Long-term Pediatric Healthcare Utilization After Hospitalization for Acute RSV Infection: A Nationwide Retrospective Study

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Abstract Background: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTI) and hospitalizations in infants and children under 1 year of age. Beyond its acute effects, RSV was linked to long-term respiratory morbidity in early childhood. This study compares long-term healthcare utilization (LT-HCU) in children following hospitalization for RSV-related LRTI (H-RSV-LRTI) versus hospitalization for non-RSV, and non-LRTI conditions (H-NRSV-NLRTI). Methods: This population-based retrospective study used nationwide healthcare database records from Clalit-Health-Services, Israel's largest health medical organization. All patient data was de-identified, and ethical approval was obtained.The study evaluated respiratory-related HCU over 6 years following hospitalization and determined as LT-HCU. Cases definition: infants aged <12 months, admitted during the RSV season (November 1st-March 31st) with LRTI, identified by ICD-9 codes, and confirmed positive for RSV via PCR. Controls were infants admitted during the same period with non-respiratory symptoms and a negative RSV-PCR test. The statistical analysis involved matching cohorts in a 1:3 ratio based on the propensity scores of the following variables: age at hospitalization, gender, ethnicity, birth weight, prematurity, and mode of delivery. Subsequently, descriptive statistics were performed, followed by Poisson regression analyses. Results: A total of 31,425 patients were enrolled in the study. After matching 3,754 were included in the H-RSV-LRTI group vs 11,262 in the H-NRSV-NLRTI group. The incidence rate ratios (IRR) were higher in the H-RSV-LRTI group vs. the H-NRSV-NLRTI group for anti-asthma medications use in the 6 years following hospitalization including inhaled corticosteroids (IRR=1.32, CI 5%-95%=1.22-1.43, Pv<0.001), and short-acting inhaled beta-agonists (IRR=1.4, CI=1.3-1.51, Pv<0.001). The average number of pulmonologist visits per patient, emergency room visits for respiratory symptoms per patient, and hospital admissions for respiratory symptoms per patient were higher by 37% (CI=1.22-1.54, Pv<0.001), 55% (CI=1.45-1.66, Pv<0.001), and 55% (CI=1.39-1.73, Pv<0.001), respectively, in the H-RSV-LRTI group vs. the H-NRSV-NLRTI (Figure). Conclusions: Respiratory-related LT-HCU, including medication use, specialist visits, and hospital visits, were significantly higher in the H-RSV-LRTI group compared to the H-NRSV-NLRTI in hospitalized infants < 1 year of age. This suggests a potential association between early childhood RSV infection and long-term pulmonary morbidity. Figure: Incidence rate ratios (IRR) of LT-HCU in the H-RSV-LRTI group compared to the H-NRSV-NLRTI group

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