1636. Prevention of respiratory syncytial virus hospitalizations (RSVH) in US infants who paid through Medicaid would have a disproportionate benefit for Black, Hispanic, Asian/Pacific Islander, Native American and Other race/ethnicity infants, and have a substantial impact on overall RSVH burden and related costs: Rates of respiratory syncytial virus hospitalization (RSVH) among US infants by race/ethnicity and insurance payer, NIS 2018-2020
Authors: Nelson Christopher B , Jiang Xiaohui , Suh Mina , Fryzek Jon 
Published: November 2023

Abstract

Background
Respiratory syncytial virus (RSV) is the leading cause of US infant hospitalization [1]. The objective of this work is to describe the rate of US infant RSV hospitalization (RSVH) and related charges by race/ethnicity and type of insurance payer.

Methods
Using the US national Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) for 2018-2020, we identified US infant RSVH and charges by RSV diagnosis in any position, race and Hispanic origin of the mother (race/ethnicity), and type of insurance payer.

Results
RSVH Rates and Burden: Rates of US infant RSVH are highest among Native American infants, are similar for White, Black, and Hispanic infants, and are lower among Other/Unknown and Asian/Pacific Islander infants. The trend of RSVH rates being higher among infants covered by Medicaid is consistent across each race/ethnicity group (Figure 1). This results in a greater proportion of the US infant RSVH burden among Black, Hispanic, Asian/Pacific Islander, Native American, and Other/Unknown infants being among infants covered by Medicaid (Figure 2). Overall, 60% of US infant RSVH is among those covered by Medicaid.
RSVH Charges: For White, Black, Native American and Other/Unknown race/ethnicity infants, mean RSVH total charges are higher for Medicaid insurance (Figure 3), despite Medicaid reimbursing at lower levels. For Hispanic and Asian/Pacific Islander race/ethnicity infants the opposite is true, charges are higher for infants with other/unknown insurance (Figure 3). This results in a greater proportion of the US infant RSVH total charges among all infants except White infants being among infants that pay with Medicaid (Figure 4). Overall, 63% of RSVH total charges is among infants that pay with Medicaid (Figure 4).

Conclusion
The prevention of RSVH in US infants covered by Medicaid would have a disproportionate benefit for Black, Hispanic, Asian/Pacific Islander, Native American and Other/Unknown race/ethnicity infants and contribute towards economic and race/ethnicity equity.
Because 60% of US infant RSVHs are covered by Medicaid accounting for 63% of RSVH total charges, the prevention of RSVH among infants who paid through Medicaid would also have a substantial impact on overall RSVH burden and related costs.

Disclosures
Christopher B. Nelson, PhD MPH, Sanofi: employee|Sanofi: employee|Sanofi: Stocks/Bonds|Sanofi: Stocks/Bonds Xiaohui Jiang, MS, Sanofi: Grant/Research Support Mina Suh, MPH, International Health, AstraZeneca: Grant/Research Support|Sanofi: Grant/Research Support|Sobi: Grant/Research Support Jon Fryzek, PhD, MPH, Sanofi: Grant/Research Support