{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T05:28:19Z","timestamp":1762838899744,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T00:00:00Z","timestamp":1762646400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health\u2019s Eunice Kennedy Shriver National Institute of Child Health and Human Development"},{"DOI":"10.13039\/100007492","name":"Baylor","doi-asserted-by":"crossref","award":["R33HD105593"],"award-info":[{"award-number":["R33HD105593"]}],"id":[{"id":"10.13039\/100007492","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100008576","name":"Central Michigan University","doi-asserted-by":"crossref","award":["1R61HD105610"],"award-info":[{"award-number":["1R61HD105610"]}],"id":[{"id":"10.13039\/100008576","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Research on the association of adverse social determinants of health (SDOH) with severe pediatric coronavirus disease (COVID-19) is limited. We examined associations between SDOH patterns and COVID-19 severity in children. Methods: We conducted a prospective, observational study of children (&lt;18 years) with symptomatic SARS-CoV-2 infection evaluated in an urban pediatric emergency department (March 2021\u2013April 2022) in Detroit, Michigan. Caregivers completed a 34-item survey based on the Healthy People 2030 framework. Severe disease was defined as the occurrence of respiratory\/cardiac failure or death within four weeks of diagnosis. Continuous and categorical variables were described using medians and percentages, respectively. Associations between disease severity and risk factors were determined using chi-square tests. Association rule mining was used for feature selection, followed by multivariate logistic regression. Results: We analyzed data from 354 children [6\u201312 years: 31.1%, Female: 51.1%, Black: 59%, not Hispanic: 84.7%, public insurance: 77.1%, chronic condition: 27.4%]. Of the total, 113 children had severe disease. Most caregivers were 30\u201344 years old (53.1%), had less than a college degree (70.4%), and income &lt; USD 50,000 (75.2%). Adverse SDOH reported included food\/housing insecurity (24.6%), no support (64.7%), unmet childcare needs (35.9%), and lack of transportation (12.7%). After controlling for age, sex, medical history, income, and obesity, severe disease was associated with caregiver use of drugs\/alcohol (OR:5.92, p &lt; 0.001) and social discrimination\/lack of support (OR: 1.74, p = 0.030). Conclusions: Two SDOH patterns (caregiver use of drugs\/alcohol and social discrimination\/lack of support) were associated with severe COVID-19. Further studies are needed to confirm findings and develop interventions.<\/jats:p>","DOI":"10.3390\/children12111515","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T08:57:55Z","timestamp":1762765075000},"page":"1515","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Social Determinants of Health Patterns in Children with Severe Disease Due to SARS-CoV-2 Infection\u2014An Exploratory Approach"],"prefix":"10.3390","volume":"12","author":[{"given":"Joshua","family":"Prabhu","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Children\u2019s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Acosta","sequence":"additional","affiliation":[{"name":"Pediatrics\u2013Critical Care, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Savorgnan","sequence":"additional","affiliation":[{"name":"Pediatrics\u2013Critical Care, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ananth V.","family":"Annapragada","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital-Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usha","family":"Sethuraman","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Pediatrics, Children\u2019s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, USA"},{"name":"Carmen and Ann Adams Department of Pediatrics, Central Michigan University, 1200 S Franklin St, Mount Pleasant, MI 48859, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,9]]},"reference":[{"key":"ref_1","unstructured":"(2025, June 10). 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