Predictors of hospital admission in young patients with COVID-19

Background The impact of age, race, and comorbidities on COVID-19 severity in younger populations is not well understood. This study aimed to identify predictors of hospital admission in young patients with COVID-19.

We conducted a retrospective analysis of 2658 COVID-19 patients under 36 years old from March 1 to August 6, 2020, using data from HEALTHeLINK, a regional health information system in western New York. Patients were divided into pediatric (0-19 years) and young adult (20-36 years) groups. We evaluated associations between risk factors and hospital admission using recursive partitioning and linear regression.

The study included 2131 young adults and 527 pediatric patients. In young adults, race was the strongest predictor of admission, followed by BMI. African Americans with BMI > 23 had the highest admission rate (63%, p<0.001). Asian race predicted outpatient management regardless of BMI. Smoking and hypertension were less significant predictors, while gender, diabetes, respiratory conditions, and sickle cell disease were not significant. In the pediatric population, race was also the primary predictor of admission, with African Americans having higher admission rates than Whites and Asians. BMI percentile was not a predictor in pediatric patients.

Race strongly predicted hospital admission in young COVID-19 patients, with African Americans most likely to be admitted and Asians least likely. For African American young adults, BMI > 23 was an additional strong predictor. A simple decision tree incorporating age, race, and BMI can help identify young patients least likely to require inpatient management. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: University at Buffalo Institutional Review Board (UBIRB) gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors