Publicly insured children less likely to receive nirsevimab for RSV
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Key takeaways:
- Patients with public insurance were less likely to receive nirsevimab, a monoclonal antibody that protects young children against RSV
- Those living in less affluent ZIP codes also were less likely to receive it.
Children in Massachusetts who were publicly insured or living in less affluent ZIP codes were less likely to receive nirsevimab, a monoclonal antibody for respiratory syncytial virus, according to research published in Pediatrics.
RSV is the leading cause of hospitalization for infants in the United States. Last year two new RSV immunizations came on the market for infants, including a maternal vaccine and nirsevimab, which the AAP recommends for all young infants.
“Understanding which primary care practices and patient populations are likely to be early adopters of a new immunization can inform future distribution, outreach and education to promote health equity,” Claire Abraham, MD, MPH, a pediatrician at the Children's Hospital Primary Care Center at Boston Children’s Hospital, told Healio. “For these reasons, we were excited about the opportunity to study initial uptake of nirsevimab in real time.”
Abraham and colleagues studied electronic health record data from a statewide pediatric primary care network in Massachusetts to analyze practice and patient characteristics between Oct. 7, 2023, and Nov. 30, 2023, among infants aged 8 months or younger with at least one office visit.
When comparing offices that carried nirsevimab with those that did not, the researchers controlled for practice characteristics such as size, urban or suburban location, number of eligible patients, and provider age, sex, and type, and patient characteristics like age, sex, insurance, race/ethnicity, preferred language, income quartile by ZIP code and medical complexity.
“Within practices offering nirsevimab, we compared patients who did and did not receive nirsevimab, controlling for all patient characteristics,” Abraham said.
In all, 52 practices and 441 providers administered nirsevimab and 27 practices and 151 providers did not. The practices served about 400,000 patients.
Large practices with eight or more providers and medium-sized practices with three to seven providers were both around two times more likely to offer nirsevimab compared with smaller practices that had one or two providers (RR = 2.12 for both; 95% CI, 1.16-3.9 for large practices and 1.15-3.92 for medium practices).
Practices that offered the mAb also had lower proportions of publicly insured patients compared with commercially insured patients (RR = 0.97; 95% CI, 0.95-0.98) and had lower proportions of patients living in lower income ZIP codes compared with higher income ZIP codes. Within practices administering nirsevimab, 47.3% of eligible patients received it.
Abraham said it was “interesting” to see two distinct levels of inequity that occurred across the primary care network in the early months of nirsevimab availability.
“Practices not administering nirsevimab were significantly smaller and served higher proportions of publicly insured patients and those living in less affluent ZIP codes,” Abraham said. “Within practices that administered nirsevimab, there were differences in which patients received it, with publicly insured patients and those living in less affluent ZIP codes significantly less likely to do so.”
The findings highlight opportunities to address potential disparities in nirsevimab availability and uptake in the next RSV season at both practice and patient levels, Abraham said, adding that more work is needed to ensure equitable availability and uptake of new immunizations.
“It’s important to be able to provide comprehensive and culturally sensitive information and education about the benefits of immunization to all patients in order to avoid further perpetuating health inequalities,” Abraham said. “Given the restricted supply of nirsevimab in the first season, it will be interesting to see if the differences persist in future seasons when it’s more widely available. More research is also needed to better understand parental feelings around nirsevimab, potential barriers to uptake, and how to best address parental concerns.”
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