Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 349-356 (doi:10.1542/peds.2004-2795)
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Respiratory Syncytial Virus
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Effect of Altitude on Hospitalizations for Respiratory Syncytial Virus Infection

Julie A. Choudhuri, RN, MSPHa, Lorraine G. Ogden, PhDa, A. James Ruttenber, MD, PhDa, Deborah S.K. Thomas, PhDb, James K. Todd, MDa,c,d and Eric A.F. Simoes, MB, BS, DCH MDd,e

a Preventive Medicine and Biometrics
d Pediatrics, School of Medicine
b Department of Geography, University of Colorado and Health Sciences Center, Denver, Colorado
c Epidemiology
e Pediatrics, Children's Hospital, Denver, Colorado

OBJECTIVE. Respiratory syncytial virus (RSV) infection is the foremost cause of serious lower respiratory tract infection in young children and infants. Because higher rates of hospitalization for bronchiolitis and pneumonia have been noted in high-altitude regions, we hypothesized that physiologic responses to altitude would predispose children to more severe illness from RSV infection. This study examined the effect of residential altitude on hospitalizations for RSV infection in Colorado from 1998 through 2002.

METHODS. A geographic information system was used to assemble data for altitude and demographic variables by zip code–tabulation areas. Data then were linked with hospital discharge data for RSV infections. Poisson regression models were developed to explore correlations between hospitalization rates and residential altitude, after adjustment for socioeconomic differences in the underlying population.

RESULTS. RSV-associated hospitalizations averaged 15.9 per 1000 infants who were younger than 1 year and 1.8 per 1000 children who were 1 to 4 years of age per season. A multivariate analysis suggested that the rate of hospitalization for RSV-specific International Classification of Diseases, Ninth Revision, Clinical Modification codes increased 25% among infants who were younger than 1 year and 53% among children who were 1 to 4 years of age for every 1000-m increase in altitude. The risk for RSV-associated hospitalization was highest at elevations above 2500 m.

CONCLUSIONS. High altitude above 2500 m is a modest predictor for RSV-associated hospitalization. Practitioners in these regions should consider additional efforts to educate parents about RSV infection and its prevention and the importance of early treatment.

Key Words: environmental factors • epidemiology • hospitalization rates • respiratory syncytial virus • risk factors

Abbreviations: RSV—respiratory syncytial virus • CHA—Colorado Health and Hospital Association • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification • ZCTA—zip code–tabulation area • GIS—geographic information systems • RR—rate ratio

Accepted May 2, 2005.


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