RSV Risk in Older Adults With Comorbidities: A Retrospective Analysis

A retrospective cohort study aimed to evaluate the association between RSV hospitalization and the risk for future acute disease worsening in adults aged 50 years or older. This research was important because limited data are available on the long-term effect of respiratory syncytial virus (RSV) in older adults, specifically those with comorbidities.

Optum’s de-identified Clinformatics Data Mart Database (CDM) health care claims from October 2015 to June 2023 were retrospectively analyzed. Adults aged 50 years or older with 12 or more months of continuous enrollment were assigned to the following cohorts:

• RSV hospitalization (RSV cohort; n=14,759)
• Influenza hospitalization (flu cohort; n=77,468)
• No recent acute respiratory illness (ARI; control cohort; n=73,795)

The index date marked the start of the ARI episode that involved hospitalization or a diagnosis of RSV or flu according to the respective cohort. Controls were matched 5:1 with the RSV cohort.

Outcomes included acute exacerbations (AEs) of chronic obstructive pulmonary disease (COPD), AEs of asthma, and hospitalizations for heart failure (HHF). The outcomes were measured during the follow-up period and analyzed as recurrent events. AEs of COPD, AEs of asthma, and HHF risks were compared between the RSV versus flu and RSV versus control cohorts using the Andersen-Gill formulation of Cox proportional hazards models in the overall population and subgroups.

Mean cumulative event counts were highest in the RSV cohort. In adjusted analyses, adults with an RSV hospitalization had a higher risk for:

• AEs of COPD for those with COPD (hazard ratio [HR], 1.15 vs flu cohort; P<.001; HR, 2.78 vs control cohort; P<.001)
• AEs of asthma for those with asthma (HR, 1.53 vs flu cohort; P<.001; HR, 6.51 vs control cohort; P<.001)
• HFF for those with heart failure (HR, 1.08 vs flu cohort; P<.001; HR, 3.07 vs control cohort; P<.001)

“Increased risk of AE COPD, AE asthma, and HHF was observed among adults with RSV hospitalization compared to influenza hospitalization and compared to adults without a recent ARI. These findings build on previous research demonstrating the importance of RSV prevention in older and comorbid adults,” the researchers concluded.