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. 2022 Aug 15;226(Suppl 2):S154-S163.
doi: 10.1093/infdis/jiac120.

Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample

Mina Suh  1 , Naimisha Movva  1 , Xiaohui Jiang  1 , Lauren C Bylsma  1 , Heidi Reichert  1 , Jon P Fryzek  1 , Christopher B Nelson  2
Affiliations

Respiratory Syncytial Virus Is the Leading Cause of United States Infant Hospitalizations, 2009-2019: A Study of the National (Nationwide) Inpatient Sample

Mina Suh et al. J Infect Dis. .

Abstract

Background: This study describes leading causes of hospitalization, including respiratory syncytial virus (RSV), in United States infants (<1 year) from 2009 through 2019.

Methods: Within the National (Nationwide) Inpatient Sample (NIS) data, hospitalizations were determined by primary diagnosis using International Classification of Diseases, Ninth or Tenth Revision codes. RSV was defined as 079.6, 466.11, 480.1, B97.4, J12.1, J20.5, or J21.0. Bronchiolitis was defined as 466.19, J21.8, or J21.9. Leading causes overall and by sociodemographic variables were identified. The Kids' Inpatient Database (KID) was used for confirmatory analyses.

Results: Acute bronchiolitis due to RSV (code 466.11 or J21.0) was the leading primary diagnosis, accounting for 9.6% (95% confidence interval [CI], 9.4%-9.9%) and 9.3% (95% CI, 9.0%-9.6%) of total infant hospitalizations from January 2009 through September 2015 and October 2015 through December 2019, respectively; it was the leading primary diagnosis in every year accounting for >10% of total infant hospitalizations from December through March, reaching >15% in January-February. From 2009 through 2011, acute bronchiolitis due to RSV was the leading primary diagnosis in every birth month. Acute bronchiolitis due to RSV was the leading cause among all races/ethnicities, except Asian/Pacific Islanders, and all insurance payer groups. KID analyses confirmed these results.

Conclusions: Acute bronchiolitis due to RSV is the leading cause of US infant hospitalizations.

Keywords: Medicaid; RSV; bronchiolitis hospitalizations; health equity; infants; respiratory syncytial virus; respiratory syncytial virus hospitalizations.

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Conflict of interest statement

Potential conflicts of interest. M. S., N. M., X. J., L. C. B., H. R., and J. P. F. are employees of EpidStrategies. C. B. N. is an employee of Sanofi and may hold shares and/or stock options in the company. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
The leading cause of infant hospitalizations during in-season (November–March) and out-of-season (April–October) months by time period, with percentage of total infant hospitalizations and corresponding 95% confidence intervals, National (Nationwide) Inpatient Sample, 2009–2019. In-season refers to respiratory syncytial virus (RSV) seasonality. Percentage of total infant hospitalizations for acute bronchiolitis due to RSV was provided for the out-of-season months as the ninth-ranked and fourth-ranked primary diagnosis in the 2 time periods, respectively.
Figure 2.
Figure 2.
The leading cause of infant hospitalizations by year and admission month, with percentage of total infant hospitalizations, National (Nationwide) Inpatient Sample, 2009–2019. A, January 2009 to September 2015 (ICD-9 diagnosis). B, October 2015 to December 2019 (ICD-10 diagnosis). Abbreviations: ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Revision; RSV, respiratory syncytial virus.
Figure 3.
Figure 3.
The leading cause of infant hospitalizations by birth month with percentage of total infant hospitalizations and corresponding 95% confidence intervals, National (Nationwide) Inpatient Sample, 2009–2011. Percentage of total infant hospitalizations for acute bronchiolitis due to respiratory syncytial virus (RSV) was provided for April, May, and June as the second-ranked primary diagnosis during those birth months.
Figure 4.
Figure 4.
The leading cause of infant hospitalizations by chronological age in months, with percentage of total infant hospitalizations and corresponding 95% confidence intervals, National (Nationwide) Inpatient Sample, 2009–2011. Percentage of total infant hospitalizations for acute bronchiolitis due to respiratory syncytial virus (RSV) was provided for age <1 month, 9 months, 10 months, and 11 months when it was not the leading cause. Among age <1 month, acute bronchiolitis due to RSV was the ninth-ranked primary diagnosis. For ages 9, 10, and 11 months, acute bronchiolitis due to RSV was the second-ranked primary diagnosis but was not statistically different from the first-ranked primary diagnosis.
Figure 5.
Figure 5.
The leading cause of infant hospitalizations by insurance payer and time period, with percentage of total infant hospitalizations and corresponding 95% confidence intervals, National (Nationwide) Inpatient Sample, 2009–2019. Percentage of total infant hospitalizations for acute bronchiolitis due to respiratory syncytial virus (RSV) was provided for other/unknown insurance in October 2015–December 2019 and it was the second-ranked primary diagnosis.
Figure 6.
Figure 6.
The leading cause of infant hospitalizations by race/ethnicity and time period, with percentage of total infant hospitalizations and corresponding 95% confidence intervals, National (Nationwide) Inpatient Sample, 2009–2019. Percentage of total infant hospitalizations for acute bronchiolitis due to respiratory syncytial virus (RSV) was provided for Asian/Pacific Islander as it was the second-ranked primary diagnosis. Abbreviation: AI/AN, American Indian/Alaska Native.
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