Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States

Dazheng Zhang; Bingyu Zhang; Qiong Wu; Ting Zhou; Jiayi Tong; Yiwen Lu; Jiajie Chen; Huiyuan Wang; Deena J. Chisolm; Ravi Jhaveri; Rachel C. Kenney; Russell L. Rothman; Suchitra Rao; David A. Williams; Mady Hornig; Linbo Wang; Jeffrey S. Morris; Christopher B. Forrest; Yong Chen

doi:10.1038/s41467-024-55273-z

Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States

Dazheng Zhang, Bingyu Zhang, Qiong Wu, Ting Zhou, Jiayi Tong, Yiwen Lu, Jiajie Chen, Huiyuan Wang, Deena J. Chisolm, Ravi Jhaveri, Rachel C. Kenney, Russell L. Rothman, Suchitra Rao, David A. Williams, Mady Hornig, Linbo Wang, Jeffrey S. Morris, Christopher B. Forrest, Yong Chen^*

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

Abstract

Racial/ethnic differences are associated with the symptoms and conditions of post-acute sequelae SARS-CoV-2 infection (PASC) in adults. These differences may exist among children and warrant further exploration. We conducted a retrospective cohort study with difference-in-differences analyzes to assess these differences in children and adolescents under the age of 21. The study utilized data from the RECOVER Initiative in the United States, which aims to learn about the long-term effects of COVID-19. The cohort included 225,723 patients with SARS-CoV-2 infection or COVID-19 diagnosis between March 2020 and October 2022. The study compared minority racial/ethnic groups to Non-Hispanic White (NHW) individuals, stratified by severity during the acute phase of COVID-19. Within the severe group, Asian American/Pacific Islanders (AAPI) had a higher prevalence of fever/chills and respiratory signs and symptoms, Hispanic patients showed greater hair loss prevalence in severe COVID-19 cases, while Non-Hispanic Black (NHB) patients had fewer skin symptoms in comparison to NHW patients. Within the non-severe group, AAPI patients had increased POTS/dysautonomia and respiratory symptoms, and NHB patients showed more cognitive symptoms than NHW patients. In conclusion, racial/ethnic differences related to COVID-19 exist among PASC symptoms and conditions in pediatrics, and these differences are associated with the severity of illness during acute COVID-19.

Original language	English (US)
Article number	878
Journal	Nature communications
Volume	16
Issue number	1
DOIs	https://doi.org/10.1038/s41467-024-55273-z
State	Published - Dec 2025

Funding

R.J. is a consultant for AstraZeneca, Seqirus, and Dynavax, and receives an editorial stipend from Elsevier and Pediatric Infectious Diseases Society and royalties from Up To Date/Wolters Kluwer. S.R. reports prior grant support from GSK and Biofire and is a consultant for Sequiris. All other authors have nothing to disclose. This study is part of the NIH Researching COVID-19 to Enhance Recovery (RECOVER) Initiative, which seeks to understand, treat, and prevent the post-acute sequelae of SARS-CoV-2 infection (PASC). For more information on RECOVER, visit https://recovercovid.org/. We gratefully acknowledge the contributions of the RECOVER consortium. We would like to thank the National Community Engagement Group (NCEG), all patients, caregivers, and community representatives, and all the participants enrolled in the RECOVER Initiative. We would like to thank patient representatives\u00A0Teresa Akintonwa\u00A0and\u00A0Lisa McCorkell for their helpful suggestions that have enriched our work. This study was supported by the National Institutes of Health (OT2HL161847-01, Y.C.). Y.C.\u2019s effort has also been supported in part by the National Institutes of Health (1R01LM012607, 1R01AI130460, 1R01AG073435, 1R56AG074604, 1R01LM013519, 1R56AG069880, 1R01AG077820, 1U01TR003709) and the Patient-Centered Outcomes Research Institute (PCORI) Project Program Awards (ME-2019C3-18315 and ME-2018C3-14899). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the PCORI, its Board of Governors, or the Methodology Committee. Finally, the content is solely the responsibility of the authors and does not necessarily represent the official views of the RECOVER Initiative, the NIH, or other funders. This study is part of the NIH Researching COVID-19 to Enhance Recovery (RECOVER) Initiative, which seeks to understand, treat, and prevent the post-acute sequelae of SARS-CoV-2 infection (PASC). For more information on RECOVER, visit https://recovercovid.org/ . We gratefully acknowledge the contributions of the RECOVER consortium. We would like to thank the National Community Engagement Group (NCEG), all patients, caregivers, and community representatives, and all the participants enrolled in the RECOVER Initiative. We would like to thank patient representatives Teresa Akintonwa and Lisa McCorkell for their helpful suggestions that have enriched our work. This study was supported by the National Institutes of Health (OT2HL161847-01, Y.C.). Y.C.\u2019s effort has also been supported in part by the National Institutes of Health (1R01LM012607, 1R01AI130460, 1R01AG073435, 1R56AG074604, 1R01LM013519, 1R56AG069880, 1R01AG077820, 1U01TR003709) and the Patient-Centered Outcomes Research Institute (PCORI) Project Program Awards (ME-2019C3-18315 and ME-2018C3-14899). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the PCORI, its Board of Governors, or the Methodology Committee. Finally, the content is solely the responsibility of the authors and does not necessarily represent the official views of the RECOVER Initiative, the NIH, or other funders.

ASJC Scopus subject areas

General Chemistry
General Biochemistry, Genetics and Molecular Biology
General Physics and Astronomy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Zhang, D., Zhang, B., Wu, Q., Zhou, T., Tong, J., Lu, Y., Chen, J., Wang, H., Chisolm, D. J., Jhaveri, R., Kenney, R. C., Rothman, R. L., Rao, S., Williams, D. A., Hornig, M., Wang, L., Morris, J. S., Forrest, C. B., & Chen, Y. (2025). Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States. Nature communications, 16(1), Article 878. https://doi.org/10.1038/s41467-024-55273-z

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title = "Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States",

abstract = "Racial/ethnic differences are associated with the symptoms and conditions of post-acute sequelae SARS-CoV-2 infection (PASC) in adults. These differences may exist among children and warrant further exploration. We conducted a retrospective cohort study with difference-in-differences analyzes to assess these differences in children and adolescents under the age of 21. The study utilized data from the RECOVER Initiative in the United States, which aims to learn about the long-term effects of COVID-19. The cohort included 225,723 patients with SARS-CoV-2 infection or COVID-19 diagnosis between March 2020 and October 2022. The study compared minority racial/ethnic groups to Non-Hispanic White (NHW) individuals, stratified by severity during the acute phase of COVID-19. Within the severe group, Asian American/Pacific Islanders (AAPI) had a higher prevalence of fever/chills and respiratory signs and symptoms, Hispanic patients showed greater hair loss prevalence in severe COVID-19 cases, while Non-Hispanic Black (NHB) patients had fewer skin symptoms in comparison to NHW patients. Within the non-severe group, AAPI patients had increased POTS/dysautonomia and respiratory symptoms, and NHB patients showed more cognitive symptoms than NHW patients. In conclusion, racial/ethnic differences related to COVID-19 exist among PASC symptoms and conditions in pediatrics, and these differences are associated with the severity of illness during acute COVID-19.",

author = "Dazheng Zhang and Bingyu Zhang and Qiong Wu and Ting Zhou and Jiayi Tong and Yiwen Lu and Jiajie Chen and Huiyuan Wang and Chisolm, {Deena J.} and Ravi Jhaveri and Kenney, {Rachel C.} and Rothman, {Russell L.} and Suchitra Rao and Williams, {David A.} and Mady Hornig and Linbo Wang and Morris, {Jeffrey S.} and Forrest, {Christopher B.} and Yong Chen",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

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doi = "10.1038/s41467-024-55273-z",

language = "English (US)",

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Zhang, D, Zhang, B, Wu, Q, Zhou, T, Tong, J, Lu, Y, Chen, J, Wang, H, Chisolm, DJ, Jhaveri, R, Kenney, RC, Rothman, RL, Rao, S, Williams, DA, Hornig, M, Wang, L, Morris, JS, Forrest, CB & Chen, Y 2025, 'Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States', Nature communications, vol. 16, no. 1, 878. https://doi.org/10.1038/s41467-024-55273-z

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T1 - Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States

AU - Zhang, Dazheng

AU - Zhang, Bingyu

AU - Wu, Qiong

AU - Zhou, Ting

AU - Tong, Jiayi

AU - Lu, Yiwen

AU - Chen, Jiajie

AU - Wang, Huiyuan

AU - Chisolm, Deena J.

AU - Jhaveri, Ravi

AU - Kenney, Rachel C.

AU - Rothman, Russell L.

AU - Rao, Suchitra

AU - Williams, David A.

AU - Hornig, Mady

AU - Wang, Linbo

AU - Morris, Jeffrey S.

AU - Forrest, Christopher B.

AU - Chen, Yong

PY - 2025/12

Y1 - 2025/12

N2 - Racial/ethnic differences are associated with the symptoms and conditions of post-acute sequelae SARS-CoV-2 infection (PASC) in adults. These differences may exist among children and warrant further exploration. We conducted a retrospective cohort study with difference-in-differences analyzes to assess these differences in children and adolescents under the age of 21. The study utilized data from the RECOVER Initiative in the United States, which aims to learn about the long-term effects of COVID-19. The cohort included 225,723 patients with SARS-CoV-2 infection or COVID-19 diagnosis between March 2020 and October 2022. The study compared minority racial/ethnic groups to Non-Hispanic White (NHW) individuals, stratified by severity during the acute phase of COVID-19. Within the severe group, Asian American/Pacific Islanders (AAPI) had a higher prevalence of fever/chills and respiratory signs and symptoms, Hispanic patients showed greater hair loss prevalence in severe COVID-19 cases, while Non-Hispanic Black (NHB) patients had fewer skin symptoms in comparison to NHW patients. Within the non-severe group, AAPI patients had increased POTS/dysautonomia and respiratory symptoms, and NHB patients showed more cognitive symptoms than NHW patients. In conclusion, racial/ethnic differences related to COVID-19 exist among PASC symptoms and conditions in pediatrics, and these differences are associated with the severity of illness during acute COVID-19.

AB - Racial/ethnic differences are associated with the symptoms and conditions of post-acute sequelae SARS-CoV-2 infection (PASC) in adults. These differences may exist among children and warrant further exploration. We conducted a retrospective cohort study with difference-in-differences analyzes to assess these differences in children and adolescents under the age of 21. The study utilized data from the RECOVER Initiative in the United States, which aims to learn about the long-term effects of COVID-19. The cohort included 225,723 patients with SARS-CoV-2 infection or COVID-19 diagnosis between March 2020 and October 2022. The study compared minority racial/ethnic groups to Non-Hispanic White (NHW) individuals, stratified by severity during the acute phase of COVID-19. Within the severe group, Asian American/Pacific Islanders (AAPI) had a higher prevalence of fever/chills and respiratory signs and symptoms, Hispanic patients showed greater hair loss prevalence in severe COVID-19 cases, while Non-Hispanic Black (NHB) patients had fewer skin symptoms in comparison to NHW patients. Within the non-severe group, AAPI patients had increased POTS/dysautonomia and respiratory symptoms, and NHB patients showed more cognitive symptoms than NHW patients. In conclusion, racial/ethnic differences related to COVID-19 exist among PASC symptoms and conditions in pediatrics, and these differences are associated with the severity of illness during acute COVID-19.

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Racial/ethnic differences in post-acute sequelae of SARS-CoV-2 in children and adolescents in the United States

Abstract

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UN SDGs

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