COVID-19 Is Now the 8th Leading Cause of Death in Children and Young Americans

The overall risk of COVID-19 mortality in children and young people is substantially less than in other age groups. However, given that death by all causes is rare in children and young adults (0-19 years), the mortality burden of COVID-19 is best understood when contextualized by all other causes of death in children and young people (CYP).

An original investigation, published yesterday in JAMA, evaluated how COVID-19 ranks as an underlying cause of death for children and young Americans, aged 0-19 years old. The primary objective was to determine whether COVID-19 is a top 10 cause of death in CYP.

Led by researchers as the University of Oxford’s Department of Computer Science, the investigators utilized the US Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiological Research (WONDER) database for their national population-level cross-sectional epidemiological analysis.

COVID-19 deaths were categorized in 12-month periods, between April 1, 2020-August 31, 2022, and compared to deaths by non-COVID causes in 2019, 2020, and 2021.

Using the National Center for Health Statistics 113 Selected Causes of Death, the investigators determined the cause of death rankings by total number of CYP deaths, crude rates per 100000 population, and percentage of all causes of death.

During the study period, there were 821 COVID-19 deaths among CYP 0-19 years of age. This resulted in a crude death rate of 1.0 per 100000 population overall.

Broken down by age, the crude death rate was 4.3 per 100000 for children younger than a year, 0.6 per 100000 for those aged 1-4 years; 0.4 per 100000 for those aged 5-9 years, 0.5 per 100000 for those aged 10-14 years; and 1.8 per 100000 for those aged 15-19 years.

During the August 1, 2021-July 31, 2022 time period, COVID-19 was among the 10 leading causes of death in CYP 0-19 years, ranking eighth in all causes of death, fifth in disease-related causes of death, and first in deaths caused by infectious or respiratory diseases.

By age group, COVID-19 was the seventh cause of death in infants, seventh in 1-4 year-olds, sixth in 5-9 year-olds, sixth in 10-14 year-olds, and fifth in 15-19 year-olds.

The finding that COVID-19 is a top 10 cause of death in children and young people should change how we think about the pandemic. Factors such as underreporting and not accounting for COVID-19 as a contributing cause of death means these estimates likely understate the mortalities COVID-19 caused in CYP.

“These results demonstrate that while it's rare for kids and teens to die in the US, COVID-19 is now the leading underlying cause of death from infectious disease for this age group,” said lead author Seth Flaxman, PhD. “Many of the 82 million American children and young people were infected during the big Delta and Omicron waves, and as a result more than 1300 children and young people have died from COVID-19 during the pandemic, most in the last two years. Fortunately, we now have an array of effective tools to minimize risk, from building ventilation to air purifiers to safe vaccines.”

The study authors emphasized that these results indicate a need to take COVID-19 prevention and vaccination seriously, even for the youngest age groups.