Neighbourhood-level burden of social risk factors on respiratory syncytial virus hospitalization in Ontario, Canada, 2016-2019

Abstract

Introduction: Beyond clinical risk factors, little is known about the impact of social determinants on respiratory syncytial virus (RSV) burden. Our study aimed to estimate RSV-related hospitalization rates across sociodemographic and housing characteristics. Methods: We conducted a population-based study of all RSV-related hospitalizations in Ontario, Canada between September 1, 2016 and August 31, 2019 using validated hospital discharge codes and census data. Crude and age-standardized annualized RSV incidence rates and rate ratios (RR) were estimated for a range of individual-level demographics and neighbourhood-level measures of marginalization and housing characteristics. Results: Overall, the annual RSV-related hospitalization rate was 27 per 100,000, with the highest rates observed in children <12 months (1049 per 100,000) and 12-23 months (294 per 100,000), and adults ≥85 years (155 per 100,000). Higher RSV-related hospitalization rates were associated with increasing marginalization quintile (Q) of material resources (RR: 1.4; Q5: 33 per 100,000 versus Q1: 24 per 100,000) and household instability (RR: 1.5; Q5: 31 per 100,000 versus Q1: 22 per 100,000). Conclusion: The burden of RSV-related hospitalization was greatest in young children and older adults, with variation by sociodemographic and housing factors. Understanding the role of these social factors is crucial for informing equitable preventive program delivery.