Respiratory Syncytial Virus Burden and Healthcare Utilization in United States Infants <1 Year of Age: Study of Nationally Representative Databases, 2011-2019

Abstract

Background: Respiratory syncytial virus (RSV) is the leading cause of hospitalizations in United States infants aged <1 year, but research has focused on select populations.

Methods: National (Nationwide) Inpatient Sample and National Emergency Department (ED) Sample data (2011-2019) were used to report RSV hospitalization (RSVH), bronchiolitis hospitalization (BH), and ED visit counts, percentage of total hospitalizations/visits, and rates per 1000 live births along with inpatient mortality, mechanical ventilation (MV), and total charges (2020 US dollars).

Results: Average annual RSVH and RSV ED visits were 56 927 (range, 43 845-66 155) and 131 999 (range, 89 809-177 680), respectively. RSVH rates remained constant over time (P = .5), whereas ED visit rates increased (P = .004). From 2011 through 2019, Medicaid infants had the highest average rates (RSVH: 22.3 [95% confidence interval {CI}, 21.5-23.1] per 1000; ED visits: 55.9 [95% CI, 52.4-59.4] per 1000) compared to infants with private or other/unknown insurance (RSVH: P < .0001; ED visits: P < .0001). From 2011 through 2019, for all races and ethnicities, Medicaid infants had higher average RSVH rates (up to 7 times) compared to infants with private or other/unknown insurance. RSVH mortality remained constant over time (P = .8), whereas MV use (2019: 13% of RSVH, P < .0001) and mean charge during hospitalization (2019: $21 513, P < .0001) increased. Bronchiolitis patterns were similar.

Conclusions: This study highlights the importance of ensuring access to RSV preventive measures for all infants.

Keywords: Medicaid; RSV; RSV hospitalizations; birth month; bronchiolitis hospitalizations; emergency department; infants; respiratory syncytial virus.

Figure 1.

Respiratory syncytial virus (RSV) (A) and bronchiolitis (B) hospitalization proportions and rates per 1000 live births by admission year, United States infants aged <1 year, National (Nationwide) Inpatient Sample, 2011–2019. To calculate proportions (%), the total number of infant hospitalizations in that year was used as the denominator. RSV and bronchiolitis were defined by International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) diagnosis codes: RSV (ICD-9: 079.6, 466.11, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0); bronchiolitis (RSV codes plus unspecified bronchiolitis: ICD-9: 079.6, 466.11, 466.19, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0, J21.8, J21.9). Excludes newborn birth hospitalizations (ICD-9: V30.XX–V39.XX; ICD-10: Z38.XX).

Figure 2.

Respiratory syncytial virus (RSV) (A) and bronchiolitis (B) emergency department (ED) visit burden proportions and rates per 1000 live births by admission year, United States infants aged <1 year, Nationwide Emergency Department Sample, 2011–2019. To calculate proportions (%), the total number of infant ED visits in that year was used as the denominator. RSV and bronchiolitis were defined by International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) diagnosis codes: RSV (ICD-9: 079.6, 466.11, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0); bronchiolitis (RSV codes plus unspecified bronchiolitis: ICD-9: 079.6, 466.11, 466.19, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0, J21.8, J21.9). Excludes newborn birth hospitalizations (ICD-9: V30.XX–V39.XX; ICD-10: Z38.XX).

Figure 3.

Respiratory syncytial virus (RSV) hospitalization rates per 1000 live births by insurance payer and race/ethnicity, United States infants aged <1 year, National (Nationwide) Inpatient Sample, 2011–2019. RSV was defined by International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) diagnosis codes: RSV (ICD-9: 079.6, 466.11, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0). Excludes newborn birth hospitalizations (ICD-9: V30.XX–V39.XX; ICD-10: Z38.XX). Abbreviations: AI/AN, American Indian/Alaska Native; API, Asian and Pacific Islander; NH, non-Hispanic; RSV, respiratory syncytial virus.

Figure 4.

Respiratory syncytial virus (RSV) (A) and bronchiolitis (B) emergency department (ED) visit proportions and rates per 1000 live births by insurance payer, United States infants aged <1 year, Nationwide Emergency Department Sample, 2011–2019. To calculate proportions (%), the total number of RSV or bronchiolitis ED visits was used as the denominator. RSV and bronchiolitis were defined by International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) diagnosis codes: RSV (ICD-9: 079.6, 466.11, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0); bronchiolitis (RSV codes plus unspecified bronchiolitis: ICD-9: 079.6, 466.11, 466.19, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0, J21.8, J21.9). Excludes newborn birth hospitalizations (ICD-9: V30.XX–V39.XX; ICD-10: Z38.XX).

Figure 5.

Respiratory syncytial virus (RSV) hospitalization rates per 1000 live births by birth month, United States infants aged <1 year, National (Nationwide) Inpatient Sample, 2011. Birth month was available only in 2011. RSV was defined by International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) diagnosis codes: RSV (ICD-9: 079.6, 466.11, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0). Excludes newborn birth hospitalizations (ICD-9: V30.XX–V39.XX; ICD-10: Z38.XX).

Figure 6.

Respiratory syncytial virus (RSV) as a proportion of total infant hospitalizations by age (in months) and by admission month, United States infants aged <1 year, National (Nationwide) Inpatient Sample, 2011. Age was available only in 2011. Proportions (%) in each cell were calculated using the total number of infant hospitalizations for chronological age and during each admission month as the denominator. Example interpretation: Of all infants aged 1 month and admitted to the hospital in January, 34.7% were hospitalized due to RSV. RSV was defined by International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) diagnosis codes: RSV (ICD-9: 079.6, 466.11, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0). Excludes newborn birth hospitalizations (ICD-9: V30.XX–V39.XX; ICD-10: Z38.XX). Sample sizes ≤10 were not reported, in accordance with the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project.

Figure 7.

Mechanical ventilation (MV) proportions among respiratory syncytial virus (RSV) hospitalizations by insurance payer and race/ethnicity, United States infants aged <1 year, National (Nationwide) Inpatient Sample, 2011–2018. To calculate proportions (%), the total number of infant RSV hospitalizations regardless of MV use for that insurance payer and race/ethnicity was used as the denominator. RSV was defined by International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) diagnosis codes: RSV (ICD-9: 079.6, 466.11, 480.1; ICD-10: B97.4, J12.1, J20.5, J21.0). Excludes newborn birth hospitalizations (ICD-9: V30.XX–V39.XX; ICD-10: Z38.XX). Abbreviations: AI/AN, American Indian/Alaska Native; API, Asian and Pacific Islander; MV, mechanical ventilation; NH, non-Hispanic; RSV, respiratory syncytial virus.