Services & Data Requests - PHC4 Data Users Series

Estimating the Burden of RSV Infection

Dr. Mary Patricia Nowalk, Professor at the University of Pittsburgh, and colleagues used data from the Pennsylvania Health Care Cost Containment Council (PHC4) to estimate the hospitalization and economic burden of adults hospitalized with infections due to respiratory syncytial virus (RSV). From this research, published in Vaccine1, these investigators suggest the age- and risk group-specific findings and economic burden estimates could help inform health care planning and resource allocation and in prioritizing RSV vaccination policy, especially for population subgroups found to be disproportionately affected.

In this study, Dr. Nowalk’s research team analyzed PHC4 hospitalization data of patients discharged from September 2015 through August 2018, in combination with clinical data from local electronic medical record extracts and US Census estimates for Allegheny County, Pennsylvania. Together, these data were used to determine the prevalence of RSV among hospitalizations with acute respiratory infection for Allegheny County residents. In addition, Dr. Nowalk noted the high value of PHC4 data because they contain the variables that enabled her team to perform subgroup analyses on factors such as age and immunosuppressed status and to analyze the economic burden across patient groups by using PHC4’s average charge data.

The main findings of the study showed that the most significant hospitalization burden was borne by adults 65 years and older, whose rates ranged from 701 to 1,076 per 100,000 across the three respiratory virus seasons during 2015-2018 and were 7.0-9.0 times those of adults 18-64 years of age, whose rates ranged from 78 to 156 per 100,000. The researchers also found that immunosuppressed patients bore the greatest relative burden of RSV hospitalizations with rates that ranged from 1,288 to 1,562 per 100,000 immunosuppressed individuals. Average total charges for RSV hospitalization in Allegheny County across all adults increased from $39 million to $89 million during the viral seasons in 2015–2018 due to increased average charges for acute respiratory hospitalization and increased numbers of RSV cases.


1 Nowalk MP, D’Agostino H, Dauer K, Stiegler M, Zimmerman R, Balasubramani GK. Estimating the burden of adult hospitalized RSV infection including special populations. Vaccine. 2022 July;40(31): 4121-4127.

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Mary Patricia Nowalk

Mary Patricia Nowalk, PhD, RDN
Professor, University of Pittsburgh School of Medicine
Department of Family Medicine

Mary Patricia Nowalk, PhD, RDN is a Professor at the University of Pittsburgh School of Medicine, Department of Family Medicine, and co-founder of PittVax, the University of Pittsburgh Vaccine Research group. She received her BS (biological sciences), MS Hygiene (nutritional epidemiology) and PhD (chronic disease epidemiology) from the University of Pittsburgh, where she also pursued her Registered Dietitian Nutritionist accreditation and licensure. She has participated in a variety of research projects on topics ranging from immunizations, infectious disease, screening, prevention, vaccination behavior, pregnancy prevention, obesity, and mental health treatment, and has served as principal investigator, co-investigator, project director and research coordinator for federally- and industry-funded grants. She has authored or co-authored over 250 peer-reviewed articles, book chapters and published abstracts. Over the last fifteen years, the primary focus of her work has been on influenza effectiveness and immunogenicity as well as other acute respiratory infections including RSV and COVID-19. Her research has also led to the creation of the 4 Pillars™ Practice Transformation Program (Toolkit), a quality improvement tool for increasing immunizations across the lifespan in primary care.

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