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. 2022 Aug 15;226(Suppl 2):S246-S254.
doi: 10.1093/infdis/jiac127.

Mortality Associated With Respiratory Syncytial Virus, Bronchiolitis, and Influenza Among Infants in the United States: A Birth Cohort Study From 1999 to 2018

Heidi Reichert  1 , Mina Suh  1 , Xiaohui Jiang  1 , Naimisha Movva  1 , Lauren C Bylsma  1 , Jon P Fryzek  1 , Christopher B Nelson  2
Affiliations

Mortality Associated With Respiratory Syncytial Virus, Bronchiolitis, and Influenza Among Infants in the United States: A Birth Cohort Study From 1999 to 2018

Heidi Reichert et al. J Infect Dis. .

Abstract

Background: Infant mortality due to respiratory syncytial virus (RSV) in the United States is not well understood.

Methods: From 1999 to 2018, RSV, bronchiolitis, and influenza deaths were described for infants <1 year using linked birth/death datasets from the National Vital Statistics System. Mortality was described overall and by infant birth and death characteristics. Bronchiolitis was included as the plausible upper limit of RSV, while influenza served as a comparator.

Results: Total infant deaths were 561 RSV, 1603 bronchiolitis, and 504 influenza, and rates were 6.9 (95% confidence interval [CI], 6.4-7.5), 19.8 (95% CI, 18.9-20.8), and 6.2 (95% CI, 5.7-6.8) per 1 000 000 live births, respectively. The highest RSV rates were observed among <29 weeks' gestational age infants (103.5; 95% CI, 81.8-129.1), American Indian/Alaskan Native (20.3; 95% CI, 11.6-33.0), and Medicaid-insured (7.3; 95% CI, 5.9-8.9). However, RSV mortality burden was greatest in full-term (53.7%), white (44.9%), and Medicaid-insured (61.7%) infants. Deaths outside the inpatient setting were 21% and 54% for RSV and bronchiolitis; more Medicaid- (58%) and other/unknown-insured (69%) infants with bronchiolitis died outside of the inpatient setting, compared to privately insured infants (48%) (P = .0327).

Conclusions: These national estimates emphasize the importance of considering all infants across all healthcare settings when describing RSV mortality.

Keywords: RSV; bronchiolitis; infants; influenza; mortality; respiratory syncytial virus.

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Conflict of interest statement

Potential conflicts of interest. EpidStrategies received a grant from Sanofi for this research. H. R., M. S., X. J., N. M., L. C. B., and J. P. F. are employees of EpidStrategies. C. B. N. is an employee of Sanofi and may hold shares and/or stock options in the company. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Infant respiratory syncytial virus (RSV), bronchiolitis, and influenza mortality rates per 1 000 000 live births by birth year, US infants aged <1 year, National Center for Health Statistics/National Vital Statistics System 1999–2018. RSV, bronchiolitis, and influenza were defined by ICD-10 cause of death code in any position: RSV, B97.4, J12.1, J20.5, J21.0; bronchiolitis, all RSV codes and J21.8, J21.9; and influenza, J09, J10.0, J10.1, J10.2, J10.8, J11.0, J11.1, J11.2, J11.8.
Figure 2.
Figure 2.
Infant respiratory syncytial virus (RSV), bronchiolitis, and influenza mortality rates per 1 000 000 live births by birth month, US infants aged <1 year, National Center for Health Statistics/National Vital Statistics System 1999–2018. RSV, bronchiolitis, and influenza were defined by ICD-10 cause of death code in any position: RSV, B97.4, J12.1, J20.5, J21.0; bronchiolitis, all RSV codes and J21.8, J21.9; and influenza, J09, J10.0, J10.1, J10.2, J10.8, J11.0, J11.1, J11.2, J11.8.
Figure 3.
Figure 3.
Percent of infant deaths (burden) and infant mortality rate per 1 000 000 live births by weeks’ gestational age (wGA), US infants aged <1 year, National Center for Health Statistics/National Vital Statistics System 1999–2018: (A) respiratory syncytial virus (RSV); (B) bronchiolitis; and (C) influenza. RSV, bronchiolitis, and influenza were defined by ICD-10 cause of death code in any position: RSV, B97.4, J12.1, J20.5, J21.0; bronchiolitis, all RSV codes and J21.8, J21.9; and influenza, J09, J10.0, J10.1, J10.2, J10.8, J11.0, J11.1, J11.2, J11.8.
Figure 4.
Figure 4.
Percent of infant deaths (burden) and infant mortality rate per 1 000 000 live births by insurance payer, US infants aged <1 year, National Center for Health Statistics/National Vital Statistics System 1999–2018: (A) respiratory syncytial virus (RSV); (B) bronchiolitis; and (C) influenza. RSV, bronchiolitis, and influenza were defined by ICD-10 cause of death code in any position: RSV, B97.4, J12.1, J20.5, J21.0; bronchiolitis, all RSV codes and J21.8, J21.9; and influenza, J09, J10.0, J10.1, J10.2, J10.8, J11.0, J11.1, J11.2, J11.8.
Figure 5.
Figure 5.
Percent of infant deaths associated with respiratory syncytial virus (RSV), bronchiolitis, and influenza by risk group, US infants aged <1 year, National Center for Health Statistics/National Vital Statistics System 1999–2018. Infant risk groups were defined as (A) full term (37+ wGA) infants without comorbidities; (B) palivizumab eligible, preterm <29 wGA, preterm 29–31 wGA with CLD, or preterm 29+ wGA with higher-risk CHD; and (C) preterm 29–31 weeks without CLD or higher-risk CHD, preterm 32–36 wGA without higher-risk CHD, or full term with other comorbidities. RSV, bronchiolitis, and influenza were defined by ICD-10 cause of death code in any position: RSV, B97.4, J12.1, J20.5, J21.0; bronchiolitis, all RSV codes and J21.8, J21.9; and influenza, J09, J10.0, J10.1, J10.2, J10.8, J11.0, J11.1, J11.2, J11.8. Abbreviations: CHD, congenital heart disease; CLD, chronic lung disease of prematurity; wGA, weeks’ gestational age.
Figure 6.
Figure 6.
Percent of infant deaths associated with respiratory syncytial virus (RSV), bronchiolitis, and influenza by setting of death, US infants aged <1 year, National Center for Health Statistics/National Vital Statistics System 1999–2018. RSV, bronchiolitis, and influenza were defined by ICD-10 cause of death code in any position: RSV, B97.4, J12.1, J20.5, J21.0; bronchiolitis, all RSV codes and J21.8, J21.9; and influenza, J09, J10.0, J10.1, J10.2, J10.8, J11.0, J11.1, J11.2, J11.8. Abbreviations: ED, emergency department.
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