Respiratory Syncytial Virus Hospitalizations Associated with Social Vulnerability by Census Tract: An Opportunity for Intervention?

Respiratory syncytial virus (RSV) can cause hospitalization in young children and older adults. With vaccines and monoclonal antibody prophylaxis increasingly available, identifying social factors associated with severe illnesses can guide mitigation efforts. Using data collected by the RSV Hospitalization Surveillance Network during 2016–2023, we identified RSV hospitalizations in Tennessee. We linked hospitalization information (e.g., patient demographic characteristics and outcome) with population-level variables (e.g., social vulnerability and healthcare insurance coverage) from publicly available datasets using census tract of residence. Hospitalization incidence was calculated and stratified by period (2016–2020 and 2020–2023). We modeled social vulnerability effect on hospitalization incidence using Poisson regression. Among 2,687 RSV hospitalizations, 677 (25.2%) included intensive care unit admission and 38 (1.4%) deaths. Highest RSV hospitalization incidences occurred among children aged <5 years and adults aged ≥65 years (272.8/100,000 person-years [95% CI: 258.6–287.0] and 60.6/100,000 person-years [95% CI: 56.0–65.2], respectively). Having public health insurance was associated with higher hospitalization incidence, compared with not having public insurance (60.5/100,000 person-years [95% CI: 57.6–63.4] vs 14.3/100,000 person-years [95% CI: 13.4–15.2]). Higher hospitalization incidence was associated with residing in a census tract in the most socially vulnerable quartile, compared with least vulnerable quartile after adjusting for age, sex, and period (IRR = 1.4 [95% CI: 1.3–1.6]). RSV hospitalization was associated with living in more socially vulnerable census tracts. Population measures of social vulnerability might help guide mitigation strategies, including vaccine and monoclonal antibody promotion and provision to reduce RSV hospitalization.