Incidence of Hospitalization for Respiratory Syncytial Virus Infection amongst Children in Ontario, Canada: A Population-Based Study Using Validated Health Administrative Data

Abstract

Importance: RSV is a common illness among young children that causes significant morbidity and health care costs.

Objective: Routinely collected health administrative data can be used to track disease incidence, explore risk factors and conduct health services research. Due to potential for misclassification bias, the accuracy of data-elements should be validated prior to use. The objectives of this study were to validate an algorithm to accurately identify pediatric cases of hospitalized respiratory syncytial virus (RSV) from within Ontario's health administrative data, estimate annual incidence of hospitalization due to RSV and report the prevalence of major risk factors within hospitalized patients.

Study design and setting: A retrospective chart review was performed to establish a reference-standard cohort of children from the Ottawa region admitted to the Children's Hospital of Eastern Ontario (CHEO) for RSV-related disease in 2010 and 2011. Chart review data was linked to Ontario's administrative data and used to evaluate the diagnostic accuracy of algorithms of RSV-related ICD-10 codes within provincial hospitalization and emergency department databases. Age- and sex-standardized incidence was calculated over time, with trends in incidence assessed using Poisson regression.

Results: From a total of 1411 admissions, chart review identified 327 children hospitalized for laboratory confirmed RSV-related disease. Following linkage to administrative data and restriction to first admissions, there were 289 RSV patients in the reference-standard cohort. The best algorithm, based on hospitalization data, resulted in sensitivity 97.9% (95%CI: 95.5-99.2%), specificity 99.6% (95%CI: 98.2-99.8%), PPV 96.9% (95%CI: 94.2-98.6%), NPV 99.4% (95%CI: 99.4-99.9%). Incidence of hospitalized RSV in Ontario from 2005-2012 was 10.2 per 1000 children under 1 year and 4.8 per 1000 children aged 1 to 3 years. During the surveillance period, there was no identifiable increasing or decreasing linear trend in the incidence of hospitalized RSV, hospital length of stay and PICU admission rates. Among the Ontario RSV cohort, 16.3% had one or more major risk factors, with a decreasing trend observed over time.

Conclusion: Children hospitalized for RSV-related disease can be accurately identified within population-based health administrative data. RSV is a major public health concern and incidence has not changed over time, suggesting a lack of progress in prevention.

Fig 1. Flow diagram of reference standard cohort creation against which algorithms were validated.

Abbreviations: CHEO = Children’s Hospital of Eastern Ontario; CIHI-DAD = Canadian Institute of Health Information—Discharge Abstract Database; FSA = Forward Sortation Area; OHIP = Ontario Health Insurance Plan; RPDB = Registered Person Database; RSV = Respiratory Syncytial Virus.

Fig 2. Incidence of hospitalized RSV (per 1000 children) 2005–2013 with 95% confidence intervals.

Legend: Incidence per 1000 person years is given for each fiscal year from 2005 to 2013. Error bars shown are the calculated 95% confidence intervals. Closed circles (•) represent the incidence in the full Ontario cohort of children under 3 years of age. Closed triangles (▾) represent the incidence for children under 1 year of age. Open circles (ο) represent the incidence for children between 1 and 3 years of age.