Abstract

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.

Methods: 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. Results: 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. Conclusions: 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.

Keywords: COVID-19;Hospital Admission;Race;BMI (Body Mass Index);Young Patients