Race/ethnic disparities in discharges from all US community, non-rehabilitation hospitals for respiratory syncytial virus among children one year or younger and the possible role of healthcare access

Introduction: According to the Centers for Disease Control and Prevention, respiratory syncytial virus (RSV) is the most prevalent cause of bronchiolitis and pneumonia in children younger than one year in the US, with 75,000-125,000 hospitalizations estimated annually in this population. Research has shown that infants of ethnic minority status are more vulnerable to severe RSV disease compared to non-ethnic minorities. Methods: The 2006 Kids' Inpatient Database (KID) was used to quantify racial disparities for RSV hospitalization risk among children one year of age or younger at the time of admission. Discharge records for infants with an International Classification of Diseases, Ninth Revision, Clinical Modification code of 079.6 (RSV), 466.11 (RSV acute bronchiolitis), and 480.1 (RSV pneumonia) in any diagnosis field were analyzed. Findings were weighted to produce national estimates and associations were evaluated using PROC SURVEYLOGISTIC. Results: Controlling for seasonality, Native American infants were at increased risk for RSV-attributable hospitalization compared to non-Hispanic white infants (odds ratio [OR] and 95% confidence interval [CI] 1.50 (95% CI: 1.23-1.83)). In contrast, Asian/Pacific Islander infants had a 53% reduced odds of RSV hospitalization than did white infants (OR: 0.47 (95% CI: 0.40-0.55)). No significant differences between black, Hispanic, and white infants were observed. Further control for primary payer source (e.g. Medicare, Medicaid) weakened the findings. Discussion: The odds of RSV hospitalization in 2006 were highest among Native American infants and lowest among Asian/Pacific Islander infants in this study. Partial confounding by payer type suggests that health care access likely contributes to the race/ethnic disparities observed.