Disparities Between Black and White Children in Hospitalizations Associated With Acute Respiratory Illness and Laboratory-confirmed Influenza and Respiratory Syncytial Virus in 3 US Counties--2002-2009

Abstract

Few US studies have assessed racial disparities in viral respiratory hospitalizations among children. This study enrolled black and white children under 5 years of age who were hospitalized for acute respiratory illness (ARI) in 3 US counties during October-May 2002-2009. Population-based rates of hospitalization were calculated by race for ARI and laboratory-confirmed influenza and respiratory syncytial virus (RSV), using US Census denominators. Relative rates of hospitalization between racial groups were estimated. Of 1,415 hospitalized black children and 1,824 hospitalized white children with ARI enrolled in the study, 108 (8%) black children and 111 (6%) white children had influenza and 230 (19%) black children and 441 (29%) white children had RSV. Hospitalization rates were higher among black children than among white children for ARI (relative rate (RR) = 1.7, 95% confidence interval (CI): 1.6, 1.8) and influenza (RR = 2.1, 95% CI: 1.6, 2.9). For RSV, rates were similar among black and white children under age 12 months but higher for black children aged 12 months or more (for ages 12-23 months, RR = 1.7, 95% CI: 1.1, 2.5; for ages 24-59 months, RR = 2.2, 95% CI: 1.3, 3.6). Black children versus white children were significantly more likely to have public insurance or no insurance (85% vs. 43%) and a history of asthma/wheezing (28% vs. 18%) but not more severe illness. The observed racial disparities require further study.

Hospitalizations for Severe Lower Respiratory Tract Infections

“…7,19 We found that 1 underlying medical condition more than doubled the risk for severe LRTI compared with no conditions, and There are several limitations that may affect our conclusions. First, all data are from administrative records, and coding practices could affect our results.…”

“…2 In high-income countries, 3% to 18% of pediatric admissions to the hospital are due to LRTI, 3,4 and among pediatric LRTI hospitalizations, 3% to 14% have been reported to require admission to an ICU. [5][6][7][8][9] Data on rates of pediatric hospitalizations for severe LRTI, including those requiring specialized care, such as ICU or mechanical ventilation, are limited. Such information might be useful for public health emergency planning for pandemics and other emerging respiratory infections, such as Middle East respiratory syndrome coronavirus.…”

Respiratory Syncytial Virus–Associated Hospitalizations Among Children Less Than 24 Months of Age

“…12,30 However, palivizumab's effect on our overall rates of RSV hospitalization was unlikely to be appreciable, because only a small proportion (,5%) of our study population was eligible for palivizumab, and its use was variable (30% to 70%) during most study years. 30 Day care attendance has also been described as a risk factor for RSV infection, 12 although inconsistently 7,22 ; the current work is limited by not analyzing this variable.…”

“…21,22 For RSV infection, information is limited, but the reported severity of disease among black versus white children has been variable and inconclusive. 14,22,23 The rates of RSV hospitalization among black children ,24 months old or ,6 months old were not significantly different from those for white children. However, after 6 months of age, black children were hospitalized nearly twice as often.…”

“…We found no differences in RSV hospitalization rates by gender in this study or in previous work. 7,22 The reported proportions of children with chronic conditions hospitalized with RSV have ranged widely, possibly reflecting the variable underlying populations and study designs. 6,15,17,24 Stockman et al 6 recently found that 12% of RSV-hospitalized children ,12 months old and 2.4% of those 12 to 23 months old had heart disease, chronic neonatal respiratory distress, or prematurity, as determined by RSV ICD-9-CMcoded discharge diagnoses.…”