Relationship between neighborhood census-tract level socioeconomic status and respiratory syncytial virus-associated hospitalizations in U.S. adults, 2015\u20132017

Jenna Holmen ,Christina B Felsen,Gayle Langley,Kyle P Openo,Shua J Chai,Christopher Rowe,Jennifer Ahern,Patricia Ryan,Kathryn Como‐Sabetti ,H Keipp Talbot,Evan J Anderson,William Schaffner,Alison Muse,Michael Whitaker,Maya Monroe,Grant Barney ,Nancy M Bennett,Erica Bye,Pam Daily Kirley,Bryanna Cikesh,Lindsay Kim,Art Reingold

doi:10.1186/s12879-021-05989-w

Abstract

BackgroundRespiratory 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.MethodsAdults 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.ResultsAmong 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.ConclusionsPoverty 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.

Highlights

Respiratory syncytial virus (RSV) infection causes substantial morbidity and mortality in children and adults
Variables that had a statistical association with death or Intensive Care Unit (ICU) admission at a p-value < 0.2 were included along with either census-tract level poverty or Results A total of 1713 cases were included in the final analysis, after excluding 45 (2.5%) with missing address information
Among adults with an RSV-associated hospitalization, there were more individuals who identified as Black, compared to White, living in census tracts with higher percentages of poverty

Summary

Introduction

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, in adults. Understanding this association is important in order to identify and address disparities and to prioritize resources for prevention. Evaluating the relationship between illness and SES at the census-tract level can be valuable, because an individual’s health is influenced by a constellation of variables at both the individual and the neighborhood-levels [12,13,14,15,16]. Census-tract level poverty has been found to be one of the most sensitive and consistent metrics by which to assess the association between disease and area/neighborhood socioeconomic status [12, 14, 15]

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