Mortality in the families of children during the COVID-19 pandemic: evidence from a repeated cross-sectional study of children in the United States.

Background: Modeling studies suggest that hundreds of thousands of U.S. children have lost caregivers since the COVID-19 pandemic began. However, few studies have directly evaluated changes in mortality in the families of U.S. children using patient-level data, characterized adult decedents and their surviving children, or accounted for the loss of the adult siblings of children.

Methods: We conducted a repeated cross-sectional analysis using Optum's De-identified Clinformatics Data Mart, a national claims database that includes privately insured children and families across the U.S. We identified families of children aged 0-17 years enrolled in a family plan during each month in 2016-2021. Among these families, we calculated the proportion with ≥ 1 death of an adult family member aged ≥ 18 years enrolled in the plan, including young adult dependents aged 18-25 years. We used descriptive statistics to assess the age and sex of adult decedents and their surviving children. Moreover, we calculated the proportion of adult decedents who were the siblings of children.

Results: From January 2016 through February 2020, the median monthly proportion of families with ≥ 1 adult death was 0.000076 (7.6 per 100,000 families). This rose to 12.1 per 100,000 families in December 2020, fell below the pre-pandemic median during March-July 2021, and exceeded this median for most months during August-December 2021. Among adult decedents, 63.8% were male and mean age was 44.8 (11.4) years. Among surviving children, 59.5% were adolescents aged 12-17 years. Among adult decedents, 4.8% were the siblings of children.

Conclusions: During the pandemic, the proportion of privately insured children experiencing the loss of an adult family members varied over time, with the highest rates occurring at the end of 2020 and the second half of 2021. Some children lost adult siblings, suggesting that screening for child bereavement should include all family members, not just parents/guardians.