Asthma-related Pediatric Healthcare Utilization after Hospitalization for RSV and Other Viral Lower Respiratory Tract Infections

Background: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI) in infants. Although influenza, parainfluenza, and human metapneumovirus also contribute to LRTI-related hospitalizations, their comparative population-level healthcare burden is not well defined. This study compared population-level healthcare utilization (HCU) associated with RSV-LRTI and LRTI caused by other respiratory viruses (ORspV-LRTI). Methods: This nationwide retrospective cohort study used electronic health records from Clalit Health Services (CHS), covering more than 5 million individuals in Israel. Infants born in 2015-2023 and hospitalized before 12 months of age with PCR-confirmed viral LRTI during the RSV season were included. Acute healthcare utilization (HCU) was assessed within 30 days following hospital discharge, and long-term respiratory HCU was evaluated through 6 years of age. HCU was expressed as population-level event rates per 100 000 live births during the study period, and incidence rate ratios (IRRs) were estimated using quasi-Poisson regression. Results: < .001 for all). Elevated HCU persisted long-term, with higher rates of respiratory medication use, pediatric pulmonologist visits (94.3 vs 16.3 per 100 000; IRR 6.44), and respiratory-related hospitalizations (IRR = 5.39) through 6 years of age. These findings remained consistent in subgroups of younger children and those who experienced more severe disease during the index bronchiolitis hospitalization. Conclusions: RSV-associated LRTI in infancy is associated with substantially greater population-level HCU than LRTI caused by other respiratory viruses, both acutely and throughout early childhood, supporting prioritization of early-life RSV prevention strategies.