Outcomes and Multimorbidity among Children and Youth with Chronic Neurologic Disorders Hospitalized for COVID-19: A Canadian Immunization Monitoring Program, ACTive Study.

Abstract

To estimate the association between chronic neurologic disorders (NDs) and severe COVID-19 among hospitalized children and youth, and assess how multimorbidity (ie, ≥2 chronic comorbidities) modifies this association. We conducted a national surveillance study at 13 children's hospitals in Canada from April 2020 to December 2022, via the Canadian Paediatric Surveillance Program and Canadian Immunization Monitoring Program, ACTive. Eligible cases were aged <17 years old and hospitalized for COVID-19. Chronic comorbidities were classified using the Medical Dictionary for Regulatory Activities. Severe COVID-19 was defined as intensive care unit admission, ventilatory/hemodynamic support, systemic complications, and/or death. Mixed-effects robust Poisson regression was conducted to estimate adjusted prevalence ratios (aPRs) between NDs and severe COVID-19, with interaction terms accounting for multimorbidity. Among 3218 cases hospitalized for COVID-19, 601 (18.7%) had NDs. Most cases with NDs had ≥2 chronic comorbidities (n = 476/601, 79.2%). Severe COVID-19 was more common among cases with cerebral palsy (aPR 1.30, 95% CI 1.08-1.57), epilepsy (aPR 1.50, 95% CI 1.14-1.96), genetic disorders with neurologic abnormalities (aPR 1.41, 95% CI 1.18-1.67), and neuromuscular disorders (aPR 1.37, 95% CI 1.08-1.75). Compared with cases without comorbidities, there was a dose-response relationship among ND cases in which additional comorbidities increased associations with severe COVID-19 (eg, aPR 1.29 [95% CI 1.03-1.62] for cases with 1 comorbidity; aPR 2.86 [95% CI 2.11-3.87] for cases with ≥ 4 comorbidities). Children and youth with NDs are disproportionately affected by severe COVID-19, and patients with multimorbidity were at greatest risk. Many cases with NDs remained unvaccinated against SARS-CoV-2 and may benefit from efforts to encourage vaccine uptake.