Objective:

to analyze the severity of the clinical course of COVID-19 in children and youth, hospitalized across different altitudes in Bolivia between 2020 and 2023.

Methods:

A retrospective case series was conducted on 412 patients of both sexes between 0-24 years of age, hospitalized with a COVID-19 diagnosis. Clinical management was described, and the variables sex, age, pandemic wave, altitude level, preexisting conditions, and signs and symptoms at admission were analyzed. A multivariate logistic regression model was used to identify factors associated with the development of severe or critical course of COVID-19.

Results:

A severe or critical course of COVID-19 developed in 45.9% (n=189) of patients during hospitalization. Higher risk was found in patients living at very high altitudes (OR 3,05; p<0,001; 95% CI 1,65-5,62) and those with dyspnea at admission (OR 3,39; p<0,001; 95% CI 2.03-5.66).

Conclusions:

Living at very high altitudes was associated with an increased risk of developing a severe or critical course of COVID-19 in hospitalized children and youth. Further research is needed to conclusively determine whether the altitude-related risk is primarily due to biological or social factors.

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