696

Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm

Elisabeth C. Mcgowan
, Monica Mcgrath
, Andrew Law
, T. Michael O'shea
, Judy L. Aschner
, Courtney K. Blackwell
, Rebecca C. Fry
, Jody M. Ganiban
, Rosemary Higgins
, Amy Margolis
, Sheela Sathyanarayana
, Genevieve Taylor
, Akram N. Alshawabkeh
, José F. Cordero
, Nicole T. Spillane
, Mark L. Hudak
, Carlos A. Camargo
, Dana Dabelea
, Anne L. Dunlop
, Amy J. Elliott

Assiamira M. Ferrara, Maria Talavera-Barber, Anne Marie Singh, Margaret R. Karagas, Catherine Karr, Thomas G. O'connor, Nigel Paneth, Rosalind J. Wright, Robert O. Wright, Whitney Cowell, Joseph B. Stanford, Casper Bendixsen, Barry M. Lester

School of Medicine

Brown University
Johns Hopkins University
University of North Carolina at Chapel Hill
Northwestern University
George Washington University
George Mason University
Florida Gulf Coast University
Columbia University
University of Washington
Children's Hospital and Regional Medical Center Seattle
Northeastern University
University of Georgia
HACKENSACK UNIVERSITY MEDICAL CENTER
University of Florida
Massachusetts General Hospital
University of Colorado Anschutz Medical Campus
Emory University
Avera Health
Kaiser Permanente
University of Wisconsin-Madison
Dartmouth College
University of Rochester
Michigan State University
Icahn School of Medicine at Mount Sinai
New York University
University of Utah
Marshfield Clinic

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	e2310696
Journal	JAMA Network Open
Volume	6
Issue number	4
DOIs	https://doi.org/10.1001/jamanetworkopen.2023.10696
State	Published - 28 Apr 2023

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10.1001/jamanetworkopen.2023.10696

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Mcgowan, E. C., Mcgrath, M., Law, A., O'shea, T. M., Aschner, J. L., Blackwell, C. K., Fry, R. C., Ganiban, J. M., Higgins, R., Margolis, A., Sathyanarayana, S., Taylor, G., Alshawabkeh, A. N., Cordero, J. F., Spillane, N. T., Hudak, M. L., Camargo, C. A., Dabelea, D., Dunlop, A. L., ... Lester, B. M. (2023). Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm. JAMA Network Open, 6(4), e2310696. https://doi.org/10.1001/jamanetworkopen.2023.10696

@article{54428a8881184e078a0fdd0c03c97d19,

title = "Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm",

abstract = "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.",

author = "Mcgowan, \{Elisabeth C.\} and Monica Mcgrath and Andrew Law and O'shea, \{T. Michael\} and Aschner, \{Judy L.\} and Blackwell, \{Courtney K.\} and Fry, \{Rebecca C.\} and Ganiban, \{Jody M.\} and Rosemary Higgins and Amy Margolis and Sheela Sathyanarayana and Genevieve Taylor and Alshawabkeh, \{Akram N.\} and Cordero, \{Jos{\'e} F.\} and Spillane, \{Nicole T.\} and Hudak, \{Mark L.\} and Camargo, \{Carlos A.\} and Dana Dabelea and Dunlop, \{Anne L.\} and Elliott, \{Amy J.\} and Ferrara, \{Assiamira M.\} and Maria Talavera-Barber and Singh, \{Anne Marie\} and Karagas, \{Margaret R.\} and Catherine Karr and O'connor, \{Thomas G.\} and Nigel Paneth and Wright, \{Rosalind J.\} and Wright, \{Robert O.\} and Whitney Cowell and Stanford, \{Joseph B.\} and Casper Bendixsen and Lester, \{Barry M.\}",

year = "2023",

month = apr,

day = "28",

doi = "10.1001/jamanetworkopen.2023.10696",

language = "English",

volume = "6",

pages = "e2310696",

journal = "JAMA Network Open",

issn = "2574-3805",

publisher = "American Medical Association",

number = "4",

}

Mcgowan, EC, Mcgrath, M, Law, A, O'shea, TM, Aschner, JL, Blackwell, CK, Fry, RC, Ganiban, JM, Higgins, R, Margolis, A, Sathyanarayana, S, Taylor, G, Alshawabkeh, AN, Cordero, JF, Spillane, NT, Hudak, ML, Camargo, CA, Dabelea, D, Dunlop, AL, Elliott, AJ, Ferrara, AM, Talavera-Barber, M, Singh, AM, Karagas, MR, Karr, C, O'connor, TG, Paneth, N, Wright, RJ, Wright, RO, Cowell, W, Stanford, JB, Bendixsen, C & Lester, BM 2023, 'Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm', JAMA Network Open, vol. 6, no. 4, pp. e2310696. https://doi.org/10.1001/jamanetworkopen.2023.10696

TY - JOUR

T1 - Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm

AU - Mcgowan, Elisabeth C.

AU - Mcgrath, Monica

AU - Law, Andrew

AU - O'shea, T. Michael

AU - Aschner, Judy L.

AU - Blackwell, Courtney K.

AU - Fry, Rebecca C.

AU - Ganiban, Jody M.

AU - Higgins, Rosemary

AU - Margolis, Amy

AU - Sathyanarayana, Sheela

AU - Taylor, Genevieve

AU - Alshawabkeh, Akram N.

AU - Cordero, José F.

AU - Spillane, Nicole T.

AU - Hudak, Mark L.

AU - Camargo, Carlos A.

AU - Dabelea, Dana

AU - Dunlop, Anne L.

AU - Elliott, Amy J.

AU - Ferrara, Assiamira M.

AU - Talavera-Barber, Maria

AU - Singh, Anne Marie

AU - Karagas, Margaret R.

AU - Karr, Catherine

AU - O'connor, Thomas G.

AU - Paneth, Nigel

AU - Wright, Rosalind J.

AU - Wright, Robert O.

AU - Cowell, Whitney

AU - Stanford, Joseph B.

AU - Bendixsen, Casper

AU - Lester, Barry M.

PY - 2023/4/28

Y1 - 2023/4/28

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85159018633

U2 - 10.1001/jamanetworkopen.2023.10696

DO - 10.1001/jamanetworkopen.2023.10696

M3 - Article

C2 - 37115545

AN - SCOPUS:85159018633

SN - 2574-3805

VL - 6

SP - e2310696

JO - JAMA Network Open

JF - JAMA Network Open

IS - 4

ER -

Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm

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