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Open Access Research article

Residential crowding and severe respiratory syncytial virus disease among infants and young children: A systematic literature review

Ann D Colosia1*, Anthony Masaquel2, Caroline Breese Hall3, Amy M Barrett1, Parthiv J Mahadevia2 and Ram Yogev4

Author Affiliations

1 RTI Health Solutions, Research Triangle Park, NC, USA

2 MedImmune, Gaithersburg, MD, USA

3 University of Rochester Medical Center, Rochester, NY, USA

4 Ann and Robert Laurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

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BMC Infectious Diseases 2012, 12:95  doi:10.1186/1471-2334-12-95

Published: 20 April 2012

Abstract

Background

The objective of this literature review was to determine whether crowding in the home is associated with an increased risk of severe respiratory syncytial virus (RSV) disease in children younger than 5 years.

Methods

A computerized literature search of PubMed and EMBASE was conducted on residential crowding as a risk factor for laboratory-confirmed RSV illness in children younger than 5 years. Study populations were stratified by high-risk populations, defined by prematurity, chronic lung disease of prematurity, hemodynamically significant congenital heart disease, or specific at-risk ethnicity (i.e. Alaska Native, Inuit), and mixed-risk populations, including general populations of mostly healthy children. The search was conducted for articles published from January 1, 1985, to October 8, 2009, and was limited to studies reported in English. To avoid indexing bias in the computerized databases, the search included terms for multivariate analysis and risk factors to identify studies in which residential crowding was evaluated but was not significant. Methodological quality of included studies was assessed using a Cochrane risk of bias tool.

Results

The search identified 20 relevant studies that were conducted in geographically diverse locations. Among studies of patients in high-risk populations, 7 of 9 found a statistically significant association with a crowding variable; in studies in mixed-risk populations, 9 of 11 found a significant association with a crowding variable. In studies of high-risk children, residential crowding significantly increased the odds of laboratory-confirmed RSV hospitalization (i.e. odds ratio ranged from 1.45 to 2.85). In studies of mixed-risk populations, the adjusted odds ratios ranged from 1.23 to 9.1. The findings on the effect of residential crowding on outpatient RSV lower respiratory tract infection were inconsistent.

Conclusions

Residential crowding was associated with an increased risk of laboratory-confirmed RSV hospitalization among high-risk infants and young children. This association was consistent despite differences in definitions of residential crowding, populations, or geographic locations.

Keywords:
Respiratory syncytial virus; Respiratory infection; Crowding; Children