Risk of childhood wheeze and asthma after respiratory syncytial virus infection in full‐term infants

BACKGROUND: Most studies addressing the association between RSV and recurrent wheezing (RW) and asthma have been conducted in patients at risk for lung morbidity. Data in full-term infants are limited. METHODS: The risk of RW/asthma during the first 5 years of life in full-term infants hospitalized with RSV during the first year (Y) of life was estimated using 2010-16 data from three claims databases in USA (Truven MarketScan Commercial Claims and Encounters Database [CCAE], Truven Health MarketScan Multi-State Medicaid [MDCD], and Optum Clinformatics Extended Data Mart-Socio-Economic Status [SES]). Full-term infants with and without RSV infection and ≥ 2 years of continuous health plan enrollment from birth were included. Incidence rates of RW/asthma, cumulative incidence, adjusted incidence rate ratios (aIRR), and odds ratios (aOR) were calculated. RESULTS: During the 16-year study, 38,494 (CCAE), 62 846 (MDCD), and 23 099 (SES) matched infant pairs were included in each cohort. In the CCAE database, RW/asthma incidence/1000 patient-years (69.7 vs 28.7, aIRR: 2.4 [2.3-2.5]); cumulative incidence (17.6%-25.2% vs 5.0%-11.4%); and aOR (Y2: 4.1 [3.9-4.4]; Y3: 3.2 [3.0-3.3]; Y4: 2.9 [2.7-3.1]; Y5: 2.6 [2.5-2.9]) were higher in the RSV vs. non-RSV cohort. Results in the SES insured population were comparable, while cumulative incidence and aIRR were higher in the Medicaid population (MDCD). CONCLUSION: Although there are limitations in this study, including possible coding errors and missing covariates, we showed that full-term infants with severe RSV infection during the first year of life, spanning several respiratory seasons and a geographically diverse population, are at significant risk of RW/asthma during childhood.