Association of Severe COVID-19 and Persistent COVID-19 Symptoms With Economic Hardship Among US Families.

Importance: Little is known about the association of severe COVID-19 and post-COVID-19 conditions with household finances. Objective: To examine associations between COVID-19 outcomes, pandemic-related economic hardship, and prepandemic socioeconomic status among families in the US. Design, Setting, and Participants: This cohort study used data from the Panel Study of Income Dynamics (PSID), a nationally representative, longitudinal study. Data included 6932 families active in the PSID in both 2019 and 2021. Exposures: Ordinal exposure categories were defined based on whether the reference person or spouse or partner reported a positive COVID-19 diagnosis and (1) persistent COVID-19 symptoms, (2) previous severe COVID-19, or (3) previous moderate, mild, or asymptomatic COVID-19. Families with no history of COVID-19 served as the reference group. Main Outcomes and Measures: Outcomes included whether a resident family member was laid off or furloughed, lost earnings, or had any financial difficulties due to the COVID-19 pandemic. Results: In this cohort study of 6932 families (772 Hispanic families [weighted, 13.5%; 95% CI, 12.4%-14.6%], 2725 non-Hispanic Black families [weighted, 13.1%; 95% CI, 12.3%-14.1%], and 3242 non-Hispanic White families [weighted, 66.8%; 95% CI, 65.2%-68.3%]), close to 1 in 4 (2222 [weighted, 27.0%; 95% CI, 25.6%-28.6%]) reported income below 200% of the US Census Bureau poverty threshold. In survey-weighted regression models adjusted for prepandemic sociodemographic characteristics and experiences of economic hardship, the odds of reporting pandemic-related economic hardship were 2.0 to 3.7 times higher among families headed by an adult with persistent COVID-19 symptoms (laid off or furloughed: adjusted odds ratio [AOR], 1.98 [95% CI, 1.37-2.85]; lost earnings: AOR, 2.86 [95% CI, 2.06-3.97]; financial difficulties: AOR, 3.72 [95% CI, 2.62-5.27]) and 1.7 to 2.0 times higher among families headed by an adult with previous severe COVID-19 (laid off or furloughed: AOR, 1.69 [95% CI, 1.13-2.53]; lost earnings: AOR, 1.99 [95% CI, 1.37-2.90]; financial difficulties: AOR, 1.87 [95% CI, 1.25-2.80]) compared with families with no history of COVID-19. Families headed by an adult with persistent COVID-19 symptoms had increased odds of reporting financial difficulties due to the pandemic regardless of prepandemic socioeconomic status (families with lower income: AOR, 3.71 [95% CI, 1.94-7.10]; families with higher income: AOR, 3.74 [95% CI, 2.48-5.63]). Previous severe COVID-19 was significantly associated with financial difficulties among families with lower income (AOR, 2.59 [95% CI, 1.26-5.31]) but was not significantly associated with financial difficulties among those with high income (OR, 1.56 [95% CI, 0.95-2.56]). Conclusions and Relevance: This cohort study suggests that persistent COVID-19 symptoms and, to a lesser extent, previous severe COVID-19 were associated with increased odds of pandemic-related economic hardship in a cohort of US families. The economic consequences of COVID-19 varied according to socioeconomic status; families with lower income before the pandemic were more vulnerable to employment disruptions and earnings losses associated with an adult family member's COVID-19 illness.

Personal belief exemptions for school-entry vaccinations, vaccination rates, and academic achievement.

Nonmedical exemptions from school-entry vaccine mandates are receiving increased policy and public health scrutiny. This paper examines how expanding the availability of exemptions influences vaccination rates in early childhood and academic achievement in middle school. We leverage 2003 legislation that granted personal belief exemptions (PBE) in Texas and Arkansas, two states that previously allowed exemptions only for medical or religious regions. We find that PBE decreased vaccination coverage among Black and low-income preschoolers by 16.1% and 8.3%, respectively. Furthermore, we find that those cohorts affected by the policy change in early childhood performed less well on standardized tests of academic achievement in middle school. Estimated effects on test scores were largest for Black students and economically disadvantaged students.

Pneumococcal Vaccination Mandates for Child Care: Impact of State Laws on Vaccination Coverage at 19-35 Months.

INTRODUCTION: Vaccination mandates for elementary and middle school attendance have been shown to increase vaccination rates and decrease the burden of vaccine-preventable diseases. Fewer studies have evaluated similar requirements for child care attendance. This study provides robust, quasi-experimental estimates of the effect of state laws mandating the pneumococcal conjugate vaccine for child care attendance on vaccination coverage among children aged 19-35 months. METHODS: Using provider-verified immunization histories from the 2001-2018 waves of the National Immunization Survey-Child and leveraging the staggered implementation of vaccination requirements across states, a generalized difference-in-differences approach was implemented to compare regression-adjusted changes in vaccination coverage among children in states with and without a child care mandate for the pneumococcal conjugate vaccine. The dynamics of estimated treatment effects were analyzed using an event study analysis. All data analyses were conducted in 2019‒2020. RESULTS: State adoption of a child care mandate for the pneumococcal conjugate vaccine increased the likelihood that resident children aged 19-35 months completed the 4-dose pneumococcal conjugate vaccine series by 3.12 percentage points (p<0.01). Statistically significant gains in pneumococcal conjugate vaccine coverage were identified in the first year following policy implementation and were found to persist over a period of ≥7 years. CONCLUSIONS: Results indicate that state adoption of a child care mandate for the pneumococcal conjugate vaccine leads to an increase in the proportion of resident children aged 19-35 months who are up to date with pneumococcal conjugate vaccine.