We read the Article by Eduardo Oliveira and colleagues1 with great interest and believe the findings from this cohort study are important, given that they directly investigated the risk factors associated with COVID-19 in children and adolescents.
In their study, patients were roughly evenly distributed among the three age groups, and risk of death was increased in infants younger than age 2 years and in adolescents aged 12–19 years, relative to children aged 2–11 years. However, the authors did not provide a rationale for the age groupings. The lower age limit of adolescence is generally defined as 10 years,2 including by the UN and WHO.3 Additionally, a study of COVID-19 trends between March 1, 2020, and Dec 12, 2020, in young people aged 0–24 years in the USA found that more than 81% of patients were older than 10 years.4 Therefore, we are interested to know how a different age stratification (<2 years, 2–9 years, and 10–19 years) would affect the study findings, and we believe that comparison between these age groups could provide further insight on the COVID-19 mortality risk in adolescents.
It is important to present the median and mean ages in the three age groups, given that this information will help readers understand how mortality risk is influenced by age within the broad age bands. Having data related to symptoms, comorbidities, admission to intensive care units, and death rate by age groups will also provide a basis for understanding the disparity in death risk among age groups.
The upper-age definition of adolescence has long posed a conundrum and varies across countries. Defining adolescence as age 10–24 years has been proposed to align more closely with adolescents’ biological growth and social-role transitions,2 and some studies on COVID-19 have included patients aged 0–24 years.4 The study by Oliveira and colleagues1 included patients younger than 20 years, and the inclusion of patients aged 21–24 years might provide a more comprehensive understanding of COVID-19 in adolescence.
We declare no competing interests.
References
- 1.Oliveira EA, Colosimo EA, Simoes ESAC, et al. Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database. Lancet Child Adolesc Health. 2021;5:559–568. doi: 10.1016/S2352-4642(21)00134-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2:223–228. doi: 10.1016/S2352-4642(18)30022-1. [DOI] [PubMed] [Google Scholar]
- 3.WHO U. Mathers C. Global strategy for women's, children's and adolescents' health (2016–2030) 2016. https://www.who.int/life-course/partners/global-strategy/ewec-globalstrategyreport-200915.pdf?ua=1 [DOI] [PMC free article] [PubMed]
- 4.Leidman E, Duca LM, Omura JD, Proia K, Stephens JW, Sauber-Schatz EK. COVID-19 trends among persons aged 0–24 years: United States, March 1–December 12, 2020. MMWR Morb Mortal Wkly Rep. 2021;70:88–94. doi: 10.15585/mmwr.mm7003e1. [DOI] [PMC free article] [PubMed] [Google Scholar]