Insurance Status and the Risk of Severe Respiratory Syncytial Virus Disease in United States Preterm Infants Born at 32-35 Weeks Gestational Age
Insurance Status and the Risk of Severe Respiratory Syncytial Virus Disease in United States Preterm Infants Born at 32-35 Weeks Gestational Age
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DOI：
10.1093/ofid/ofw163
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发表时间：
2016-06-01
影响因子：
4.2
通讯作者：
Simoes, Eric A. F.
中科院分区：
文献类型：
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作者：
Franklin, Jeremy A.;Anderson, Evan J.;Simoes, Eric A. F.
背景。数据库研究已经确定，公共健康保险状况与美国婴儿严重呼吸道合胞病毒（RSV）疾病风险增加有关。然而，这些研究并没有调整其他危险因素的存在，也没有评估早产儿的风险。在本研究中，我们评估了公共保险与严重RSV疾病结局之间的独立关联，并调整了其他危险因素。这项前瞻性、观察性的早产儿RSV呼吸事件结局和风险追踪（REPORT）研究在188个美国临床站点连续2个RSV季节进行，纳入了32-35 wGA出生、未接受帕利珠单抗RSV免疫预防的早产儿。在RSV高发季节（11月至3月），对私立和公立保险的婴儿进行RSV相关终点的门诊下呼吸道感染（LRI）、急诊（ED）就诊、RSV住院（RSVHs）和重症监护病房入院的调整发病率每100个婴儿季进行比较。在参与报告研究的1642名可评估婴儿中，50.1%拥有私人医疗保险，49.9%拥有公共医疗保险。RSV门诊LRIs的调整率相似；然而，公共保险受试者的急诊科就诊率（风险比[HR]， 2.04； 95%可信区间[CI]， 1.20-3.45）更高，住院率也有类似但不显著的趋势（风险比，1.61;95% CI, 0.93 -2.78）。通过公共医疗保险和私人医疗保险评估，社会经济地位是美国早产儿使用ED的重要独立风险因素，并可能导致该人群rsvh增加。
Background. Database studies have identified that public health insurance status is associated with an increased risk of severe respiratory syncytial virus (RSV) disease in US infants. However, these studies did not adjust for the presence of other risk factors and did not evaluate the risk in preterm infants.Methods. In this study, we evaluate the independent association between public insurance and severe RSV disease outcomes adjusting for other risk factors. The prospective, observational RSV Respiratory Events among Preterm Infants Outcomes and Risk Tracking (REPORT) study was conducted over 2 consecutive RSV seasons at 188 US clinical sites that enrolled preterm infants born at 32-35 wGA who had not received RSV immunoprophylaxis with palivizumab. Adjusted incidence rates per 100 infantseasons of the RSV-associated endpoints of outpatient lower respiratory tract infection (LRI), emergency department (ED) visits, RSV hospitalizations (RSVHs), and intensive care unit admissions during peak RSV season (November-March) were compared for infants with private and public insurance.Results. Of 1642 evaluable infants enrolled in the REPORT study, 50.1% had private insurance and 49.9% had public health insurance. Adjusted rates of RSV outpatient LRIs were similar; however, rates of ED visits (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.20-3.45) were higher for subjects with public insurance, with a similar but nonsignificant trend observed for hospitalization (HR, 1.61; 95% CI, .93-2.78).Conclusions. Socioeconomic status, as evaluated by public versus private healthcare insurance, is a significant independent risk factor for ED use in US preterm infants and may contribute to increased RSVHs in this population.