Background: The epidemiology of SARS-CoV-2 infection in the pediatric population, with a focus on racial and ethnic disparities and impact of societal public health measures, remains poorly understood.

Methods: This large observational study used electronically abstracted data from pediatric (≤ 19 years of age) patients who received a molecular test for SARS-CoV-2 at a UMass Memorial Health Care (UMMHC) site between March 8, 2020 and April 3, 2021 which was further supplemented by manual chart review of a subset of pediatric SARS-CoV-2 cases. Multivariable logistic regression models with interaction terms were used to identify risk factors for SARS-CoV-2 infection. Segmented regression analysis using Poisson models was used to estimate the effect of public health measures on the weekly incidence of SARS-CoV-2 infection.

Results: A total of 25,426 unique pediatric patients were tested for SARS-CoV-2 among whom 2,920 (11.5%) tested positive. The average age of those who tested positive was 10.8 years (SD: 5.8) and 48.1% were female. In the subset analysis, nearly three-quarters (75.9%) of SARS-CoV-2 diagnoses occurred through a telephone encounter, meaning that the child was not physically examined by a provider prior diagnosis and only 2.0% were admitted for inpatient care at diagnosis. Results of multivariable regression revealed that children or parents who self-reported Black race, Hispanic ethnicity, and non-English primary language were associated with approximately twice the odds of testing positive in comparison with White or English-speaking patients. Furthermore, increasing age was associated with increased odds of testing positive for SARS-CoV-2 (aOR: 1.1 (1-4 years), 1.2 (5-9 years), 1.4 (10-14 years), 1.6 (15-17 years), 1.7 (18-19 years)). However, this association between age and positivity rate, varies by race/ethnicity and primary language such that Non-Hispanic Black, Hispanic, and non-English speaking children had markedly greater odds of testing positive during adolescence in comparison to Non-Hispanic White and English-speaking counterparts. Results from segmented regression analysis demonstrated a decline in weekly incidence of cases 9.9% (95% CI: 7.8 – 11.9) after the Massachusetts state mask mandate was implemented. During the winter holidays, the rate of increase in the weekly incidence of cases was 12.1% (95% CI: 11.9 – 12.3) in this pediatric population.

Conclusions: Many SARS-CoV-2 cases have been diagnosed at UMMHC sites and notable racial/ethnic disparities exist that vary based on patient age. Public health measures are effective at preventing transmission of SARS-CoV-2 among children.