Disparities in Admissions for RSV

OBJECTIVES: Respiratory viruses, including respiratory syncytial virus (RSV), result in many hospital admissions among young children. In this observational study, we sought to determine whether the odds of admission varied by race, ethnicity, and preferred language, while adjusting for disease severity and other demographic factors for children diagnosed with RSV bronchiolitis in the emergency department (ED). METHODS: We included children under 2 years of age who had a positive test for RSV in an urban freestanding children's hospital ED from 2020 to 2024. We used multivariable logistic regression to test the association between race, ethnicity, and preferred language with hospitalization and specifically ICU hospitalization, adjusting for sociodemographic factors and clinical covariates, including tachypnea, hypoxia, fever, laboratory testing, chest x-ray performance, and viral coinfection. RESULTS: A total of 2948 children were diagnosed with RSV in the ED during the study period, of which 33.8% were admitted. Decreased odds of admission were found for Black (aOR=0.53, 95% CI: 0.39-0.73) and multiracial (aOR=0.64, 95% CI: 0.47-0.87) children compared with White children. Increased odds of ICU admission were found among patients who spoke Spanish (aOR=2.00, 95% CI: 1.03-3.90) or languages other than English (aOR=2.17, 95% CI: 1.07-4.24). CONCLUSIONS: Our results revealed important disparities: Black and multiracial children with RSV had lower odds of hospital admission, while children who speak languages other than English had higher odds of ICU admission. These patterns underscore the need to better understand how clinical and structural factors shape these outcomes. Further research is essential to clarify the mechanisms driving these inequities and to advance more equitable care for all children with RSV.