Abstract
BackgroundThe burden of disease due to norovirus infection has been well described in the general United States population, but studies of norovirus occurrence among persons with chronic medical conditions have been limited mostly to the immunocompromised. We assessed the impact of norovirus gastroenteritis on health care utilization in US subjects with a range of chronic medical conditions.MethodsWe performed a retrospective cohort study using MarketScan data from July 2002 to December 2013, comparing the rates of emergency department visits, outpatient visits and hospitalizations among patients with chronic conditions (renal, cardiovascular, respiratory, immunocompromising, gastrointestinal, hepatic/pancreatic and neurological conditions and diabetes) with those in a healthy population. We estimated the rates of these outcomes due to norovirus gastroenteritis using an indirect modelling approach whereby cases of gastroenteritis of unknown cause and not attributed to a range of other causes were assumed to be due to norovirus.ResultsHospitalization rates for norovirus gastroenteritis were higher in all of the risk groups analyzed compared with data in otherwise healthy subjects, ranging from 3.2 per 10,000 person-years in persons with chronic respiratory conditions, to 23.1 per 10,000 person-years in persons with chronic renal conditions, compared to 2.1 per 10,000 among persons without chronic conditions. Over 51% of all norovirus hospitalizations occurred in the 37% of the population with some form of chronic medical condition. Outpatient visits for norovirus gastroenteritis were also increased in persons with chronic gastrointestinal or immunocompromising conditions.ConclusionNorovirus gastroenteritis leads to significantly higher rates of healthcare utilization in patients with a chronic medical condition compared to patients without any such condition.
Highlights
Norovirus is the most common cause of acute gastroenteritis (AGE) [1]
Hospitalization rates for norovirus gastroenteritis were higher in all of the risk groups analyzed compared with data in otherwise healthy subjects, ranging from 3.2 per 10,000 person-years in persons with chronic respiratory conditions, to 23.1 per 10,000 person-years in persons with chronic renal conditions, compared to 2.1 per 10,000 among persons without chronic conditions
Outpatient visits for norovirus gastroenteritis were increased in persons with chronic gastrointestinal or immunocompromising conditions
Summary
Norovirus is the most common cause of acute gastroenteritis (AGE) [1]. Transmission may be person-to-person, or via food, water or environmental sources [2,3]. Norovirus is estimated to result in more than 400,000 ED visits, 1.7 million outpatient visits and 70,000 hospitalizations annually in the US [10,11], with higher numbers estimated in epidemic years. These estimates are derived from administrative databases such as the Nationwide Inpatient Sample, and have far focused on the general population, not taking into account underlying morbidities. The burden of disease due to norovirus infection has been well described in the general United States population, but studies of norovirus occurrence among persons with chronic medical conditions have been limited mostly to the immunocompromised. Johns Hopkins Bloomberg School of Public Health, UNITED STATES
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