Conference Coverage

Social Risk Factors Associated With Older Adults Hospitalized For RSV-Related Illnesses

Khalel De Castro • Ashley Tippett, MPH, MLS(ASCP)cm • Christina A. Rostad, MD

In this video, Ashley Tippett, MPH, MLS(ASCP)cm, Khalel De Castro, and Christina A. Rostad, MD, speak about the social risk factors associated with older adults diagnosed with respiratory syncytial virus (RSV) who are hospitalized with RSV-related illnesses. They discuss the common risk factors for RSV-related hospitalizations in older adults, and how clinicians can use their findings to prevent RSV and RSV-related illnesses in this population. They presented on this topic during their session titled, “Social Risk Factors for RSV-related Hospitalizations in Adults ≥ 50 years of age” at IDWeek 2023 in Boston, MA.

Additional Resources: 

  • De Castro K, Tippett A, Hussaini L, et al. Social risk factors for RSV-related hospitalizations in adults ≥ 50 years of age. Talk presented at: IDWeek 2023. October 11-15. Accessed February 27, 2023.
  • Busack B, Schorr AF. Going Viral—RSV as the Neglected Adult Respiratory Virus. Pathogens. 2022;11(11):1324. doi:10.3390/pathogens11111324
  • Kaler J, Hussain A, Patel K, Hernandez T, Ray S. Respiratory Syncytial Virus: A Comprehensive Review of Transmission, Pathophysiology, and Manifestation. Cureus. Published online March 18, 2023. doi:10.7759/cureus.36342



Christina A. Rostad, MD: Hi, I am Christina Rostad. I'm a pediatric infectious disease physician and clinical investigator at Emory Children's Healthcare of Atlanta.

Khalel De Castro: Hi, I'm Khalel De Castro. I'm a clinical research coordinator here at Emory.

Ashley Tippett, MPH, MLS(ASCP)cm: My name is Ashley Tippett. I am a data manager here that conducts a lot of our data analysis.

Constultant360: Please provide an overview of your session that you presented at IDWeek 2023 titled, “Social Risk Factors for RSV-Related Hospitalizations in Adults 50 years of Age.”

Khalel De Castro: So although RSV is found to be a significant pathogen in infants, it also notably affects the elderly. And little information is known about the social risk factors for RSV in this population. So we sought to evaluate that in RSV-related hospitalizations. So our team conducted a surveillance study during the respiratory viral seasons here in Georgia. So that's from October to March of 2018 to 2020, so that's about two years. And we included hospitalized adults, 50 years old and up who were admitted with an acute respiratory infection (ARI) symptoms, could be cough, shortness of breath or if they had a diagnosis at the hospital of an ARI or if they were admitted with a [congestive heart failure] CHF or COPD exacerbation. And the participants were tested for RSV and they also participated in an interview just covering their medical history such as whether or not they have a chronic disease or immunocompromised status. And we also looked into their social history. So we looked at their behaviors such as smoking, drinking, travel, their place of residence, how many people they lived with, how active were they, were they taking care of children, questions like that. And after Ashley analyzed our data, that we collected and generated the adjusted odds ratios, we found that for adults 50 and up, the four variables that have higher odds of being at risk for RSV-associated hospitalization were women, elderly that have moderate activity and those who traveled within two weeks of before being admitted to the hospital, and elderly who were also immunocompromised.

C360: How do your findings contribute to the existing literature on this topic?

Khalel De Castro: Yeah, so some of our findings are consistent and even support the results of current papers today. Our study found that the immunocompromised participants, such as those with HIV/AIDs, had higher odds of the hospitalized RSV. And according, I actually have some articles that pulled up. So according to this 2022 RSV article by Bethany Busak, immunocompromised patients will face a higher risk for severe RSV disease and increased mortality. And that RSV/ARI was around five to 24 times more for HIV infected older adults. Another finding is looking at the elderly in those who have pulmonary disease. So in Jasndeep Kaler's 2023 RSV article, they said that there is an increase in vulnerability in illness in elderly populations, or they may be more vulnerable because of a blunted immune response. And they found that one of the most significant risk factors for RSV is those who have pulmonary disease such as COPD, which support how we define the population we want to look at for this study.

C360: For clinicians, how does understanding the social determinants of RSV-related hospitalizations help in treating patients with the disease?

Dr Rostad: I think it's important for clinicians to understand the burden of RSV disease, first of all in older adults and adults with under underlying cardiopulmonary conditions. So recent data have been published describing the burden of disease in adults greater than 60 and 65 years of age. But this study illuminates that there's a great burden of disease in adults down to 50 years of age, as well. It's underappreciated. I think this study further helps illuminate, among those older adults and those with cardiopulmonary conditions, which ones would benefit most from targeted vaccination efforts, including those who are immunocompromised and those with HIV and AIDs And so this study really helps clinicians understand who would benefit most from targeted vaccination efforts. Currently, the RSV vaccine is approved and recommended using shared clinical decision making for adults younger than 60 years of age. So this study further highlights who might benefit from RSV vaccination, even the younger adults.

C360: What other knowledge gaps exist in this area of RSV research?

Khalel De Castro: So although the majority of RSV research is geared towards children, there is also limited number of studies just focused on the social risk factors for older adults, specifically those involved behaviors such as traveling or their activity levels. And our study was limited by not assessing the risk factors for the elderly population who did get RSV, but were not hospitalized. Before we could not include that population in our study, thus not really identify groups for community-based preventative measures. And we also focus more on the behavioral risk factors than other social risk factors such as housing instability, food and income securities, violence. Certainly future studies and more research can be done to help narrow down these gaps.

Ashley Tippett: More focus on socioeconomic access to health care, availability of transportation. There's a lot of different social factors that we don't have included in this study. Specifically, that I think would be great to look into for the future.

C360: What is the overall take-home message from your presentation?

Khalel De Castro: So overall understanding the behaviors and social risk factors in elderly, especially those who are at higher risk, such as having CHF or COPD or having immunucompromised status, such as those with HIV or AIDS, is important in identifying populations who would potentially benefit from preventative measures against RSV-related hospitalizations. And we can use this information to help encourage vaccination. And although the RSV vaccine for adults is recommended for ages 60 and up, especially those who are at risk for RSV, may also benefit from getting vaccinated a little bit earlier

Ashley Tippett: Since there's not really a set treatment course for those who have RSV prevention's really where the focus is most helpful.

© 2023 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Consultant360 or HMP Global, their employees, and affiliates.