Gantenberg Jason R, van Aalst Robertus, Diakun David R, Bengtson Angela M, Limone Brendan L, Nelson Christopher B, Savitz David A, Zullo Andrew R
Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, United States of America.
Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, United States of America.
PLoS One. 2025 Feb 10;20(2):e0313573. doi: 10.1371/journal.pone.0313573. eCollection 2025.
Respiratory syncytial virus (RSV) is the leading cause of infant hospitalization in the United States. Understanding healthcare utilization associated with medically attended (MA) RSV lower respiratory tract infection (LRTI) might inform research priorities aimed at reducing RSV-associated pediatric morbidity. We described healthcare utilization during acute MA RSV LRTI episodes within a geographically diverse cohort of infants in the United States.
We created retrospective cohorts of infants born in the United States from July 1, 2016 through February 29, 2020 in each of three de-identified insurance claims datasets: Merative MarketScan Commercial Claims and Encounters, Multi-State MarketScan Medicaid, and Optum's de-identified Clinformatics ® Data Mart. We identified infants' first MA RSV LRTI diagnosis during their first RSV season and followed them for 7 subsequent days to record outpatient, emergency department, and inpatient hospital utilization. We calculated the number of outpatient visits, emergency department visits, and inpatient hospital stays occurring during this acute episode and estimated the proportion of episodes involving ≥ 2 visits to a given healthcare setting.
In the CCAE database, we identified 25,409 acute MA RSV LRTI episodes under the specific RSV definition and 69,068 under the sensitive definition. In the MDCD database, these totals were 67,357 and 170,744, while in the CDM database, they were 12,402 and 31,363, respectively. Across data sources, 34%-69% of infants' first acute MA RSV LRTI episodes involve 2 or more visits to a healthcare setting within 7 days. The percentage of episodes involving at least 2 visits ranged from 34-62% among healthy term infants, 38-65% for Palivizumab-eligible infants, and 38-69% for infants with other comorbidities.
Within a week of their first MA RSV LRTI diagnosis, infants frequently experience at least 2 visits to one or more healthcare settings, regardless of their comorbidity profile. The percentage of MA RSV LRTI episodes involving at least 2 visits to a healthcare setting may vary by insurance claims database, even between commercial payers.
呼吸道合胞病毒（RSV）是美国婴儿住院的主要原因。了解与就医（MA）的RSV下呼吸道感染（LRTI）相关的医疗保健利用情况，可能会为旨在降低RSV相关儿童发病率的研究重点提供信息。我们描述了美国一个地理分布多样的婴儿队列中急性MA RSV LRTI发作期间的医疗保健利用情况。
我们在三个去识别化的保险理赔数据集的每一个中，创建了2016年7月1日至2020年2月29日在美国出生的婴儿的回顾性队列：Merative MarketScan商业理赔与就诊数据库、多州市场扫描医疗补助数据库以及Optum的去识别化临床信息学®数据集市。我们确定了婴儿在其第一个RSV季节期间首次MA RSV LRTI诊断，并在随后7天对他们进行跟踪，以记录门诊、急诊科和住院医院的利用情况。我们计算了在这一急性发作期间发生的门诊就诊、急诊科就诊和住院天数，并估计了涉及到在给定医疗保健机构就诊≥2次的发作比例。
在CCAE数据库中，根据特定的RSV定义，我们识别出25409例急性MA RSV LRTI发作，根据敏感定义则为69068例。在MDCD数据库中，这些总数分别为67357例和170744例，而在CDM数据库中，分别为12402例和31363例。在所有数据源中，34%-69%的婴儿首次急性MA RSV LRTI发作涉及在7天内到医疗保健机构就诊2次或更多次。在健康足月儿中，涉及至少2次就诊的发作百分比为34%-62%，在符合使用帕利珠单抗条件的婴儿中为38%-65%，在有其他合并症的婴儿中为38%-69%。
在首次MA RSV LRTI诊断后的一周内，无论其合并症情况如何，婴儿经常至少到一个或多个医疗保健机构就诊2次。涉及到在医疗保健机构至少就诊2次的MA RSV LRTI发作百分比可能因保险理赔数据库而异，即使在商业付款人之间也是如此。
