Socio-Economic Inequities in the Age-Specific Burden of Severe Respiratory Syncytial Virus (RSV) in Canada, 2016-2019

Jenna Alessandrini; Brendan T Smith; Tiffany Fitzpatrick; Sarah A Buchan

doi:10.1093/infdis/jiae635

Socio-Economic Inequities in the Age-Specific Burden of Severe Respiratory Syncytial Virus (RSV) in Canada, 2016-2019

J Infect Dis. 2024 Dec 24:jiae635. doi: 10.1093/infdis/jiae635. Online ahead of print.

Authors

Jenna Alessandrini¹, Brendan T Smith^{1

2}, Tiffany Fitzpatrick^{1

2

3

4}, Sarah A Buchan^{1

2

3

4

5}

Affiliations

¹ Public Health Ontario, Toronto, ON, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ Center for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada.
⁴ ICES, Toronto, ON, Canada.
⁵ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

PMID: 39718985
DOI: 10.1093/infdis/jiae635

Abstract

Background: Socio-economic status (SES) is an important determinant of severe respiratory infections. Despite being a leading cause of hospitalization, limited attention has been given to social inequities in respiratory syncytial virus (RSV), particularly outside of childhood and beyond neighbourhood-level measures. This study aimed to quantify the burden of severe RSV disease across the age continuum by individual-level SES indicators.

Methods: We conducted a longitudinal descriptive study of Canadians (excluding Québec) ≥6 months of age using linked socio-demographic and hospitalization data from the 2016 Canadian Census Health and Environment Cohort (2016-2019). Crude and age-stratified International Classification of Diseases, 10th Revision, Canada (ICD-10-CA) coded RSV-related hospitalization rates, rate ratios (RRs), and rate differences (RDs) per 100,000 person-years were estimated across SES indicators using Poisson regression.

Results: Rates of RSV-related hospitalization were greatest among Canadians with lower compared to higher SES, as indicated through multiple measures including income (RD: 11.7 [95% confidence interval, 10.1-13.3]; RR: 2.8 [2.4-3.2]), education (RD: 18.7 [16.6-20.9]; RR: 3.3 [2.9-3.7]), and various indicators of poorer housing conditions including unaffordable housing and apartment-living. Inequities in RSV-related hospitalization varied by SES measure and age group; while rates were highest among 6-59-month- and ≥80-year-olds overall, some of the greatest relative SES inequities were among other age groups.

Conclusions: This work highlights novel individual-level social determinants influencing the burden of severe RSV disease. In addition to clinical characteristics, understanding SES factors role in age-specific RSV-related hospitalization risk is necessary to inform equitable prevention efforts, including delivery of emerging RSV immunizations.

Keywords: Canada; Respiratory syncytial virus; hospitalization; socio-economic status.