Jenna E Holmen1, Lindsay Kim2,3, Bryanna Cikesh2, Pam Daily Kirley4, Shua J Chai2,4, Nancy M Bennett5, Christina B Felsen5, Patricia Ryan6, Maya Monroe6, Evan J Anderson7,8,9, Kyle P Openo8,9,10, Kathryn Como-Sabetti11, Erica Bye11, H Keipp Talbot12, William Schaffner12, Alison Muse13, Grant R Barney13, Michael Whitaker2, Jennifer Ahern14, Christopher Rowe14,15, Gayle Langley2, Art Reingold14. 1. UCSF Benioff Children's Hospital, 747 52nd St, Oakland, CA, 94609, USA. Jenna.Holmen@ucsf.edu. 2. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. 3. US Public Health Service, Atlanta, GA, USA. 4. California Emerging Infections Program, Oakland, CA, USA. 5. University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. 6. Maryland Department of Health, Baltimore, MD, USA. 7. Departments of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA. 8. Emerging Infections Program, Georgia Department of Health, Atlanta, GA, USA. 9. Veterans Affairs Medical Center, Atlanta, GA, USA. 10. Foundation for Atlanta Veterans Education and Research, Decatur, GA, USA. 11. Minnesota Department of Health, St. Paul, MN, USA. 12. Vanderbilt University Medical Center, Nashville, TN, USA. 13. New York State Department of Health, Albany, NY, USA. 14. Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA. 15. San Francisco Department of Public Health, San Francisco, CA, USA.
Abstract
BACKGROUND: Respiratory syncytial virus (RSV) infection causes substantial morbidity and mortality in children and adults. Socioeconomic status (SES) is known to influence many health outcomes, but there have been few studies of the relationship between RSV-associated illness and SES, particularly in adults. Understanding this association is important in order to identify and address disparities and to prioritize resources for prevention. METHODS: Adults hospitalized with a laboratory-confirmed RSV infection were identified through population-based surveillance at multiple sites in the U.S. The incidence of RSV-associated hospitalizations was calculated by census-tract (CT) poverty and crowding, adjusted for age. Log binomial regression was used to evaluate the association between Intensive Care Unit (ICU) admission or death and CT poverty and crowding. RESULTS: Among the 1713 cases, RSV-associated hospitalization correlated with increased CT level poverty and crowding. The incidence rate of RSV-associated hospitalization was 2.58 (CI 2.23, 2.98) times higher in CTs with the highest as compared to the lowest percentages of individuals living below the poverty level (≥ 20 and < 5%, respectively). The incidence rate of RSV-associated hospitalization was 1.52 (CI 1.33, 1.73) times higher in CTs with the highest as compared to the lowest levels of crowding (≥5 and < 1% of households with > 1 occupant/room, respectively). Neither CT level poverty nor crowding had a correlation with ICU admission or death. CONCLUSIONS: Poverty and crowding at CT level were associated with increased incidence of RSV-associated hospitalization, but not with more severe RSV disease. Efforts to reduce the incidence of RSV disease should consider SES.
BACKGROUND:Respiratory syncytial virus (RSV) infection causes substantial morbidity and mortality in children and adults. Socioeconomic status (SES) is known to influence many health outcomes, but there have been few studies of the relationship between RSV-associated illness and SES, particularly in adults. Understanding this association is important in order to identify and address disparities and to prioritize resources for prevention. METHODS: Adults hospitalized with a laboratory-confirmed RSV infection were identified through population-based surveillance at multiple sites in the U.S. The incidence of RSV-associated hospitalizations was calculated by census-tract (CT) poverty and crowding, adjusted for age. Log binomial regression was used to evaluate the association between Intensive Care Unit (ICU) admission or death and CT poverty and crowding. RESULTS: Among the 1713 cases, RSV-associated hospitalization correlated with increased CT level poverty and crowding. The incidence rate of RSV-associated hospitalization was 2.58 (CI 2.23, 2.98) times higher in CTs with the highest as compared to the lowest percentages of individuals living below the poverty level (≥ 20 and < 5%, respectively). The incidence rate of RSV-associated hospitalization was 1.52 (CI 1.33, 1.73) times higher in CTs with the highest as compared to the lowest levels of crowding (≥5 and < 1% of households with > 1 occupant/room, respectively). Neither CT level poverty nor crowding had a correlation with ICU admission or death. CONCLUSIONS: Poverty and crowding at CT level were associated with increased incidence of RSV-associated hospitalization, but not with more severe RSV disease. Efforts to reduce the incidence of RSV disease should consider SES.
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