Comparisons between ethnic groups in hospitalizations for respiratory syncytial virus bronchiolitis in Israel

Background
Ethnic disparities have been shown in respiratory syncytial virus (RSV) bronchiolitis. However, it is unclear whether such differences are related to access to care. We compared demographic and clinical characteristics of Arab and Jewish children hospitalized for RSV bronchiolitis in Israel, a country with universal health insurance.
Methods
We reviewed the medical records of all children (n = 309) aged less than 24 months who were hospitalized with RSV between 2008 and 2011 in one medical center in Israel. Demographic, clinical, laboratory and radiological data were collected. The RSV antigen was identified using immunochromatography.
Results
The annual incidence of RSV hospitalization was 5.4/1000 and 6.8/1000 among Arab and Jewish children, respectively. Arab patients were significantly younger and had significantly younger parents; most lived in low socioeconomic status towns (93.7% vs. 13.3%; p<0.001) and had more siblings (median 2 vs. 1; p = 0.01) compared to Jewish patients. Disease severity did not differ between the two ethnic groups (p = 0.3). The main predictors of severe illness were having pneumonia (adjusted odds ratio [OR] 3.86; 95% confidence intervals [CI] 1.87–7.97) and history of respiratory diseases (adjusted OR 3.89; 95% CI 1.22–12.38).
Conclusions
The incidence of hospitalizations for RSV bronchiolitis tended to be higher among Jewish than Arab children, possibly due to differences in health care utilization patterns. Differences between the Jewish and Arab patients in demographic factors likely mirror differences between the groups in the general population. Pneumonia, and not ethnicity, affected the severity of RSV bronchiolitis.