Influence of socioeconomic factors on COVID-19 mortality in children: a scoping review



COVID-19; Socioeconomic Factors; Child; Mortality.


Objective: to identify the scientific evidence on the relationship between socioeconomic factors and mortality in children due to COVID-19. Methods: this is a scoping review. Searches were carried out in the following databases: US National Library of Medicine - National Institutes of Health; Scientific Electronic Library Online; Institute for Scientific Information; Cumulative Index to Nursing and Allied Health Literature; and SciVerse Scopus. Results: 15 articles were selected that showed the influence of socioeconomic factors on infant mortality from Severe Acute Respiratory Syndrome Coronavirus 2. Conclusion: it was shown that socioeconomic factors are related to increased mortality from COVID-19 in the infant population, low income and residence in locations considered to be of greater socioeconomic vulnerability, which were presented as important variables to be considered in the COVID-19 pandemic. Contributions to practice: several factors are related to increased susceptibility to Severe Acute Respiratory Syndrome Coronavirus infection and worsening of the disease in children. However, understanding that socioeconomic factors can be a determinant of COVID-19 incidence and mortality in children highlights the need to invest in actions aimed at reducing socioeconomic inequalities, to reduce preventable deaths.



Pathak EB, Salemi JL, Sobers, N Menard, J Hambleton, IR. COVID-19 in children in the United States: intensive care admissions, estimated total infected, and projected numbers of severe pediatric cases in 2020. J Public Health Manag. Pract. 2020;26(4):325-33. doi:

Gupta SL, Tyagi R, Dhar A, Oswal N, Khandelwal A, Jaiswal RK. Children’s SARS-CoV-2 infection and their vaccination. Vaccines. 2023;2;11(2):418. doi:

Howard-Jones AR, Burgner DP, Crawford NW, Goeman E, Gray PE, Hsu P, et al. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health. 2022;58(1):46-53. doi:

Taytard J, Prevost B, Schnuriger A, Aubertin G, Berdah L, Bitton L, et al. SARS-CoV-2 B.1.1.529 (Omicron) variant causes an unprecedented surge in children hospitalizations and distinct clinical presentation compared to the SARS-CoV-2 B.1.617.2 (Delta) variant. Front Pediatr. 2022;27(10):932170. doi:

Müller GC, Ferreira LS, Campos FEM, Borges ME, Almeida GB, Poloni S, et al. Modeling the impact of child vaccination (5-11 y) on overall COVID-19 related hospitalizations and mortality in a context of omicron variant predominance and different vaccination coverage paces in Brazil. Lancet Reg Health Am. 2023;17:100396. doi:

Santos VS, Siqueira TS, Atienzar AIC, Santos MARDR, Vieira SCF, Lopes ASA, et al. Spatial clusters, social determinants of health and risk of COVID-19 mortality in Brazilian children and adolescents: a nationwide population-based ecological study. Lancet Reg Health Am. 2022;13:100311. doi:

Martins-Filho PR, Quintans-Júnior LJ, Araújo AAS, Sposato KB, Tavares CSS, Gurgel RQ, et al. Socio-economic inequalities and COVID-19 incidence and mortality in Brazilian children: a nationwide register-based study. Public Health. 2021;190:4-6. doi:

Aromataris E, Munn Z, editors. JBI manual for evidence synthesis [Internet]. 2020 [cited Aug 13, 2023]. Available from:

Fabbri S, Silva C, Hernandes E, Octaviano F, Di Thommazo A, Belgamo A. Improvements in the StArt tool to better support the systematic review process [Internet]. 2016 [cited Aug 13, 2023]. Available from:

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73. doi:

Sanhueza-Sanzana C, Aguiar IWO, Almeida RLF, Kendall C, Mendes A, Kerr LRFS. Social inequalities associated with COVID-19 case fatality rate in Fortaleza, Ceará state, Brazil, 2020. Epidemiol Serv Saúde. 2021;30(3):e2020743. doi:

Souza WM, Buss LF, Candido DDS, Carrera JP, Li S, Zarebski AE, et al. Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil. Nat Hum Behav. 2020;4(8):856-65. doi:

Baggio JAO, Machado MF, Carmo RFD, Armstrong ADC, Santos ADD, Souza CDF. COVID-19 in Brazil: spatial risk, social vulnerability, human development, clinical manifestations and predictors of mortality - a retrospective study with data from 59 695 individuals. Epidemiol Infect. 2021;149:e100. doi:

Duarte-Salles T, Vizcaya D, Pistillo A, Casajust P, Sena AG, Lai LYH, et al. Thirty-day outcomes of children and adolescents with COVID-19: an international experience. Pediatrics. 2021;148(3):e2020042929. doi:

Oliveira EA, Colosimo EA, Silva ACS, Mak RH, Martelli DB, Silva LR, 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(8):559-68. doi:

Oliveira MC, Eleuterio TA, Corrêa ABA, Silva LDR, Rodrigues RC, Oliveira BA, et al. Correction to: Factors associated with death in confirmed cases of COVID-19 in the state of Rio de Janeiro. BMC Infect Dis. 2021;21(1):728. doi:

Phaswana-Mafuya N, Shisana O, Jassat W, Baral SD, Makofane K, Phalane E, et al. Understanding the differential impacts of COVID-19 among hospitalised patients in South Africa for equitable response. S Afr Med J. 2021;111(11):1084-91. doi:

Poulson M, Geary A, Annesi C, Allee L, Kenzik K, Sanchez S, et al. National disparities in COVID-19 outcomes between black and white Americans. J Natl Med Assoc. 2021;113(2):125-32. doi:

Saatci D, Ranger TA, Garriga C, Clift AK, Zaccardi F, Tan PS, et al. association between race and COVID-19 outcomes among 2.6 million children in England. JAMA Pediatrics. 2021;175(9):928-38. doi:

Sousa BLA, Brentani A, Ribeiro CCC, Dolhnikoff M, Grisi SJFE, Ferrer APS, et al. Non-communicable diseases, sociodemographic vulnerability and the risk of mortality in hospitalised children and adolescents with COVID-19 in Brazil: a cross-sectional observational study. BMJ Open. 2021;6;11(9):e050724. doi:

Bocong Y, Xinting H, Jiannan L, Longtao H. Socioeconomic disadvantages and vulnerability to the pandemic among children and youth: a macro-level investigation of American counties. Child Youth Serv Rev. 2022;36:106429. doi:

Nogueira MC, Leite ICG, Teixeira MTB, Vieira MT, Colugnati FAB. COVID-19’s intra-urban inequalities and social vulnerability in a medium-sized city. Rev Soc Bras Med Trop. 2022;55:e0445–2021. doi:

Oliveira EA, Mak RH, Colosimo EA, Mendonça ACQ, Vasconcelos MA, Martelli-Júnior H, et al. Risk factors for COVID-19-related mortality in hospitalized children and adolescents with diabetes mellitus: An observational retrospective cohort study. Pediatric Diabetes. 2022;23(6):763-72. doi:

Stordal K, Ruiz PL, Greve-Isdahl M, Surén P, Knudsen PK, Gulseth HL, et al. Risk factors for SARS-CoV-2 infection and hospitalisation in children and adolescents in Norway: a nationwide population-based study. BMJ Open. 2022;12(3):e056549. doi:

Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Infect Dis. 2020;20(8):911-9. doi:

Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145(6):e20200702. doi:

Aleem A, Akbar Samad AB, Vaqar S. Emerging variants of SARS-CoV-2 and novel therapeutics against coronavirus (COVID-19) [Internet]. 2022 [cited Aug 2, 2023]. Available from:

Pokorska-Śpiewak M. The influence of SARS-CoV-2 variants B.1.1.7 and B.1.617.2 on a different clinical course and severity of COVID-19 in children hospitalized in 2021 compared with 2020. Pediatr Infect Dis J Pediat. 2023;42(7):584-89. doi:

Seriakova I, Yevtushenko V, Kramarov S, Palatna L, Shpak I, Kaminska T. Clinical course of COVID-19 in hospitalized children of Ukraine in different pandemic periods. Eur Respir J. 2022;9(1):2139890. doi:

Quintero AM, Eisner M, Sayegh R, Wright T, Ramilo O, Leber AL, et al. Differences in SARS-CoV-2 clinical manifestations and disease severity in children and adolescents by infecting variant. Emerg Infect Dis. 2022;28(11):2270-80. doi:

Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, Schiergens TS, et al. SARS-CoV-2 Cell entry depends on ACE2 and TMPRSS2 and Is blocked by a clinically proven protease inhibitor. Cell. 2020;16;181(2):271-280.e8. doi:

Mihalopoulos M, Levine AC, Marayati NF, Chubak BM, Archer M, Badani KK, et al. The resilient child: sex-steroid hormones and COVID-19 incidence in pediatric patients. J Endocr Soc. 2020;28;4(9):106. doi:

Cristiani L, Mancino E, Matera L, Nenna R, Pierangeli A, Scagnolari C, et al. Children reveal their secret? The coronavirus dilemma. Eur Respir J. 2020;23;55(4):2000749.

Nickbakhsh S, Mair C, Matthews L, Reeve R, Johnson PCD, Thorburn F, et al. Virus-virus interactions impact the population dynamics of influenza and the common cold. Proc Natl Acad Sci USA. 2019;116(52):27142-50. doi:

Fortunato F, Martinelli D, Lo Caputo S, Santantonio T, Dattoli V, Lopalco PL, et al. Sex and gender differences in COVID-19: an Italian local register-based study. BMJ Open. 2021;11(10):e051506. doi:

Kragholm K, Andersen MP, Gerds TA, Butt JH, Ostergaard L, Polcwiartek C, et al. Association between male sex and outcomes of coronavirus disease 2019 (COVID-19)-a Danish nationwide, register-based study. Clin Infect Dis. 2021;73(11):e4025-30. doi:

Tsankov BK, Allaire JM, Irvine MA, Lopez AA, Sauvé LJ, Vallance BA, et al. COVID-19 infection and pediatric comorbidities: a systematic review and meta-analysis. Int J Infect Dis. 2021;103:246-56. doi:

Souza BLA, Silva CA, Ferraro AA. An update on the epidemiology of pediatric COVID-19 in Brazil. Rev Paul Pediatr. 2022;4(40):e2021367. doi:

Kitano T, Kitano M, Krueger C, Jamal H, Al Rawahi H, Lee-Krueger R, et al. The differential impact of pediatric COVID-19 between high-income countries and lowand middle-income countries: a systematic review of fatality and ICU admission in children worldwide. PLoS One. 2021;16(1):e0246326. doi:

Smith C, Odd D, Harwood R, Ward J, Linney M, Clark M, et al. Deaths in children and young people in England after SARS-CoV-2 infection during the first pandemic year. Nature Med. 2022;28(1):185-92. doi:

Dorn AV, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. Lancet. 2020;395(10232):1243-44. doi:

Wang Z, Tang K. Combating COVID-19: health equity matters. Nature Med. 2020;26(4):458. doi:

Midões C, Seré M. Viver com rendimento reduzido: uma análise da vulnerabilidade financeira familiar perante a COVID-19. Soc Indic Res. 2022;161:125-49. doi:

Gissandaner TD, Lim CS, Sarver DE, Brown D, McCulloh R, Malloch L, et al. Impact of COVID-19 on families with children: examining sociodemographic differences. J Dev Behav Pediatr. 2023;44(2):e88–94. doi:

Rebouças P, Falção IR, Barreto ML. Social inequalities and their impact on children’s health: a current and global perspective. J Pediatr. 2022;98(S1):555-65. doi:

González-Rábago Y, Cabezas-Rodríguez A, Martín U. Social inequalities in health determinants in Spanish children during the COVID-19 lockdown. Int J Environ Res Public Health. 2021;18:4087. doi:

Kim C, Yee R, Bhatkoti R, Carranza D, Henderson D, Kuwabara SA, et al. COVID-19 vaccine provider access and vaccination coverage among children aged 5-11 years - United States, November 2021-January 2022. Morb Mortal Wkly Rep. 2022;11;71(10):378-83. doi:

Nguyen KH, Nguyen K, Mansfield K, Allen JD, Corlin L. Child and adolescent COVID-19 vaccination status and reasons for non-vaccination by parental vaccination status. Public Health. 2022;209:82-9. doi:



How to Cite

Silva, B. C. da, Ribeiro, A. C., & Uehara, S. C. da S. A. (2023). Influence of socioeconomic factors on COVID-19 mortality in children: a scoping review. Rev Rene, 24, e91978. Retrieved from



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