Abstract
BackgroundRespiratory syncytial virus (RSV) is an established cause of serious lower respiratory disease in children, but the burden in adults is less well studied.MethodsWe conducted a retrospective study of hospitalizations among adults ≥20 years from the 1997–2012 National Inpatient Sample. Trends in RSV admissions were described relative to unspecified viral pneumonia admissions. Hospitalization severity indicators were compared among immunocompromised RSV, non-immunocompromised RSV, and influenza admissions.ResultsAn estimated 28237 adult RSV hospitalizations occurred, compared with 652818 influenza hospitalizations; 34% were immunocompromised individuals. Respiratory syncytial virus and influenza patients had similar age, gender, and race distributions, but RSV was more often diagnosed in urban teaching hospitals (73.0% for RSV vs 34.6% for influenza) and large hospitals (71.9% vs 56.4%). Respiratory syncytial virus hospitalization rates increased from 1997 to 2012, particularly for those ≥60, increasing from 0.5 to 4.6 per 100000, whereas unspecified pneumonia admission rates decreased significantly (P < .001). Immunocompromised patients with RSV hospitalization had significantly higher inpatient mortality (P = .013), use of mechanical ventilation (P = .016), mean length of stay (LOS) (P < .001), and mean cost (P < .001) than non-immunocompromised RSV hospitalizations. Overall, RSV hospitalizations were more severe than influenza hospitalizations (6.2% mortality for RSV vs 3.0% for influenza, 16.7% vs 7.2% mechanical ventilation, mean LOS of 6.0 vs 3.6 days, and mean cost of $38828 vs $14519).ConclusionsRespiratory syncytial virus hospitalizations in adults are increasing, likely due to increasing recognition and diagnosis. The burden of RSV in adults deserves attention. Although there are fewer hospitalizations than influenza, those that are diagnosed are on average more severe.
Highlights
Respiratory syncytial virus (RSV) is an established cause of serious lower respiratory disease in children, but the burden in adults is less well studied
RSV hospitalizations were more severe than influenza hospitalizations (6.2% mortality for RSV vs 3.0% for influenza, 16.7% vs 7.2% mechanical ventilation, mean length of stay (LOS) of 6.0 vs 3.6 days, and mean cost of $38 828 vs $14 519)
Respiratory syncytial virus has been confirmed in 1% to 8% of chronic obstructive pulmonary disease (COPD) exacerbations [5,6,7,8,9,10] and in 5% to 11% of adults admitted with pneumonia, COPD, heart failure, or asthma [2]
Summary
We conducted a retrospective study of hospitalizations among adults ≥20 years from the 1997–2012 National Inpatient Sample. A retrospective study of RSV hospitalizations among adults (≥20 years) was conducted using discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality (AHRQ) for the years 1997 to 2012. The NIS is a nationally representative sample of hospital inpatient stays developed by the HCUP and sponsored by the AHRQ. Data are contributed from the HCUP State Inpatient Databases (http://www.hcup-us.ahrq.gov/db/hcupdatapartners.jsp) and include records for more than 7 million all-payer hospital stays each year [23]. Our analysis included all hospitalizations occurring in adults ≥20 years of age with at least 1 of the 3 RSV-specific ICD-9 codes listed in any diagnostic position in their hospitalization record
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