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Among American children and teens who died of COVID-19, a large majority had an underlying medical condition or were nonwhite, CDC researchers found.

From Feb. 12 to July 31, 121 deaths of patients under age 21 were reported to the CDC, of whom 75% had underlying medical conditions, such as asthma, obesity, neurologic/developmental conditions, and cardiac conditions, while a quarter were previously healthy, reported Danae Bixler, MD, of the CDC in Atlanta, and colleagues.

Nearly half had two or more underlying conditions, the researchers said in an early edition.

Also, 45% of fatal cases were Hispanic, 29% were non-Hispanic Black, and 4% were non-Hispanic American Indian/Alaska Native.

Most deaths were in pediatric patients ages 10-20, with a median age of 16 (IQR 7-19); but 10% were in infants and 20% were in children 1-9.

Virtually all of the pediatric deaths met the COVID-19 case definition, 12% met the multi-inflammatory syndrome in children (MIS-C) case definition, and 12% met both case definitions.

Case-based surveillance indicated 391,814 confirmed or probable COVID-19 or MIS-C cases in people under age 21 in the U.S. -- about 8% of all cases as of the end of July. The findings of just over 100 deaths confirm that the illness is much less severe in general than in older individuals, Bixler's group said.

But the racial-ethnic disparity is a matter of concern, they suggested.

The researchers noted that, while Hispanic, Black, and American Indian/Alaskan Natives represent 41% of the U.S. population under age 21, they comprised about 75% of pediatric COVID-19 deaths.

"These racial/ethnic groups are also disproportionately represented among essential workers unable to work from their homes, resulting in higher risk for exposure to SARS-CoV-2," Bixler and colleagues wrote.

Disparities in social determinants of health could contribute to "racial and ethnic disparities and COVID-19 and MIS-C incidence and outcomes," they added. "Ultimately, health departments, health providers, and community partners can mobilize to remove systemic barriers that contribute to health disparities."

SARS-CoV-2 and MIS-C-associated deaths were categorized as such by the local jurisdiction. All 50 states plus New York City, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands were asked to submit information. Among these 55 jurisdictions, 47 responded, and 27 reported the 121 deaths that met inclusion criteria.

Of the young people who died, 63% were male, and 45% had two or more underlying medical conditions. Asthma (28%) and obesity (27%) were the most commonly reported medical conditions, followed by neurologic and developmental conditions (22%) and cardiovascular conditions (18%).

Two-thirds of deaths occurred after hospital admission. Among those who died in the hospital, median onset from symptoms to admission was 3 days, and median interval from hospital admission to death was 8 days.

Of the remaining deaths, 55% were critically ill and died in the emergency department, while 38% died at home. The highest proportion of out-of-hospital deaths occurred among adolescents and young adults (37%) and infants (33%).

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