Deficits in hospital care among clinically vulnerable children aged 0 to 4 years during the COVID-19 pandemic
Abstract
Objective
To quantify deficits in hospital care for clinically vulnerable children during the COVID-19 pandemic.
Design
Birth cohort in Hospital Episode Statistics (HES).
Setting
NHS hospitals in England.
Study population
All children aged <5 years with a birth recorded in hospital administrative data (January 2010 to March 2021).
Main exposure
Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks gestation) or low birthweight (<2500g).
Main outcomes
Deficits in care defined by predicted rates for 2020, estimated from 2015- 2019, minus observed rates per 1000 child years during the pandemic (March 2020-2021).
Results
Of 3,813,465 children, 17.7% (1 in 6) were clinically vulnerable (9.5% born preterm or low birthweight, 10.3% had a chronic condition). Deficits in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 versus 73 per 1000 child years), planned admissions (55 versus 10), and unplanned admissions (105 versus 79). Clinically vulnerable children accounted for 50.1% of the deficit in outpatient attendances, 55.0% in planned admissions, and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to pre-pandemic levels for infants with chronic conditions but not older children. Deficits in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic.
Conclusion
1 in 6 clinically vulnerable children accounted for one-third to one half of the deficit in hospital care during the pandemic.
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