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Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
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Chronic Conditions as Risk Factors for RSV -Associated
Hospitalization
Rebecca C. Woodruff, PhD, MPH
Epidemiologist, Centers for Disease Control and Prevention
February 29, 2024Advisory Committee on Immunization Practices Meeting
Information is needed about which chronic conditions
increase the risk of hospitalization for RSV infection.
2
Research Questions
Which chronic medical conditions are associated with higher rates of
RSV-associated hospitalization among community -dwelling adults
aged ≥50 years?
What are the rate ratios comparing RSV hospitalization rates among
community -dwelling adults aged ≥50 years with and without
chronic medical conditions?
How do the rates and rate ratios comparing RSV hospitalization rates
among community -dwelling adults aged ≥50 years with and without
chronic medical conditions vary by age group ?
3
Methods
We leveraged multiple data sources to calculate RSV -
associated hospitalization rates during the 2017 -2018 RSV
season by chronic condition and age group.
Numerator
Denominator
•RSV-Associated Hospitalization
Surveillance Network (RSV -NET)•Behavioral Risk Factor Surveillance
System (BRFSS)
•Census population counts
Methods adapted from Ko JY , Danielson ML, Town M, Derado G, Greenlund KJ, Daily Kirley P , Alden NB, Yousey -Hindes K, Anderson EJ, Ryan PA, Kim S, Lynfield R, Torres SM, Barney GR, Bennett NM, Sutton M, Talbot HK, Hill M, Hall AJ, Fry AM, Garg S, Kim L. Risk Factors for Coronaviru s
Disease 2019 (COVID -19)-Associated Hospitalization: COVID -19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System. Clin Infect Dis. 2021 Jun 1; 72(11):e695 -e703. https://doi.org/10.1093/cid/ciaa1419 5
▪RESP -NET: a population -based hospitalization
surveillance platform
▪Active, population -based surveillance of
laboratory -confirmed RSV -associated
hospitalizations
–>300 acute -care hospitals, 58 counties in 12 states
–~8.6% of U.S. population
▪Tests positive for RSV within 14 days prior to
or during hospitalization
–Clinician -driven testingRSV -Associated Hospitalization Surveillance Network
(RSV -NET)
California
Oregon
Utah
Colorado
New
MexicoMichigan
MarylandNew York
Connecticut
Tennessee
Georgia
RSV-NET surveillance areas
with percentage of state
population represented by
participating RSV -NET
counties
Minnesota
6
Behavioral Risk Factor Surveillance System
(BRFSS) Overview
•Annual telephone -based survey in the US, DC, and
select territories
•Self-reported history of select chronic conditions
•Representative of the state population
•Eligible participants:
•Civilian, community -dwelling residents
•Aged ≥18 years
7
▪Asthma
▪Chronic kidney disease (CKD)
▪Chronic obstructive pulmonary disease (COPD)
▪Coronary artery disease (CAD)
▪Current smoking
▪Diabetes mellitus
▪Obesity (body mass index 30 -39 kg/m2)
▪Severe obesity (body mass index ≥40 kg/m2)
▪StrokeWe evaluated 9 chronic medical conditions as potential risk
factors for RSV -associated hospitalization.
8
We calculated RSV -associated hospitalization rates using
the following methods.
Obtained counts of RSV -associated hospitalizations among community -dwelling
adults aged ≥50 years with and without chronic medical conditions during the 2017 -
2018 surveillance season (RSV -NET)
Obtained estimated counts of community -dwelling adults aged ≥50 years with and
without chronic medical conditions in 2018 for the 38 -county RSV -NET catchment
area
Calculated RSV-associated hospitalization rates (per 100,000 population) among
adults with and without chronic medical conditions stratified by age group (50 -64,
65-74, ≥75 years)
Applied burden multipliers to the rates to account for frequency of RSV testing
among adults hospitalized with respiratory illness and sensitivity of diagnostic tests
9
We calculated RSV -associated hospitalization rate ratios
using the following methods.
Divided the RSV -associated hospitalization rates in adults with vs. without
chronic medical conditions (ages 50 -64, 65 -74, ≥75 years)
Used Monte Carlo simulation and generalized Poisson models to estimate rate
ratios adjusted for sex and race or ethnicity group and 95% Monte Carlo
(confidence) intervals
10
Preliminary Results
Adults Aged 50 -64 Years
0100200300400500
≥40 30-39 <30
All Chronic
Kidney
DiseaseCOPD Body Mass Index
(kg/m2)Coronary
Artery
DiseaseAsthma Diabetes Current
smokerStrokeRSV-associated hospitalization rate
(per 100,000)RSV-associated hospitalization rates among community -dwelling adults aged 50-64 years with and without
chronic medical conditions, 2017 -2018 surveillance season
COPD: Chronic Obstructive Pulmonary Disease. Data are preliminary and unpublished. Rates of laboratory -confirmed RSV -associated hospitalization account for under -detection of RSV infection among hospitalized adults and sensitivity of diagnostic tests;
rates exclude residents of nursing homes and long -term care facilities and are not adjusted for sex or race/ethnicity group. Adj usted rate ratios are derived from generalized Poisson models using Monte Carlo simulation methods and adjust for sex and rac e
and ethnicity group. 7.9
(4.7–13.8)
5.8
(3.7–9.3)
3.3
(2.1–5.1)3.7
(2.4–5.7) 2.8
(1.9–4.1)2.4
(1.4–4.0)4.2
(2.5–7.1)
1.5
(1.0–2.3)1.4
(0.7–2.8)Adjusted rate ratio:
12
Adults Aged 50 -64 Years
0100200300400500
≥40 30-39 <30
All Chronic
Kidney
DiseaseCOPD Body Mass Index
(kg/m2)Coronary
Artery
DiseaseAsthma Diabetes Current
smokerStrokeRSV-associated hospitalization rate
(per 100,000)RSV-associated hospitalization rates among community -dwelling adults aged 50-64 years with and without
chronic medical conditions, 2017 -2018 surveillance season
COPD: Chronic Obstructive Pulmonary Disease. Data are preliminary and unpublished. Rates of laboratory -confirmed RSV -associated hospitalization account for under -detection of RSV infection among hospitalized adults and sensitivity of diagnostic tests;
rates exclude residents of nursing homes and long -term care facilities and are not adjusted for sex or race/ethnicity group. All adults
≥75 years
13
Adults Aged 65 -74 Years
0100200300400500600700800
≥40 30-39 <30
All Chronic
Kidney
DiseaseBody Mass Index
(kg/m2)COPD Asthma Current
smokerCoronary
Artery
DiseaseDiabetes StrokeRSV-associated hospitalization rate
(per 100,000)RSV-associated hospitalization rates among community -dwelling adults aged 6 5-74 years with and without
chronic medical conditions, 2017 -2018 surveillance season
6.1
(3.7–10.7)
4.2
(2.7–6.7)3.3
(2.0–5.9)2.5
(1.6–4.2)2.2
(1.5–3.3)4.5
(2.3–8.8)
1.5
(1.0–2.4)2.3
(1.4–3.8) 1.6
(0.8–3.0)Adjusted rate ratio:
COPD: Chronic Obstructive Pulmonary Disease. Data are preliminary and unpublished. Rates of laboratory -confirmed RSV -associated hospitalization account for under -detection of RSV infection among hospitalized adults and sensitivity of diagnostic tests;
rates exclude residents of nursing homes and long -term care facilities and are not adjusted for sex or race/ethnicity group. Adj usted rate ratios are derived from generalized Poisson models using Monte Carlo simulation methods and adjust for sex and rac e
and ethnicity group.
14
Adults Aged 65 -74 Years
0100200300400500600700800
≥40 30-39 <30
All Chronic
Kidney
DiseaseBody Mass Index
(kg/m2)COPD Asthma Current
smokerCoronary
Artery
DiseaseDiabetes StrokeRSV-associated hospitalization rate
(per 100,000)RSV-associated hospitalization rates among community -dwelling adults aged 6 5-74 years with and without
chronic medical conditions, 2017 -2018 surveillance season
COPD: Chronic Obstructive Pulmonary Disease. Data are preliminary and unpublished. Rates of laboratory -confirmed RSV -associated hospitalization account for under -detection of RSV infection among hospitalized adults and sensitivity of diagnostic tests;
rates exclude residents of nursing homes and long -term care facilities and are not adjusted for sex or race/ethnicity group. All adults
≥75 years
15
Adults Aged ≥75 Years
0200400600800100012001400160018002000
≥40 30-39 <30
All Chronic
Kidney
DiseaseBody Mass Index
(kg/m2)COPD Asthma Coronary
Artery
DiseaseDiabetes Stroke Current
smokerRSV-associated hospitalization rate
(per 100,000)0.9
(0.4–2.2)1.9
(1.2–2.9)RSV-associated hospitalization rates among community -dwelling adults aged ≥75 years with and without
chronic medical conditions, 2017 -2018 surveillance season
6.1
(3.6–12.6)
4.2
(2.7–6.6) 2.9
(1.5–6.2)2.9
(1.3–6.7)
1.1
(0.7–1.7)1.6
(1.0–2.6)1.5
(0.8–3.1)Adjusted rate ratio:
COPD: Chronic Obstructive Pulmonary Disease. Data are preliminary and unpublished. Rates of laboratory -confirmed RSV -associated hospitalization account for under -detection of RSV infection among hospitalized adults and sensitivity of diagnostic tests;
rates exclude residents of nursing homes and long -term care facilities and are not adjusted for sex or race/ethnicity group. Adj usted rate ratios are derived from generalized Poisson models using Monte Carlo simulation methods and adjust for sex and rac e
and ethnicity group.
16
RSV -Associated Hospitalization Rates by Chronic Condition
and Age Group
02004006008001000120014001600
50-64
65-74
≥75
50-64
65-74
≥75
50-64
65-74
≥75
50-64
65-74
≥75
50-64
65-74
≥75
50-64
65-74
≥75
50-64
65-74
≥75
50-64
65-74
≥75
50-64
65-74
≥75
50-64
65-74
≥75
All adults Chronic
Kidney
DiseaseCOPD Severe
obesity
(BMI ≥40)Asthma Coronary
Artery
DiseaseDiabetes
mellitusStroke Obesity
(BMI 30-
39)Current
smokerRSV-associated hospitalization rate
(per 100,000)RSV-associated hospitalization rates among community -dwelling adults aged ≥50 years with chronic medical
conditions, 2017 -2018 season
COPD: Chronic Obstructive Pulmonary Disease. Data are preliminary and unpublished. Rates of laboratory -confirmed RSV -associated hospitalization account for under -detection of RSV infection among hospitalized adults and sensitivity of diagnostic tests;
rates exclude residents of nursing homes and long -term care facilities and are not adjusted for sex or race/ethnicity group.
17
Adjusted Rate Ratios for RSV -Associated Hospitalization
by Chronic Condition among Adults Aged ≥50 Years
6.5
4.6
3.12.8
2.42.0 1.91.51.1
0.11.010.0100.0
Chronic
Kidney
DiseaseCOPD Asthma Severe
obesityCoronary
Artery
DiseaseDiabetes
mellitusCurrent
smokerStroke ObesityaRR
COPD: Chronic Obstructive Pulmonary Disease. Data are preliminary and unpublished. Adjusted rate ratios are derived from gene ralized Poisson models using Monte Carlo simulation methods and adjust for sex and race and ethnicity group. 18
RSV -Associated Hospitalization Rates by
Combinations of Chronic Conditions
By Number of Chronic Conditions
02004006008001000
50-64
years65-74
years≥75
yearsRSV-associated hospitalization rate
(per 100,000)RSV-associated hospitalization rates* among community -dwelling adults aged ≥50 years by
number of chronic conditions and age group, 2017 -2018 season
10.6
(6.3–18.6)6.4
(3.7–11.2)
2.9
(1.7–5.1)2.6
(1.4–4.9)2.6
(1.4–4.7)12.4
(7.8–20.2)Adjusted rate ratio:
* Data are preliminary and unpublished. Rates of laboratory -confirmed RSV -associated hospitalization account for under -detection o f RSV infection among hospitalized adults and sensitivity of diagnostic tests; rates exclude residents of nursing homes and
long -term care facilities and are not adjusted for sex or race/ethnicity group. Adjusted rate ratios are derived from generalize d Poisson models using Monte Carlo simulation methods and adjust for sex and race and ethnicity group.
20
By Chronic Kidney Disease & Coronary Artery Disease
0200400600800100012001400160018002000
50-64
years65-74
years≥75
yearsRSV-associated hospitalization rate
(per 100,000)RSV-associated hospitalization rates* among community -dwelling adults aged ≥50 years by
chronic kidney disease (CKD), coronary artery disease (CAD), and age group, 2017 -2018 season
15.7
(6.8–37.7)
7.3
(3.8–13.9)
3.1
(1.6–5.5)10.5
(4.8–23.3)
5.7
(3.0–11.2)
2.1
(1.1–4.0)7.9
(3.5–17.6)
6.3
(3.4–13.4)
1.7
(0.9–3.2)Adjusted rate ratio:
* Data are preliminary and unpublished. Rates of laboratory -confirmed RSV -associated hospitalization account for under -detection o f RSV infection among hospitalized adults and sensitivity of diagnostic tests; rates exclude residents of nursing homes and
long -term care facilities and are not adjusted for sex or race/ethnicity group. Adjusted rate ratios are derived from generalize d Poisson models using Monte Carlo simulation methods and adjust for sex and race and ethnicity group.
21
By Chronic Kidney Disease & Diabetes
0200400600800100012001400160018002000
50-64
years65-74
years≥75
yearsRSV-associated hospitalization rate
(per 100,000)RSV-associated hospitalization rates* among community -dwelling adults aged ≥50 years by
chronic kidney disease (CKD), diabetes, and age group, 2017 -2018 season
12.8
(6.1–27.7)
7.3
(3.4–16.4)
2.3
(1.3–3.8)9.0
(4.6–18.7)
6.0
(2.6–13.7)
1.7
(1.0–3.0)5.8
(2.7–13.1)
7.4
(4.0–14.9)
1.4
(0.8–2.7)Adjusted rate ratio:
* Data are preliminary and unpublished. Rates of laboratory -confirmed RSV -associated hospitalization account for under -detection of RSV infection among hospitalized adults and sensitivity of diagnostic tests; rates exclude residents of n ursing homes and
long -term care facilities and are not adjusted for sex or race/ethnicity group. Adjusted rate ratios are derived from generalize d Poisson models using Monte Carlo simulation methods and adjust for sex and race and ethnicity group.
22
▪Denominator data were created based on self -reported history of chronic conditions
from BRFSS
–~49.9% response rate in 2018
–Subject to recall & social desirability biases
▪BRFSS might underestimate true prevalence of select chronic medical conditions, which
would drive the rates and rate ratios upwards
▪Could not assess all chronic medical conditions or potential risk factors of interest
–Heart failure
–End-stage renal disease
–Immunocompromise
▪Results do not necessarily generalize to non -community -dwelling adults (e.g., residents
of nursing homes, long -term care facilities, shelters, treatment facilities, or correctional
institutions)Limitations
23
Select chronic medical
conditions were associated
with higher rates of RSV -
associated hospitalization
among community -dwelling
adults, which varied by
condition and age group.
24
Acknowledgements
Centers for Disease Control and Prevention
Coronavirus and Other Respiratory Viruses Division
•Gordana Derado, PhD
•Sarah Hamid, PhD
•Fiona P . Havers, MD
•Michael Melgar, MD
•Huong Pham, MPH
•Christopher A. Taylor, PhD
Division for Heart Disease and Stroke Prevention
•Fleetwood V. Loustalot, PhD
•Elizabeth Lundeen, PhD
•Ahlia Sekkarie, PhD
RSV-Associated Hospitalization Surveillance Network (RSV -NET) Site
Investigators, Surveillance Officers, and Staff 25
For more information, contact CDC
1-800 -CDC -INFO (232 -4636)
TTY: 1 -888 -232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.