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Disclosures: The authors report no relevant financial disclosures.
October 14, 2021
3 min read

One child loses a caregiver for every four COVID-19-related deaths

Disclosures: The authors report no relevant financial disclosures.
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More than 140,000 children in the U.S. have lost a primary or secondary caregiver due to the COVID-19 pandemic, according to findings published in Pediatrics.

Specifically, these children lost a parent, custodial grandparent or grandparent caregiver between April 1, 2020, and June 30, 2021.

Graphical depiction of data included in article.
Hillis S, et al. Pediatrics. 2021;doi:10.1542/peds.2021-053760.

“Children facing orphanhood as a result of COVID-19 is a hidden, global pandemic that has sadly not spared the U.S.,” Susan Hillis, PhD, a CDC researcher, said in a press release. “All of us — especially our children — will feel the serious immediate and long-term impact of this problem for generations to come. Addressing the loss that these children have experienced — and continue to experience — must be one of our top priorities, and it must be woven into all aspects of our emergency response, both now and in the post-pandemic future.”

Hillis and colleagues used data on fertility rates, excess mortality, COVID-19-related mortality and household composition to estimate rates of orphanhood and deaths of caregivers. The observational modeling study disaggregated data by state, age, race and ethnicity. Deaths associated with COVID-19 included indirect causes like decreased access to health services, which the researchers delineated as excess deaths. These were deemed as “excess” after Hillis and colleagues compared them to average deaths between 2015 and 2019. They regarded an “orphanhood” as the loss of one or both parents. A secondary caregiver was considered to be someone who provided some basic needs or care, as opposed to a primary caregiver, who was responsible for a child’s most basic needs and care.

During the study period, 120,630 children in the U.S. lost a primary caregiver and 22,007 children lost a secondary caregiver due to a COVID-19-associated death, according to the researchers. Children of historically underrepresented groups disproportionately experienced this loss, accounting for 65% of children whose primary caregiver died despite only making up 39% of the total population. Meanwhile, white children accounted for 35% of those who lost a primary caregiver but made up 61% of the total population.

Specifically, Hispanic children represented 32% of all children who lost a caregiver but made up 19% of the population, and Black children represented 26% of all children who lost a caregiver but made up 13% of the population. Overall, American Indian/Alaskan Native, Black, Hispanic and Asian children were 4.5, 2.4, 1.8 and 1.1 times more likely to lose a parent or caregiver, Hillis and colleagues wrote.

States with large populations had the greatest loss of primary caregivers, such as California (16,179 deaths), Texas (14,135 deaths) and New York (7,175 deaths). In Southern states, a large proportion of children whose primary caregivers died were Hispanic. They represented 67% of children whose caregivers died in California, 58% in Texas and 49% in New Mexico. In Southeast states, many children whose caregivers died were Black, representing 54% of children who lost a caregiver in Louisiana, 45% in Alabama and 57% in Mississippi. Children who identified as American Indian/Alaskan Native were disproportionately affected in select states, accounting for 18% of children who lost a caregiver in Arizona, 39% in New Mexico, 23% in Oklahoma, 38% in Montana and 55% in South Dakota.

The researchers estimated that one in every 753 white children lost a parent or grandparent caregiver compared with one in every 168 American Indian/Alaskan Native children, one in every 412 Hispanic children and one in every 310 Black children. Factors that influenced these inequities include discrimination, neighborhood environment, barriers in access to health care, occupation, educational gaps, economic instability, living arrangements and unstable housing, Hillis and colleagues wrote. Also, individuals of underrepresented racial and ethnic groups had greater exposure to SARS-CoV-2 “due to their disproportionate representation in essential jobs and increased likelihood of living in multigenerational homes,” the researchers wrote.

They further noted that orphanhood and caregiver loss can have a “profound long-term impact” on children and increase their risk for mental health problems, shorter schooling, lower self-esteem, sexual risk behaviors, suicide, sexual abuse and exploitation.

“The magnitude of young people affected is a sobering reminder of the devastating impact of the past 18 months,” Alexandra Blenkinsop, PhD, study coauthor from Imperial College London, said in the press release. “These findings really highlight those children who have been left most vulnerable by the pandemic, and where additional resources should be directed.”


Hillis S, et al. Pediatrics. 2021;doi:10.1542/peds.2021-053760.

More than 140,000 U.S. children lost a primary or secondary caregiver due to the COVID-19 pandemic. Published Oct. 7, 2021. Accessed Oct. 7, 2021.