COVID-19 Hospitalizations Disproportionately Impacted Black, Hispanic Children

Hispanic and Black children were disproportionately hospitalized and more likely to experience severe symptoms from COVID-19 when compared with White and Asian or Pacific Islander patients, according to a study published in JAMA Network Open.¹ The researchers’ findings highlight a need for increasing equitable access to therapies and vaccines for COVID-19.

“Since the start of the COVID-19 pandemic in 2020, most hospitalizations for COVID-19 have occurred among adults, and multiple studies demonstrated that COVID-19 hospitalizations disproportionately affected and exacerbated existing health disparities among adults of racial and ethnic minority populations, with hospitalization rates more than 5-fold higher among Black and Hispanic populations compared with White adult populations in 2020,” wrote authors of the study.

While severe COVID-19 infection was most prominent among older adults, it indeed occurred among children throughout the pandemic’s peaks. According to American Academy of Pediatrics News, around 234,000 children under 18 were hospitalized with COVID-19 between fall 2020 and spring 2024.²

Researchers explored over 13,000 COVID-19–related pediatric hospitalizations. | image credit: Nina Lawrenson/peopleimages.com / stock.adobe.com

READ MORE: Increased COVID-19 Testing Skewed Understanding of Respiratory Disease Trends

During the formative days of the pandemic in 2020 and 2021, the older adult population was a keen focus for public health experts. While the first COVID-19 vaccine approval in August 2021 included anyone 16 or over,³ they were set aside for older adults, as the first 2 recipients were a 90-year-old woman and 81-year-old man.⁴

It wasn’t until late in 2021 when younger children began receiving approval for COVID-19 vaccines. Those 5 to 11 were given approval in November of that year and children 6 months to 5 years were given approval in June 2022.⁵

“Although a 2022 report demonstrated that disparities in hospitalizations by race and ethnicity also occurred among pediatric populations, few studies have examined these disparities over the course of the pandemic,” continued the authors.¹ “This analysis examines observed racial and ethnic disparities and outcomes among children hospitalized with COVID-19 from March 2020 to September 2023.”

Throughout this time frame, researchers explored COVID-19 Hospitalization Surveillance Network (COVID-NET) data from over 13,000 hospitalizations of patients 17 years or younger with lab-confirmed SARS-CoV-2 infection. All participants resided in 12 states part of COVID-NET catchment areas, which consist of an estimated 10% of the US population.

On top of providing patients’ age, sex, race, and ethnicity, researchers also separated both age groups and time periods within the study. To better understand hospitalization rates, pediatric age groups were separated into children 12 to 17, 5 to 11, and those 4 or under. Time periods were separated into 4, beginning with March to December 2020, October 2020 to September 2021, October 2021 to September 2022, and October 2022 to September 2023.

The final analysis included a total of 13,555 COVID-19–related pediatric hospitalizations (median age, 3.3 years; 52.5% boys).

“Cumulative and weekly hospitalization rates from March 2020 to September 2023 overall indicated that Hispanic and Black children were disproportionately hospitalized compared with their Asian or Pacific Islander and White peers,” they wrote.¹ “COVID-19–associated hospitalization rates were consistently highest among Black and Hispanic children aged 17 years or younger and among all age groups.”

Based on COVID-NET data, Black children experienced the highest rates of hospitalizations from COVID-19 during this time, while Asian or Pacific Islander children had the lowest rates. Indeed, rates were 2.15 times higher for Black children and 2.06 times higher for Hispanic children when compared with Asian or Pacific Islander groups.

Furthermore, they saw the highest rates of intensive care unit (ICU) visits at 1.88 times higher for Black patients and 2.13 times higher for Hispanic patients. Finally, among the hospitalized children, 61.4% of those that were Black had at least 1 underlying medical condition. For Hispanic, White, and Asian or Pacific Islander children, however, they reported at least 1 underlying condition in under 46% of each population.

“These disparities were evident early in the pandemic and persisted over multiple years,” the authors continued. “Although hospitalization and ICU admission rates decreased during the period from October 2022 to September 2023 compared with earlier surveillance periods, both were highest among Black and Hispanic children, with rates nearly twice those among Asian or Pacific Islander children.”
Similar to many other areas of health care and social spaces in the US, racial disparities are persisting. With minority groups being more at-risk yet receiving under-valued care, they are continuously treated disproportionately when compared with their White counterparts. This reality has been reinforced by both the current study and the ongoing data releasing from COVID-19 and pandemic-related literature—all highlighting health care’s failure to combat racial inequities.

“This study found that among pediatric patients hospitalized with COVID-19, Black and Hispanic children were disproportionately more likely to be hospitalized for COVID-19 and experience severe disease compared with White and Asian or Pacific Islander children,” concluded authors of the study.¹ “This study underlines the need for targeted interventions, particularly for children with underlying medical conditions, and the need for equitable access and use of vaccines and therapeutics for disproportionately affected populations.”

READ MORE: COVID-19 Resource Center

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References

1. Anglin O, Patel K, Daily Kirley P, et al. Pediatric COVID-19 hospitalization trends by race and ethnicity, 2020-2023. JAMA Netw Open. 2025;8(7):e2521009. doi:10.1001/jamanetworkopen.2025.21009

2. AAP analyzes pediatric COVID-19 hospitalizations from 2020-’24. AAP News. July 1, 2024. Accessed July 16, 2025. https://publications.aap.org/aapnews/news/29182/AAP-analyzes-pediatric-COVID-19-hospitalizations

3. FDA approves first COVID-19 vaccine. News Release. CDC. August 23, 2021. Accessed July 16, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine

4. Morrow-Howell N. Why older people are among the first to get the vaccine. Washington University in St. Louis Institute for Public Health. December 16, 2020. Accessed July 16, 2025. https://publichealth.wustl.edu/why-older-people-are-among-the-first-to-get-the-vaccine/

5. Kates J, Williams E, Rudowitz R. The last major phase of the COVID-19 vaccination roll-out: children under 5. KFF. June 21, 2022. Accessed July 16, 2025. https://www.kff.org/coronavirus-covid-19/issue-brief/the-last-major-phase-of-the-covid-19-vaccination-roll-out-children-under-5/