Background: The objective of this literature review was to determine whether crowding in the home is associated\r\nwith an increased risk of severe respiratory syncytial virus (RSV) disease in children younger than 5 years.\r\nMethods: A computerized literature search of PubMed and EMBASE was conducted on residential crowding as a\r\nrisk factor for laboratory-confirmed RSV illness in children younger than 5 years. Study populations were stratified by\r\nhigh-risk populations, defined by prematurity, chronic lung disease of prematurity, hemodynamically significant\r\ncongenital heart disease, or specific at-risk ethnicity (i.e. Alaska Native, Inuit), and mixed-risk populations, including\r\ngeneral populations of mostly healthy children. The search was conducted for articles published from January 1,\r\n1985, to October 8, 2009, and was limited to studies reported in English. To avoid indexing bias in the\r\ncomputerized databases, the search included terms for multivariate analysis and risk factors to identify studies in\r\nwhich residential crowding was evaluated but was not significant. Methodological quality of included studies was\r\nassessed using a Cochrane risk of bias tool.\r\nResults: The search identified 20 relevant studies that were conducted in geographically diverse locations. Among\r\nstudies of patients in high-risk populations, 7 of 9 found a statistically significant association with a crowding\r\nvariable; in studies in mixed-risk populations, 9 of 11 found a significant association with a crowding variable. In\r\nstudies of high-risk children, residential crowding significantly increased the odds of laboratory-confirmed RSV\r\nhospitalization (i.e. odds ratio ranged from 1.45 to 2.85). In studies of mixed-risk populations, the adjusted odds\r\nratios ranged from 1.23 to 9.1. The findings on the effect of residential crowding on outpatient RSV lower\r\nrespiratory tract infection were inconsistent.\r\nConclusions: Residential crowding was associated with an increased risk of laboratory-confirmed RSV\r\nhospitalization among high-risk infants and young children. This association was consistent despite differences in\r\ndefinitions of residential crowding, populations, or geographic locations.
Loading....