About

Dr. Daniel B. Horton, MD, MSCE, FISPE, is a board-certified pediatric rheumatologist and physician-scientist with research training in pharmacoepidemiology. He earned his MSCE in Clinical Epidemiology from the University of Pennsylvania in 2015, his MD from Harvard Medical School in 2008, and his AB from Harvard College in 2001. At Rutgers, he serves as an Associate Professor of Pediatrics and Epidemiology, a Chancellor’s Scholar, and a founding core faculty member of the Center for Pharmacoepidemiology and Treatment Science (PETS) at the Institute for Health, Health Care Policy and Aging Research (IFH). He is also the Faculty Director of the IFH Data Core and a Co-Leader of the Team Science Core of NJ ACTS (CTSA). Within the Department of Pediatrics at Rutgers Robert Wood Johnson Medical School, he belongs jointly to the Divisions of Population Health, Quality, and Implementation Sciences (PopQuIS) and Pediatric Rheumatology, and he co-chairs the Pediatric Resident Scholarly Oversight Committee. Additionally, he holds a secondary appointment in the Department of Biostatistics and Epidemiology at the Rutgers School of Public Health, where he directs the Clinical Epidemiology Certificate Program. Dr. Horton’s research focuses on the utilization, effectiveness, and safety of medicines in large pediatric populations, as well as the origins and management of juvenile idiopathic arthritis (JIA) and other childhood diseases. His expertise includes performing large retrospective studies using administrative claims, electronic health records, and other electronic health databases, along with prospective clinical, translational, interventional, and mixed methods research. His work has been funded by the National Institutes of Health and several research foundations. Dr. Horton has served as a Consultant to the Food and Drug Administration Drug Safety and Risk Management Advisory Committee and as an Associate Editor for Pharmacoepidemiology and Drug Safety.

Research topics

• Medicine
• Internal medicine
• Immunology
• Intensive care medicine
• Biology
• Pathology
• Virology
• Emergency medicine
• Psychiatry
• Demography
• Pediatrics
• Physical therapy
• Genetics
• Computational biology
• Bioinformatics

Selected publications

• Cumulative Social Disadvantage and Disease Activity in Juvenile Idiopathic Arthritis: A Childhood Arthritis and Rheumatology Research Alliance Registry Study

  Arthritis Care & Research · 2026-04-03

  article

  OBJECTIVE: Social determinants of health (SDOH) contribute to juvenile idiopathic arthritis (JIA) disparities, but most studies have assessed SDOH independently rather than cumulatively across individual, family, and neighborhood levels. Using a socioecological framework, we investigated the relationship among cumulative social disadvantage, neighborhood disadvantage, and JIA disease activity. METHODS: We conducted a retrospective cohort study using the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry (2015-2022). Individual- and family-level SDOH were combined into a cumulative social disadvantage score (range: 0-3), with one point each for public or no insurance, family income less than $50,000 per year, and guardian education of high school level or less. Neighborhood disadvantage was measured using Area Deprivation Index (quartiles). The primary outcome was active disease by clinical Juvenile Arthritis Disease Activity-10 (cJADAS-10). Mixed effects models were generated to assess associations adjusted for demographic and clinical covariates, and causal mediation analysis evaluated whether cumulative social disadvantage mediated the relationship between neighborhood disadvantage and disease activity. RESULTS: Among 9,609 children with JIA with a median follow-up time of 2.1 (interquartile range 0.3-5.8) years, 39.1% had a cumulative social disadvantage score greater than 0 with higher scores correlating with greater neighborhood disadvantage. In adjusted analysis, cumulative social disadvantage was associated with higher odds of active disease (adjusted odds ratio 2.10, 95% confidence interval [CI] 1.73-2.53 for a score of 3 vs 0). A total of 87% (95% CI 38-100) of the effect of neighborhood disadvantage was mediated through cumulative social disadvantage. CONCLUSION: Cumulative social disadvantage is strongly associated with active JIA and mediates much of the effect of neighborhood disadvantage. Interventions addressing multilevel SDOH will be essential to reducing JIA health disparities.

  PublisherDOI

• Pediatric Pharmacoepidemiology and Drug Development From a Regulatory Perspective

  Clinical Pharmacology & Therapeutics · 2025-02-18 · 1 citations

  articleOpen access

  Safe and effective pediatric medical products developed in an efficient manner ensure the availability of medicines for children. Objectives for the field of pediatric pharmacoepidemiology include fostering collaborations among academia, industry, and government in pediatric medical product development, establishing generally accepted priorities within this field, and utilizing organized widely accessible pediatric registries—especially within subspecialties. The tools in pharmacoepidemiology include commonly used data resources in healthcare, such as Electronic Medical Records (EMRs) and claims data generated from sources such as Medicare and Medicaid. Data collected in the context of routine care are more abundant, accessible, inexpensive, and may be more generalizable than data collected through randomized controlled trials (RCTs). In addition, the advantages of conducting pediatric pharmacoepidemiologic studies, include the following: (1) the eligibility criteria for treatment in RCTs are almost always narrower than the criteria used for treatment in the general population, thus potentially limiting the generalizability of RCT results to broader populations; (2) adequately powered pharmacoepidemiologic studies can detect and evaluate rare and delayed events that are often not identified in shorter-term RCTs. Like adults, children should have access to products that have undergone rigorous evaluation.1 Adequate and well-controlled investigations of products intended for pediatric use must demonstrate substantial evidence of effectiveness and clinical benefit,2 and have sufficient safety data to support an adequate risk–benefit assessment for the intended population.1, 2 There are disadvantages to pediatric pharmacoepidemiology, as compared to RTCs. Pharmacoepidemiologic studies are not randomized. The observed effects could be related to residual confounding, selection bias, information bias, and other forms of bias. For example, it may be difficult to interpret differences between age groups in observational settings due to the lack of randomization, making any differences subject to confounding, and leading to difficulties in interpretability of the findings. Methods for limiting confounding and other sources of bias in observational settings, such as active-comparator/new-user designs, propensity scoring, target trial emulation, and outcome validation, have been described elsewhere.3, 4 In recent years, the terminology regarding commonly used data resources in healthcare used in pharmacoepidemiology has been formalized. As defined in the FDA guidance, real-world data (RWD) are data relating to patient health status and/or the delivery of health care routinely collected from a variety of sources.5 Real-world evidence (RWE) is the clinical evidence about the usage and potential benefits or risks of a medical product derived from analysis of RWD.5 Common sources of RWD in pediatric pharmacoepidemiologic studies include claims databases, electronic health records data, and registries. Multidatabase studies, such as those conducted through the FDA Sentinel Initiative (https://www.sentinelinitiative.org/), can enable the study of especially large pediatric populations, which can enhance both statistical power and generalizability of pharmacoepidemiologic studies. Pharmacoepidemiologic studies may also be used to evaluate specific medical product use in pediatric populations such as Drug Utilization Review studies (DURs).6 These studies have the usual challenges in pharmacoepidemiology of lack of randomization and also have pediatric interpretability challenges (see next paragraph). Generally, the principles of data collection and analysis of RWD/E are similar in adults and children. The content of the data may differ depending on the age group of the children, the subspecialty, and the setting (school vs. retirement community). Some outcomes are almost exclusively pediatric (e.g., rheumatic fever, Kawasaki disease). The prevalence, clinical presentation, and treatment outcomes in children, usually necessitate independent validation in pediatric populations. Growth or development is key in children, which may be important as ways to express exposure (e.g., weight-based dosing), outcomes of interest, or effect modifiers. Educational outcomes (e.g., achievement, attainment) and education-related issues (e.g., drug holidays during breaks from school) may be important variables in children. Other key variables (depending on the specific pediatric population and research question) include prenatal events, gestational age or weight at birth, mode of birth delivery, family history, and passive tobacco exposure. And additional designs, such as sibling-comparison designs are frequently used in pediatric pharmacoepidemiology. Structured, generalizable RWD approaches, such as registries, may be able to be harnessed for regulatory purposes.7 Continued efforts are needed to ensure data quality, integrity, and accessibility by specialists, healthcare practitioners, and the public. Quality registries provide equal outcome measures for some eligible children in the United States though for wider proportions of the population in some other countries. Fit-for-purpose, prospective registries should incorporate data that are specific to the questions that are intended to be answered just as they would be for an RCT. On the contrary, in non-prospectively designed pharmacoepidemiologic data sources, for example, claims databases, vital signs, disease measures, and patient-reported outcomes are generally not available unless there is a possibility to link claims data with patient medical records. In EMRs in the United States, not all claims databases are able to be linked to patient medical records. One registry that collects data in one subspecialty, pediatric rheumatology, is well organized and provides comparable data to RCTs for pediatric rheumatology.7 Specific data that would be clinically useful in pediatric rheumatology data sources include age and other demographics, vital signs (e.g., temperature), anthropomorphic measurements (e.g., height, weight), disease assessments (e.g., joint counts, validated measurements), laboratory values, radiographic information, and patient/caregiver-reported outcomes. Other registries that have the potential to span much pediatric morbidity and mortality in the United States and could potentially expand care substantially are widely accessible pediatric registries that might cover illnesses such as orphan diseases, hematology, nephrology, endocrine, cardiovascular, and other individual subspecialty registries have the potential to be “think tanks” for that subspecialty and could be a resource for primary care physicians. Pharmacoepidemiologic studies completement data collected in RCTs, particularly with respect to safety in pediatrics. A larger sample size can enable enhanced safety signal detection and study of rare events. Additionally, well-designed comparative effectiveness studies that move toward addressing confounding by indication or disease severity and other potential sources of bias (e.g., selection bias, immortal time bias) through new-user designs and target trial emulation have been described. Note that close emulation of observational studies has resulted in comparable findings to those in RCTs.8 Pharmacoepidemiologic studies have successfully been used in children to support clinical trial designs. For example, the use of well-designed, carefully collected, fit-for-purpose RWD has been used to create an external control arm that can be used as a comparator arm in single-arm registration trials for rare, life-threatening diseases.2 Natural history data were used as an external comparator for a single-arm study to approve Brineura (cerliponase alfa) for the treatment of Batten disease, a rare, life-threatening condition in children. However, the use of RWD in this context must be carefully considered and agreed upon with regulatory authorities because the control arm data are not concurrently collected which can lead to bias and incorrect conclusions about the effect of the treatment. FDA has issued guidance, “Considerations for the Design and Conduct of Externally Controlled Trials for Drug and Biological Products,” that provides more detailed information on the appropriate use of this type of study design.9 RWD can also be used to provide evidence to support a pediatric extrapolation approach. Pediatric extrapolation is defined as “an approach to providing evidence in support of effective and safe use of drugs in the pediatric population when it can be assumed that the course of the disease and the expected response to a medicinal product would be sufficiently similar in the pediatric [target] and reference (adult or other pediatric) population,”10 and can be used to support meeting substantial evidence standards when used appropriately. “In the development of the pediatric extrapolation concept, a review of data from RWD sources including but not limited to electronic health records, claims databases, and registries, can be considered”.10 Additionally, given the challenges in using RWD, it is important to evaluate whether the scientific question and the methodological considerations will be appropriate for the regulatory requirements (e.g., good clinical practice). The use of sound pharmacoepidemiologic principles and rigorous approaches in study design and conduct is of paramount importance for regulatory considerations of pediatric RWD/RWE. The use of pediatric pharmacoepidemiology studies, including the use of RWD to evaluate drug outcomes, is currently dynamic and developing novel approaches to addressing common data gaps. The selection of the RWD sources should be driven by the specific study questions at hand. Additionally, innovative strategies are essential for integrating clinical care data with clinical trial data, and for linking broader data sources, such as claims data with electronic health records or registry data. This integration will provide access to larger, more complete datasets with complementary information essential for conducting rigorous, well-powered pharmacoepidemiologic research. Given the challenges of conducting pediatric studies in small, more heterogeneous populations, these advances hold particular promise in pediatric drug development. Continued efforts are needed to ensure data quality, accessibility, and integrity. Pediatric pharmacoepidemiology studies, including the use of RWD/RWE, can be used to support but not replace controlled clinical trials for regulatory decision making in all phases of pediatric therapeutics development. The potential applications of pediatric pharmacoepidemiology have been expanding over recent decades with the availability of improved analytic approaches and computing technology. Rigorous and judicious use of fit-for-purpose pediatric pharmacoepidemiology has the potential to increase the speed and efficiency of pediatric therapeutics development with the goal of efficient availability of safe and effective medicines to all children who need them. No funding was received for this work. The authors declared no conflict of interest. Rutgers University receives, on Dr. Horton's behalf, research funding from the Childhood Arthritis and Rheumatology Research Alliance and the Arthritis Foundation.

  PublisherOA PDFDOI

• A genetically modulated Toll-like receptor-tolerant phenotype in peripheral blood cells of children with multisystem inflammatory syndrome

  The Journal of Immunology · 2025-03-01 · 5 citations

  articleOpen access

  Dysregulated innate immune responses contribute to multisystem inflammatory syndrome in children (MIS-C), characterized by gastrointestinal, mucocutaneous, and/or cardiovascular injury occurring weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. To investigate innate immune functions, we stimulated ex vivo peripheral blood cells from MIS-C patients with agonists of Toll-like receptors (TLR), key innate immune response initiators. We found severely dampened cytokine responses and elevated gene expression of negative regulators of TLR signaling. Increased plasma levels of zonulin, a gut leakage marker, were also detected. These effects were also observed in fully convalescent children months after MIS-C recovery. When we investigated the genetic background of patients in relation to TLR responsiveness, we found that cells from MIS-C children carrying rare heterozygous variants of lysosomal trafficking regulator (LYST) were less refractory to TLR stimulation and exhibited lysosomal and mitochondrial abnormalities with altered energy metabolism. Moreover, these rare LYST variant heterozygous carriers tended to exhibit unfavorable clinical laboratory indicators of inflammation, including more profound lymphopenia. The results of our observational study have several implications. First, TLR hyporesponsiveness may be associated with hyperinflammation and/or excessive or prolonged stimulation with gut-originated TLR ligands. Second, TLR hyporesponsiveness during MIS-C may be protective, since LYST variant heterozygous carriers exhibited reduced TLR hyporesponsiveness and unfavorable clinical laboratory indicators of inflammation. Thus, links may exist between genetic background, ability to establish a refractory immune state, and MIS-C clinical spectrum. Third, the possibility exists that prolonged TLR hyporesponsiveness is one of the mechanisms driving long coronavirus disease (COVID), which highlights the need to monitor long-term consequences of MIS-C.

  PublisherOA PDFDOI

• Risk of Ventricular Arrhythmia and Sudden Cardiac Arrest Among Older Patients Using Lamotrigine for Epilepsy

  Neurology · 2025-06-11 · 10 citations

  article

  BACKGROUND AND OBJECTIVES: Lamotrigine, an antiseizure medication, blocks the activation of voltage-gated sodium channels and reduces the excitability of cardiomyocytes in vitro. Based on concerns for QT prolongation and case reports of arrhythmias among lamotrigine users, the US Food and Drug Administration placed a safety warning on lamotrigine's label in 2020. However, limited evidence exists on the cardiac risk of lamotrigine in patients with epilepsy. This study assessed whether lamotrigine users with epilepsy had an increased risk of ventricular arrhythmia and sudden cardiac arrest (VA/SCA) compared with users of levetiracetam. METHODS: This was a retrospective cohort study among Medicare-insured individuals aged 65 years or older with epilepsy (2007-2019). We identified new users of lamotrigine and levetiracetam without inpatient or emergency VA/SCA diagnosis in the 12-month continuous enrollment baseline period before initiation of treatment. Using inverse probability of treatment weighting derived from propensity scores based on baseline covariates, we compared adjusted incidence rates of inpatient or emergency VA/SCA events in lamotrigine vs levetiracetam users and estimated adjusted hazard ratios (HRs) with 95% CIs using Cox proportional hazard regression. RESULTS: The study cohort (mean age 77.6 years and 60.5% female) consisted of 11,786 new lamotrigine users and 147,130 new levetiracetam users. At baseline, lamotrigine users were younger and less likely to have cardiovascular and noncardiovascular comorbidities than the levetiracetam users. The incidence and HR of VA/SCA were not statistically higher among lamotrigine users (7.0 vs 8.2 per 1,000 person-years for the lamotrigine and levetiracetam users, respectively; HR 0.84, 95% CI 0.67-1.06). Secondary analyses stratified by baseline cardiac abnormalities showed significantly reduced risk among lamotrigine users in subgroups with baseline arrhythmia (HR 0.51, 95% CI 0.32-0.80) or use of antiarrhythmic drugs (HR 0.67, 95% CI 0.50-0.91). DISCUSSION: In older adults with epilepsy, lamotrigine was not associated with an increased risk of VA/SCA compared with levetiracetam, including among those with underlying heart disease. Our findings do not support the reported cardiac risks associated with lamotrigine or the recent changes to its safety label.

  PublisherDOI

• Effects of the COVID-19 Pandemic on Pediatric Hospitalizations for Life-Threatening Conditions

  The Journal of Pediatrics Clinical Practice · 2025-08-25

  articleOpen access

  Mitigation measures implemented during the COVID-19 pandemic led to low levels of circulating non-SARS-CoV-2 viruses, providing a unique opportunity to study trends in pediatric conditions linked to viral triggers. We identified significant reductions in first pediatric hospitalizations for acute flaccid paralysis (-96.2%), myocarditis (-79.4%), Guillain-Barré syndrome (-44.1%), and other conditions.

  PublisherDOI

• Factors influencing biospecimen collection in decentralized pregnancy and birth cohorts: A qualitative study

  Journal of Clinical and Translational Science · 2025-01-01

  articleOpen access

  Introduction: Although decentralized research is being used more frequently, few data are available regarding barriers for potential subjects related to engaging in decentralized research with remote biospecimen collection, especially within pregnancy and birth cohorts that include individuals of diverse racial and ethnic backgrounds. Methods: Focus groups and individual interviews with pregnant and postpartum women were conducted in English and Spanish. Thematic analysis was used to identify motivators and barriers to participation in decentralized research involving biospecimens. Results: Sixty women (35% Hispanic/Latino, 23% Black, 18% Asian, 15% non-Hispanic White) participated in 10 focus groups (English = 8, Spanish = 2) and 11 individual interviews (English = 7, Spanish = 4). Three themes emerged about factors that could promote participation in decentralized biospecimen collection: 1) convenience, 2) autonomy, and 3) benefit (to self, community or society). Four themes emerged about potential barriers: 1) lack of interaction with trained professionals, 2) inability to coordinate with existing clinical care, 3) discomfort and invasiveness, and 4) concerns about data transparency and security. Overall, participants felt more comfortable providing biospecimens for themselves compared to their child and with biospecimens perceived as less painful or invasive to obtain. Discussion: Our findings suggest that transparency about the purposes and use of collecting biospecimen and clear instructions (such as written and instructional videos) could improve biospecimen collection in decentralized pregnancy and birth cohorts. Additionally, opportunities for virtual interaction with study staff and options related to collection of certain biospecimens such as blood (mobile collection unit with trained staff versus a self-collection device) may also improve participant engagement.

  PublisherOA PDFDOI

• Barriers and strategies for recruitment of pregnant women in contemporary longitudinal birth cohort studies

  BMC Medical Research Methodology · 2025-04-28 · 6 citations

  articleOpen access

  BACKGROUND: Pregnancy and birth cohort studies are essential for studying the social and biological determinants of human health, yet racial and ethnic minority populations are underrepresented due to low recruitment and retention rates. Remote data collection has potential to improve recruitment of underrepresented populations. The aims of this descriptive qualitative study were to explore the perspectives of pregnant and postpartum women about the barriers and facilitators to enrolling themselves, their child, and their partner in a longitudinal birth cohort study, identify data collection strategies to address barriers, and generate recommendations for future cohort studies. METHODS: Online focus groups and in-person interviews in English and Spanish were conducted between August and November 2022 with pregnant and postpartum women. Participants were recruited from Black and Hispanic serving obstetric clinics and community-based health and social organizations to ensure a racially and ethnically diverse sample. Analysis was conducted using an inductive thematic approach. RESULTS: 60 women participated in 10 focus groups and 11 interviews. Five themes emerged: challenges in committing time and resources to a research study; utility of compensation and resources; fears that research procedures would negatively impact child; concerns regarding data privacy and children's consent; and benefits for their family, community, and society. Black participants voiced concern about historical discrimination in science and mistrust of research, but also wanted to increase Black representation in research for future generations. Spanish-speaking participants expressed hesitancy related to fear of child injury and misuse of data. Women felt their partners would be reluctant to participate, but that incentives such as parental education would be motivating. Participants liked the flexibility of remote data collection in easing logistical challenges to participation but also expressed importance of personal study contact for facilitating access to resources, enhancing trust in the research process, and motivating retention. Participants also expressed the importance of transparency in data collection procedures and communication on study progress. CONCLUSIONS: Leveraging technological advances in remote data collection may reduce some challenges to recruitment of women and families to birth cohort studies. However, building and maintaining trust among communities with engagement, transparency, and communication is critical for recruitment of underrepresented populations.

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• Out-of-Pocket and Total Health Care Costs Among Commercially Insured Adults and Children With Multiple Sclerosis

  JAMA Neurology · 2025-12-08 · 1 citations

  articleOpen access

  This cross-sectional study assesses trends in annual out-of-pocket and total health care costs among commercially insured US individuals with multiple sclerosis younger than 65 years from 2002 to 2021.

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• Trends in Initiation of Disease‐Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among Commercially Insured Adults in the United States, 2001–2021

  Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · 2025-08-12

  articleOpen access

  OBJECTIVE: To evaluate patterns in disease-modifying antirheumatic drugs (DMARDs) initiations between 2001 and 2021 among adults with Rheumatoid Arthritis (RA) in the United States METHODS: This retrospective cohort study used a US commercial claims database (2001-2021) to identify patients (≥ 18 years) with RA newly initiating a DMARD. We calculated the annual proportion of initiations for 22 DMARDs, categorized as conventional synthetic (csDMARDs), biologic (bDMARDs), and targeted synthetic (tsDMARDs). Secondary analyses examined trends in first-line non-csDMARD initiation and biosimilar uptake. RESULTS: We identified 407,728 DMARD initiation episodes among 229,365 unique patients with RA (median age: 50 years [IQR], 44-58 years; 79.4% female). There were shifts in DMARD initiations, with csDMARD initiation declining from 79.9% of initiations in 2001 to 54.7% by 2021 (p < 0.001 for trend). Meanwhile, bDMARDs and tsDMARDs initiations increased from 20.3% in 2001 to 33.1% in 2021 (p < 0.001) and from 0.1% in 2012 to 12.2% in 2021 (p = 0.171), respectively. Methotrexate remained the most initiated DMARD over the 21-year study period, albeit declining from 28.7% to 15.0% of initiations over the study period (p < 0.001). Adalimumab was the most frequently initiated bDMARD (13.3% in 2003 and 12.2% in 2021; p = 0.05). Among tsDMARDs, tofacitinib initiation peaked at 8.9% in 2019 and declined to 4.4% in 2021, while upadacitinib initiation increased from 1.2% to 7.6% during the same period (p < 0.001). For secondary analyses, adalimumab was the predominant first-line b/tsDMARD initiated (> 40%). Biosimilar uptake stayed below 1%. CONCLUSION: Expanded DMARD options over the last two decades have led to decreased csDMARD initiations and increased b/tsDMARD initiations, reflecting patient- and system-level factors.

  PublisherOA PDFDOI

• Evolving Characteristics of Children and Youth With COVID-19 or MIS-C in US Children’s Hospitals

  Pediatrics Open Science · 2025-11-03

  articleOpen accessSenior author

  OBJECTIVE To describe trends in sociodemographic and clinical characteristics in children and youth treated at US children’s hospitals for COVID-19 or multisystem inflammatory syndrome in children (MIS-C). METHODS We conducted a serial cross-sectional study using data from the Pediatric Health Information System (March 2020 to June 2024). Patients were aged 21 years or younger and hospitalized with COVID-19 or MIS-C or discharged from emergency departments with COVID-19 diagnosis (comparator). Sociodemographic and clinical characteristics of subjects were tracked by pandemic wave. Community-level resources were assessed using the Child Opportunity Index. Temporal changes were assessed descriptively and with logistic regression models incorporating interaction terms between covariates and pandemic waves. RESULTS Among 295 264 children and youth, 94.5% were identified with nonhospitalized COVID-19, 3.4% with hospitalized COVID-19, and 2.1% with MIS-C. Compared with early waves of the pandemic, hospitalizations for COVID-19 and MIS-C increased disproportionately among children younger than 12 years and non-Hispanic white populations by the Omicron era. Although community-level differences in hospitalizations for COVID-19 and MIS-C were observed early in the pandemic, these differences diminished over time. Trends in hospitalized SARS-CoV-2–associated disease varied by comorbid conditions, with early excesses in hospitalizations followed by declines among those diagnosed with obesity, hematologic disorders, and immunodeficiencies. CONCLUSIONS The pediatric populations at greatest risk for hospitalization from COVID-19 or MIS-C in the United States changed over time, with increasing risks among younger and non-Hispanic white patients, reduced differences in hospitalizations based on community-level characteristics, and decreasing risks in those with obesity and several other comorbidities. These findings may inform efforts for targeted prevention (eg, vaccination).

  PublisherOA PDFDOI

Recent grants

• New Jersey ECHO

  NIH · $3.2M · 2023–2025

• Drugs, Germs, and Joints: Antibiotics, Gut Microbiota, and Juvenile Idiopathic Arthritis

  NIH · $909k · 2016–2021

• NIH Grant F32AR066461

  NIH · $74k · 2015

• Antibiotics, Juvenile Idiopathic Arthritis, and Antirheumatic Treatment Response

  NIH · $2.1M · 2019–2025

• COVID-19 Network of Networks Expanding Clinical and Translational approaches to Predict Severe Illness in Children (CONNECT to Predict SIck Children)

  NIH · $3.0M · 2021–2025

Frequent coauthors

• Susan Shenoi

  University of Washington

  118 shared

• Sarah Ringold

  Seattle Children's Hospital

  117 shared

• Daniel J. Lovell

  114 shared

• Melissa L. Mannion

  University of Alabama at Birmingham

  112 shared

• Homaira Rahimi

  University of Rochester Medical Center

  99 shared

• Susan Thornhill

  Johns Hopkins University

  98 shared

• Vibeke Strand

  Stanford University

  98 shared

• Clifton O. Bingham

  Johns Hopkins University

  98 shared

Awards & honors

• FISPE (Fellow of the International Society for Pharmacoepide…