COVID-19 pandemic related racial/ethnic disparities in the foster care system in the United States

Background: The impact of COVID-19 pandemic on racial/ethnic differences in the US foster care system is unknown. Objective: To study the COVID-19 pandemic-related differences in racial/ethnic disparities in entry rates, exit rates, and adverse exits from foster care in US. Methods: Dataset: Adoption and Foster Care Analysis Reporting System (AFCARS) data from Census Bureau. Population: 1,040,581 children entering and 1,140,370 children exiting foster care between 2017 and 22, under age 25 years. Analyses: Age-group, sex, and race/ethnicityspecific entry rates were compared using Fisher's exact test. Exit rates and adverse exits were compared using Cox proportional hazard and logistic regression models respectively using difference-in-difference approach. Results: Entry rates increased for all children <1 year during COVID [entry ratio = 2.75 (2.72, 2.78)], especially American Indian/Alaska Native (AIAN) [entry ratio = 3.00 (2.80, 3.22)]. Exit rates decreased for all children during pandemic [exit ratio (ER) for white children = 0.399 (0.395, 0.403), p < 0.0001] with persistent disparities for AIAN [ER = 0.86 (0.83, 0.90)] and Hispanic children [ER = 0.96 (0.94, 0.97)] compared to white children. Adverse exits increased slightly during pandemic for most racial/ethnic groups [OR for white children = 1.09 (1.06, 1.12), p < 0.0001] with increase in disparities for most children of color, except Asian children. The greatest increase in disparities was for AIAN children [OR for adverse exits compared to white children post pandemic = 9.43 (8.82, 10.07), p < 0.0001]. Conclusion: The pandemic adversely affected all children in foster care. Entry rates disproportionately increased for AIAN children. Disparities in exit rates persisted for AIAN and Hispanic children. Disparities in adverse exits increased for most children of color, especially, AIAN children.