International heterogeneity in coronavirus disease 2019 pediatric mortality rates

BACKGROUND: Severe coronavirus disease 2019 (COVID-19) is infrequent in children and shows a mortality rate of around 0 08% This study aims to explore international differences in the pediatric mortality rate METHODS: We analyzed several countries with populations over 5 million that report disaggregated data of COVID-19 deaths by quinquennial or decennial age groups Data were extracted from COVID-19 cases and deaths by age database, National Ministeries of Health, and the World Health Organization RESULTS: We included 23 countries in the analysis Pediatric mortality varied from 0 to 12 1 deaths per million children of the corresponding age group, with the highest rate in Peru In most countries, deaths were more frequent in the 0-4-year-old age group, except for Brazil The pediatric/general COVID-19 mortality showed a great variation and ranged from 0% (Republic of Korea) to 10 4% (India) Pediatric and pediatric/general COVID mortality correlates strongly with 2018 neonatal mortality (r = 0 77, p < 0 001;and r = 0 88, p < 0 001, respectively), while shows a moderate or no correlation (r = 0 47, p = 0 02;and r = 0 19, p = 0 38, respectively) with COVID-19 mortality in the general population CONCLUSIONS: International heterogeneity in pediatric COVID-19 mortality importantly parallels historical neonatal mortality Neonatal mortality is a well-known index of the quality of a country's health system, which points to the importance of social determinants of health in pediatric COVID-19 mortality disparities This issue should be further explored