ICES, Toronto, Ontario, Canada.
Dalla Lana School of Public Health.
Pediatrics. 2021 Apr;147(4). doi: 10.1542/peds.2020-029090. Epub 2021 Mar 18.
Most infants hospitalized with respiratory syncytial virus (RSV) do not meet common "high-risk" criteria and are otherwise healthy. The objective of this study was to quantify the risks and relative importance of socioeconomic factors for severe, early-life RSV-related illness. We hypothesized several of these factors, particularly those indicating severe social vulnerability, would have statistically significant associations with increased RSV hospitalization rates and may offer impactful targets for population-based RSV prevention strategies, such as prophylaxis programs.
We used linked health, laboratory, and sociodemographic administrative data for all children born in Ontario (2012-2018) to identify all RSV-related hospitalizations occurring before the third birthday or end of follow-up (March 31, 2019). We estimated rate ratios and population attributable fractions using a fully adjusted model.
A total of 11 782 RSV-related hospitalizations were identified among 789 484 children. Multiple socioeconomic factors were independently associated with increased RSV-related admissions, including young maternal age, maternal criminal involvement, and maternal history of serious mental health and/or addiction concerns. For example, an estimated 4.1% (95% confidence interval: 2.2 to 5.9) of RSV-related admissions could be prevented by eliminating the increased admissions risks among children whose mothers used welfare-based drug insurance. Notably, 41.6% (95% confidence interval: 39.6 to 43.5) of admissions may be prevented by targeting older siblings (eg, through vaccination).
Many social factors were independently associated with early-life RSV-related hospitalization. Existing RSV prophylaxis and emerging vaccination programs should consider the importance of both clinical and social risk factors when determining eligibility and promoting compliance.
大多数因呼吸道合胞病毒（RSV）住院的婴儿不符合常见的“高危”标准，且身体状况良好。本研究旨在量化社会经济因素对严重、早发性 RSV 相关疾病的风险和相对重要性。我们假设其中一些因素，特别是那些表明严重社会脆弱性的因素，与 RSV 住院率的增加具有统计学显著关联，并可能为基于人群的 RSV 预防策略提供有影响力的目标，例如预防方案。
我们使用安大略省（2012-2018 年）所有儿童的健康、实验室和社会人口统计学行政数据，确定所有在三岁生日前或随访结束前（2019 年 3 月 31 日）发生的与 RSV 相关的住院治疗。我们使用完全调整后的模型估计比率比和人群归因分数。
在 789484 名儿童中，共发现 11782 例与 RSV 相关的住院治疗。多个社会经济因素与 RSV 相关的入院率增加独立相关，包括母亲年龄较小、母亲犯罪行为以及母亲有严重精神健康和/或成瘾问题的病史。例如，通过消除那些母亲使用基于福利的药物保险而增加的入院风险，估计有 4.1%（95%置信区间：2.2 至 5.9）的 RSV 相关入院可以得到预防。值得注意的是，通过针对年龄较大的兄弟姐妹（例如通过接种疫苗），可能预防 41.6%（95%置信区间：39.6 至 43.5）的入院。
许多社会因素与早发性 RSV 相关的住院治疗独立相关。现有的 RSV 预防和新兴的疫苗接种计划在确定资格和提高依从性时，应考虑临床和社会风险因素的重要性。
