Xu Hanmeng, Pitzer Virginia E, Warren Joshua L, Shapiro Eugene D, Weinberger Daniel M
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
medRxiv. 2025 Jan 12:2025.01.10.24319265. doi: 10.1101/2025.01.10.24319265.
Multiple prophylactic products are now available to protect against respiratory syncytial virus (RSV) in different age groups. Assessing the pre-intervention burden of RSV infections across various severity levels and risk groups is crucial, as it provides a baseline for evaluating the impact of these products.
We obtained monthly time series data on hospitalizations, intensive care unit (ICU) admissions, and deaths by age group, ZIP code, and cause for New York state from 2005 to 2019. Socioeconomic status (SES) of the ZIP codes was classified using supervised principal component analysis (PCA). We estimated the incidence of hospitalizations, ICU admissions, and deaths attributable to RSV and to influenza using hierarchical Bayesian regression models. Additionally, we assessed severity, defined by ICU admission and mortality risks, as well as recording fraction (i.e., percent of estimated virus-associated hospitalizations recorded as being due to the specific virus), stratified by age, SES, and over time.
The estimated annual incidence of RSV-associated hospitalizations and ICU admissions were highest in infants under 1 in the low SES group (2,240 [95% credible interval (CrI): 2,200-2,290] hospitalizations and 330 [95% CrI: 320-350] ICU admissions per 100,000 person-years). The incidence of RSV-associated deaths was highest among adults ≥85 years old (61 [95% CrI: 49-74] per 100,000 person-years). In contrast to RSV, the burden of influenza was greatest in age groups ≥65 years. The risk of ICU admission varied by patients' age and SES, and the mortality risk increased dramatically with age for both pathogens (RSV: 11.9% [95% CrI: 9.6-14.3%], influenza: 14.4% [95% CrI: 13.1-15.6%] among ≥85 year age group). Incidence varied by epidemic year and season, and we observed an increasing recording fraction of RSV among all age groups over the study period.
RSV and influenza contribute significantly to the burden of hospitalizations, ICU admissions, and deaths, particularly among infants and older adults. Although the recording fraction of RSV increased over the study period, it remains lower, particularly for adults. Our findings reveal a disparity in hospitalization burden by SES, particularly among younger age groups.
目前有多种预防性产品可用于保护不同年龄组人群免受呼吸道合胞病毒（RSV）感染。评估RSV感染在不同严重程度水平和风险组中的干预前负担至关重要，因为这为评估这些产品的影响提供了基线。
我们获取了2005年至2019年纽约州按年龄组、邮政编码和病因划分的住院、重症监护病房（ICU）收治及死亡的月度时间序列数据。使用监督主成分分析（PCA）对邮政编码区域的社会经济地位（SES）进行分类。我们使用分层贝叶斯回归模型估计了RSV和流感所致的住院、ICU收治及死亡的发病率。此外，我们评估了由ICU收治和死亡风险定义的严重程度，以及记录比例（即估计的与病毒相关的住院病例中记录为由特定病毒引起的百分比），并按年龄、SES和时间进行分层。
在低SES组中，1岁以下婴儿的RSV相关住院和ICU收治的估计年发病率最高（每10万人年有2240例[95%可信区间（CrI）：2200 - 2290]住院和330例[95% CrI：320 - 350]ICU收治）。RSV相关死亡的发病率在85岁及以上成年人中最高（每10万人年有61例[95% CrI：49 - 74]）。与RSV不同，流感负担在65岁及以上年龄组中最大。ICU收治风险因患者年龄和SES而异，两种病原体的死亡风险均随年龄急剧增加（RSV：85岁及以上年龄组中为11.9%[95% CrI：9.6 - 14.3%]，流感：为14.4%[95% CrI：13.1 - 15.6%]）。发病率因流行年份和季节而异，在研究期间我们观察到所有年龄组中RSV的记录比例都在增加。
RSV和流感对住院、ICU收治和死亡负担有显著贡献，尤其是在婴儿和老年人中。尽管在研究期间RSV的记录比例有所增加，但仍然较低，尤其是对成年人而言。我们的研究结果揭示了SES在住院负担方面的差异，特别是在较年轻年龄组中。
