Healthcare use in 700 000 children and adolescents for six months after covid-19: before and after register based cohort study

  1. Karin Magnusson
  2. Katrine Damgaard Skyrud
  3. Pål Suren
  4. Margrethe Greve-Isdahl
  5. Ketil Størdal
  6. Doris Tove Kristoffersen
  7. Kjetil Telle

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Abstract

Objectives

To explore whether and for how long use of healthcare services is increased among children and adolescents after covid-19.

Design

Before and after register based study.

Setting

General population of Norway.

Participants

Norwegians aged 1-19 years (n=706 885) who were tested for SARS-CoV-2 from 1 August 2020 to 1 February 2021 (n=10 279 positive, n=275 859 negative) or not tested (n=420 747) and were not admitted to hospital, by age groups 1-5, 6-15, and 16-19 years.

Main outcome measures

Monthly percentages of all cause and cause specific healthcare use in primary care (general practitioner, emergency ward) and specialist care (outpatient, inpatient) from six months before to about six months after the week of being tested for SARS-CoV-2, using a difference-in-differences approach.

Results

A substantial short term relative increase in primary care use was observed for participants during the first month after a positive SARS-CoV-2 test result compared with those who tested negative (age 1-5 years: 339%, 95% confidence interval 308% to 369%; 6-15 years: 471%, 450% to 491%; 16-19 years: 401%, 380% to 422%). Use of primary care for the younger age groups was still increased at two months (1-5 years: 22%, 4% to 40%; 6-15 years: 14%, 2% to 26%) and three months (1-5 years: 26%, 7% to 46%, 6-15 years: 15%, 3% to 28%), but not for the oldest group (16-19 years: 11%, −2% to 24% and 6%, −7% to 19%, respectively). Children aged 1-5 years who tested positive also showed a minor long term (≤6 months) relative increase in primary care use (13%, −0% to 26%) that was not observed for the older age groups, compared with same aged children who tested negative. Results were similar yet the age differences less pronounced compared with untested controls. For all age groups, the increase in primary care visits was due to respiratory and general or unspecified conditions. No increased use of specialist care was observed.

Conclusion

Covid-19 among children and adolescents was found to have limited impact on healthcare services in Norway. Preschool aged children might take longer to recover (3-6 months) than primary or secondary school students (1-3 months), usually because of respiratory conditions.

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  1. Version published to 10.1136/bmj-2021-066809
  2. ScreenIT

    SciScore for 10.1101/2021.06.02.21258211: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were run in STATA MP v.16.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths & Limitations: Important strengths of our study are its sample size, the inclusion of children with confirmed positive or negative PCR test for SARS-CoV-2 and the use of two comparison groups. Another strength is the use of routinely collected data from registers that are mandated by law and cover the entire population. This ensures representativeness and that our findings can be used to inform actions to control the virus in Norway and comparable countries. Along this line, the most obvious limitation is that health care utilization cannot always be used as a proxy for a population’s health or medical conditions. Thus, symptoms may persist that are not dealt with in primary or specialist care. Other important limitations are the methodological challenges arising due to differences in the age-specific testing patterns (Figure 1). As an example, parents may decide to test their 2-year old based on only non-verbal information, whereas teenagers to a larger extent may book a PCR test by own initiative. Although recommendations for testing have included all symptomatic individuals, parents may be more likely to test children having pre-existing conditions and younger children, rather than their healthy and older children, which may give different selection criteria into the different age strata’s groups for those testing positive or negative for SARS-CoV-2. We circumvented this selection issue of the children being at-risk or in need of health care also being more often...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.06.02.21258211 on medRxiv