Singer David, Horn Emily K, Wang Yan, Wu Aozhou, La Elizabeth M, Gerber Susan I, Boland Joanna, Betts Keith A
GSK, FMC Tower, Suite 1700, 2929 Walnut Street, Philadelphia, PA, 19104, USA.
Analysis Group, Los Angeles, CA, USA.
Infect Dis Ther. 2025 Aug 31. doi: 10.1007/s40121-025-01217-z.
Respiratory syncytial virus (RSV) is a common respiratory virus that can cause severe disease, particularly in older adults and adults with underlying medical conditions. However, RSV infections often go underdiagnosed due to infrequent testing and assay sensitivity limitations. To better understand RSV epidemiology and disease burden, we investigated respiratory virus testing patterns and characteristics associated with RSV testing among United States (US) adults aged ≥ 50 years with acute respiratory illnesses (ARIs).
This was a retrospective study using Optum electronic health records data from 2015 to 2023. Medically-attended ARIs were identified among adults aged ≥ 50 years; percentages of ARIs tested for RSV and other respiratory viruses were calculated and stratified by epidemiological year (EY) and most intensive care setting during the ARI episode. Patient, provider, and ARI characteristics associated with the likelihood of RSV testing were assessed using multivariable logistic regression models.
Among 22,475,891 included ARIs, RSV testing occurred in 2.4% (n = 530,452) of episodes. RSV testing increased over time (1.3-5.9% from 2016-2017 to 2022-2023 EYs), though it remained markedly lower than influenza (5.8-15.1%; 2016-2017 to 2022-2023 EYs) and SARS-CoV-2 (5.8-22.6%; 2019-2020 to 2022-2023 EYs) testing. By most intensive level of care received, RSV testing from 2016-2023 was more frequent in inpatient (9.5-27.5%) and emergency department (ED; 1.4-17.9%) settings than the outpatient setting (0.3-1.4%). Among included covariates in adjusted analyses, most intensive care setting [ED: 9.3-fold, inpatient: 31.2-fold (versus outpatient)] and healthcare organization (0.02-13.8-fold) were most significantly associated with likelihood of RSV testing.
The likelihood of RSV testing varied significantly by most intensive care setting and healthcare organization. Despite increasing RSV testing over time, RSV remains infrequently tested among US adults. Under-detection of medically-attended RSV cases should be accounted for when estimating RSV disease burden and the potential impact of RSV prevention strategies. A Graphical Abstract is available for this article.
呼吸道合胞病毒（RSV）是一种常见的呼吸道病毒，可导致严重疾病，尤其是在老年人和有基础疾病的成年人中。然而，由于检测频率低和检测方法灵敏度有限，RSV感染常常未得到充分诊断。为了更好地了解RSV的流行病学和疾病负担，我们调查了美国年龄≥50岁的急性呼吸道疾病（ARI）成人患者中呼吸道病毒检测模式以及与RSV检测相关的特征。
这是一项回顾性研究，使用了2015年至2023年Optum电子健康记录数据。在年龄≥50岁的成年人中识别出接受医疗护理的ARI；计算了针对RSV和其他呼吸道病毒进行检测的ARI百分比，并按流行病学年份（EY）和ARI发作期间最密集的护理环境进行分层。使用多变量逻辑回归模型评估与RSV检测可能性相关的患者、提供者和ARI特征。
在纳入的22475891例ARI中，2.4%（n = 530452）的发作进行了RSV检测。RSV检测随时间增加（从2016 - 2017年到2022 - 2023年EYs从1.3%增至5.9%），尽管仍明显低于流感（5.8% - 15.1%；2016 - 2017年到2022 - 2023年EYs）和SARS-CoV-2（5.8% - 22.6%；2019 - 2020年到2022 - 2023年EYs）检测。按接受的最密集护理级别划分，2016 - 2023年RSV检测在住院（9.5% - 27.5%）和急诊科（ED；1.4% - 17.9%）环境中比门诊环境（0.3% - 1.4%）更频繁。在调整分析中纳入的协变量中，最密集护理环境[ED：9.3倍，住院：31.2倍（相对于门诊）]和医疗机构（0.02 - 13.8倍）与RSV检测可能性最显著相关。
RSV检测的可能性因最密集护理环境和医疗机构的不同而有显著差异。尽管随着时间推移RSV检测有所增加，但在美国成年人中RSV检测仍不常见。在估计RSV疾病负担和RSV预防策略的潜在影响时，应考虑到接受医疗护理的RSV病例未被检测到的情况。本文提供了图形摘要。
