Socioeconomic Inequities in the Age-Specific Burden of Severe Respiratory Syncytial Virus in Canada, 2016-2019.

Abstract

Limited attention has been given to social inequities in respiratory syncytial virus (RSV), particularly beyond childhood and neighborhood-level measures. This study aimed to quantify the burden of severe RSV disease across the age continuum by individual-level socioeconomic status (SES) indicators. We conducted a longitudinal descriptive study of Canadians (excluding Québec) ≥6 months of age using the 2016 Canadian Census Health and Environment Cohort (2016-2019). International Classification of Diseases, 10th Revision-coded RSV-related hospitalization rates, rate ratios (RRs), and rate differences (RDs) per 100 000 person-years were estimated using Poisson regression. Rates of RSV-related hospitalization were greatest among Canadians with lower compared to higher SES, as indicated through income (RD, 11.7 [95% confidence interval {CI}, 10.1-13.3]; RR, 2.8 [95% CI, 2.4-3.2]), education (RD, 18.7 [95% CI, 16.6-20.9]; RR, 3.3 [95% CI, 2.9-3.7]), and measures of poorer housing conditions including unaffordable housing and apartment living. Inequities varied by measure and age group; while rates were highest among 6- to 59-month-olds and ≥80-year-olds overall, some of the greatest relative SES inequities were among other ages. Understanding SES factors' role in RSV-related hospitalization risk is necessary to inform equitable prevention efforts, including delivery of emerging RSV immunizations.