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Increasing social vulnerability is linked to RSV hospitalization, influenced by socioeconomic status, household composition, minority status, and housing type.
“For vaccine and other mitigation efforts to be most effective at preventing RSV-associated morbidity and mortality, identifying which communities are at highest risk for severe illnesses is important,” Christine Thomas, DO, MPH, and colleagues wrote in a study published in Open Forum Infectious Diseases. “Prior experiences with influenza and COVID-19 have shown that social determinants of health, including socioeconomic status and race, are frequently associated with greater burden of illness. Similarly, prior studies have suggested that RSV hospitalizations might be associated with social factors, such as socioeconomic status and crowding; studies have also identified racial disparities, with Black, American Indian, and Alaskan Native communities disproportionately affected.”
For the study, the researchers set out to identify social factors related to the burden of RSV-related hospitalizations in eight counties in Tennessee. Dr. Thomas spoke with Physician’s Weekly (PW) about how social vulnerability relates to RSV hospitalization.
Why was it important to study how social vulnerability impacts the risk for RSV hospitalization?
During the COVID-19 pandemic, we had a heightened appreciation for how structural and societal factors play a role in disease burden and its related impacts in all their wide breadth. Of course,infectious none of this is new. There have always been populations that are differentially impacted by disease, but as a society, we’ve become more aware of these differences. We wanted to take that to RSV, which is a separate infection but has a lot of similarities, too. We knew that immunoprophylaxis and vaccines were coming quickly when we designed this study. We wanted to look and say, “Here in Tennessee, what populations are being disproportionately impacted?” If we understand more about when things become available to help us prevent RSV impacts, then we can use this information in our prevention efforts.
How did you carry out your study?
We leveraged existing systems of data collection for this project. In Tennessee, our health department participates in the Emerging Infections Program through collaboration with Vanderbilt University. As part of that, we do RSV hospitalization surveillance in eight counties, which provides robust data for those counties and gives us an idea of what’s happening in the population. We took that Tennessee data and then pulled from other platforms: Census Bureau data and the American Community Survey, which also lines up with census data. All of these have different components of data, whether it’s demographics or social vulnerability measures. However, they all use this census tract as their basis for population. We can overlay everything to get the factors that we need.
What questions did you want to ask?
The questions we wanted to answer were basically: Who is being hospitalized with RSV? We already had an idea that older adults tended to be the ones who are more often hospitalized. But within that, are people of a certain race hospitalized more frequently? Or people with a certain insurance status, such as public or private insurance? And then this idea of where people live and the social and structural surroundings that they’re in. Does that play a role in who’s being hospitalized or not? We essentially just matched people. We know this person was hospitalized and that this was their address. We matched where they lived in a census tract to what proportion of people in that census tract was White or Black, had public or private insurance, or the social vulnerability level of that census tract. Matching that gave us an idea of which characteristics or which populations were being hospitalized at higher rates than the others.
What did you learn from this approach?
The number one thing that we learned is that increasing social vulnerability is associated with RSV hospitalizations. Notably, this trend occurred across all four sub-themes of social vulnerability that we examined: socioeconomic status, household composition, minority status, and housing type. We saw hospitalization increasing with increases in all four of them. That tells me it’s not just one social factor or one structural thing associated with RSV hospitalizations but a constellation of factors that can surround people and be part of communities.
In addition to the census tract level measure and the more community population measure, is the individual levels: Black race, Hispanic ethnicity, and public health insurance. Those are the variables we took at the individual level.
What is important for clinicians to know about your findings?
Like in many other diseases, social vulnerability is associated with adverse health outcomes in RSV. In this case, hospitalization and ICU admission were severe markers of infection. We also need to be aware that this understanding is just the beginning. Unfortunately, it’s probably not surprising to many clinicians that social vulnerability is yet again linked to adverse health outcomes. But then, what’s our next step? What strategies do we need to take to mitigate RSV burden and impacts? We know what communities might be disproportionately impacted. How, then, do we address the barriers they face to get them the tools they need to protect themselves?
How do these factors impact the management of RSV?
Our paper wasn’t looking at interventions to say, “This works, or this doesn’t work.” It is a basic analysis of where we’re seeing the problem. We thought about what we found and compared it to similar respiratory viruses, namely COVID-19, which raises the question of whether this is a place where mobile vaccine clinics could be helpful to get into certain areas. I’m a big believer in community engagement and understanding what is needed. We need to ask, what are the barriers and how do we overcome them? I would love to see people think about how to meet communities where they are and to bring them the resources that they need. Ask, “What is going to be helpful?”
