Respiratory hospitalizations and ICU admissions among children with and without medical complexity at the end of the COVID-19 pandemic

Decreased severe respiratory illness was observed during the first 2 years of the COVID-19 pandemic, with a relatively smaller decrease among children with medical complexity (CMC) compared to non-CMC. We extended this analysis to the third pandemic year (April 1, 2022, to March 31, 2023) when pandemic public health measures were loosened. A population-based repeated cross-sectional study evaluated respiratory hospitalizations among CMC and non-CMC (<18 years) in Ontario, Canada. Among the 67,517 CMC and 3,006,504 non-CMC in Ontario, there were more CMC respiratory hospitalizations compared with the expected prepandemic levels (n = 3145 hospitalizations, corresponding to rate ratio [RR], 1.20; 95% confidence interval [CI], 1.16–1.25) with an even larger relative increase among non-CMC (n = 6653, RR, 1.36; 95% CI, 1.34–1.38). Increased intensive care unit admissions for respiratory illness were also observed (CMC: RR, 1.44; 95% CI, 1.31–1.59; non-CMC: RR, 2.02; 95% CI, 1.89–2.16). Understanding respiratory surge drivers may provide insights to protect at-risk children from respiratory morbidity.