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.

Rates of Influenza-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death by Race and Ethnicity in the United States From 2009 to 2019

“…Notably, differences in rates of hospitalization, ICU admission, and in-hospital deaths by race and ethnicity Across all age groups, we found that Black persons had the highest rates of hospitalization and ICU admission, followed by American Indian or Alaska Native persons and Hispanic persons. Our findings are similar to prior studies that have identified disparities in influenza-associated hospitalizations in children during 2002 through 2009 using data from the New Vaccine Surveillance Network, 20 and across all ages in 2 separate FluSurv-NET analyses. 12,13 In one FluSurv-NET analysis that examined hospitalization rates by race and ethnicity and census-tract poverty level during 2010 to 2012, 12 age-adjusted hospitalization rates were highest for Black persons; within each race and ethnicity group, hospitalization rates within high-poverty census tracts were nearly 2-fold the rates in low-poverty census tracts.…”

Rates of Influenza-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death by Race and Ethnicity in the United States From 2009 to 2019

“…Notably, differences in rates of hospitalization, ICU admission, and in-hospital deaths by race and ethnicity Across all age groups, we found that Black persons had the highest rates of hospitalization and ICU admission, followed by American Indian or Alaska Native persons and Hispanic persons. Our findings are similar to prior studies that have identified disparities in influenza-associated hospitalizations in children during 2002 through 2009 using data from the New Vaccine Surveillance Network, 20 and across all ages in 2 separate FluSurv-NET analyses. 12,13 In one FluSurv-NET analysis that examined hospitalization rates by race and ethnicity and census-tract poverty level during 2010 to 2012, 12 age-adjusted hospitalization rates were highest for Black persons; within each race and ethnicity group, hospitalization rates within high-poverty census tracts were nearly 2-fold the rates in low-poverty census tracts.…”

Estimated Burden of Community-Onset Respiratory Syncytial Virus–Associated Hospitalizations Among Children Aged <2 Years in the United States, 2014–15

“…A limitation to this comparison is that the above-mentioned influenza data are from 2003 to 2012, whereas the RSV data are from the 2014-15 season. Despite this limitation, a number of other studies have found RSV to have a higher incidence among children aged <5 years compared with influenza [4,8,24,26,29,30]. Our findings reaffirm that among young children in the United States, RSV represents a major cause of respiratory disease-associated hospitalizations.…”

Respiratory Syncytial Virus–Associated Hospitalizations Among Young Children: 2015–2016

“…In considering other characteristics previously associated with severe RSV disease, such as male sex, race, underlying medical conditions, and environmental factors (including exposure to smoking and contact with other children), [27][28][29][30][31][32][33][34][35] we found higher RSV-associated hospitalization rates among male children, NH African American children, and Hispanic or Latino children that were statistically significant but small in magnitude. Although higher rates of RSV hospitalization in $12-month-old Nashville, and Cincinnati) over multiple years, analyses of Hispanic or Latino children were not possible in those studies because of low numbers.…”

Rates of Influenza-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death by Race and Ethnicity in the United States From 2009 to 2019

“…Notably, differences in rates of hospitalization, ICU admission, and in-hospital deaths by race and ethnicity Across all age groups, we found that Black persons had the highest rates of hospitalization and ICU admission, followed by American Indian or Alaska Native persons and Hispanic persons. Our findings are similar to prior studies that have identified disparities in influenza-associated hospitalizations in children during 2002 through 2009 using data from the New Vaccine Surveillance Network, 20 and across all ages in 2 separate FluSurv-NET analyses. 12,13 In one FluSurv-NET analysis that examined hospitalization rates by race and ethnicity and census-tract poverty level during 2010 to 2012, 12 age-adjusted hospitalization rates were highest for Black persons; within each race and ethnicity group, hospitalization rates within high-poverty census tracts were nearly 2-fold the rates in low-poverty census tracts.…”

Estimated Burden of Community-Onset Respiratory Syncytial Virus–Associated Hospitalizations Among Children Aged &lt;2 Years in the United States, 2014–15

“…A limitation to this comparison is that the above-mentioned influenza data are from 2003 to 2012, whereas the RSV data are from the 2014-15 season. Despite this limitation, a number of other studies have found RSV to have a higher incidence among children aged <5 years compared with influenza [4,8,24,26,29,30]. Our findings reaffirm that among young children in the United States, RSV represents a major cause of respiratory disease-associated hospitalizations.…”

Respiratory Syncytial Virus–Associated Hospitalizations Among Young Children: 2015–2016

“…In considering other characteristics previously associated with severe RSV disease, such as male sex, race, underlying medical conditions, and environmental factors (including exposure to smoking and contact with other children), [27][28][29][30][31][32][33][34][35] we found higher RSV-associated hospitalization rates among male children, NH African American children, and Hispanic or Latino children that were statistically significant but small in magnitude. Although higher rates of RSV hospitalization in $12-month-old Nashville, and Cincinnati) over multiple years, analyses of Hispanic or Latino children were not possible in those studies because of low numbers.…”

Rates of Influenza-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death by Race and Ethnicity in the United States From 2009 to 2019

“…Notably, differences in rates of hospitalization, ICU admission, and in-hospital deaths by race and ethnicity Across all age groups, we found that Black persons had the highest rates of hospitalization and ICU admission, followed by American Indian or Alaska Native persons and Hispanic persons. Our findings are similar to prior studies that have identified disparities in influenza-associated hospitalizations in children during 2002 through 2009 using data from the New Vaccine Surveillance Network, 20 and across all ages in 2 separate FluSurv-NET analyses. 12,13 In one FluSurv-NET analysis that examined hospitalization rates by race and ethnicity and census-tract poverty level during 2010 to 2012, 12 age-adjusted hospitalization rates were highest for Black persons; within each race and ethnicity group, hospitalization rates within high-poverty census tracts were nearly 2-fold the rates in low-poverty census tracts.…”

Estimated Burden of Community-Onset Respiratory Syncytial Virus–Associated Hospitalizations Among Children Aged &lt;2 Years in the United States, 2014–15

“…A limitation to this comparison is that the above-mentioned influenza data are from 2003 to 2012, whereas the RSV data are from the 2014-15 season. Despite this limitation, a number of other studies have found RSV to have a higher incidence among children aged <5 years compared with influenza [4,8,24,26,29,30]. Our findings reaffirm that among young children in the United States, RSV represents a major cause of respiratory disease-associated hospitalizations.…”

Respiratory Syncytial Virus–Associated Hospitalizations Among Young Children: 2015–2016

“…In considering other characteristics previously associated with severe RSV disease, such as male sex, race, underlying medical conditions, and environmental factors (including exposure to smoking and contact with other children), [27][28][29][30][31][32][33][34][35] we found higher RSV-associated hospitalization rates among male children, NH African American children, and Hispanic or Latino children that were statistically significant but small in magnitude. Although higher rates of RSV hospitalization in $12-month-old Nashville, and Cincinnati) over multiple years, analyses of Hispanic or Latino children were not possible in those studies because of low numbers.…”