Background: A primary characteristic of Herpes Simplex Virus (HSV) infections is its ability to remain latent in sensory neurons and reactivate later in life. Symptoms of HSV typically present at or near the point of entry. Each of the HSV subtypes is distinguishable from one another via their mode of transmission in addition to symptoms. However, there is a growing need for further monitoring of inpatient infection trends given the unpredictable reinfection. The aim of this study is to further evaluate the factors that impact the large prevalences of these diseases in concurrence with their dynamic qualities, specifically the factors of race, age, and payer status.
Methods: Data from the CERNER Health Facts® data were aggregated for inpatient hospitalizations and ICD-10-CM diagnosis codes for HSV infections. Patient sampled were de-identified and within the past 10 years. Regression analysis was performed for each cohort using a binary format to prevent overfitting of the data. All statistical analyses were performed using STATA 16 (StataCorp, USA)
Results: 447 inpatient encounters of HSV infections were identified through analysis. The minority populations included in this study have shown varying ranges for the incidences of every HSV type as compared to their Caucasian counterparts. The widest range was evident among the Asian population having HSV-1. The boundaries were reported to be 0.15x and 30.6x that of Caucasians. However, there was an uneven skew in the race distribution among the data set. There were significantly fewer minorities sampled in this study. In fact, when each of the minority populations was totaled, it was still less than the number of Caucasians by roughly 44 individuals. Patients with private insurance were found to have a greater likelihood of being hospitalized with HHV-6 as compared to those paying with government insurance. The values range from 0.928 to 3.69x the government insurance payers. Among HSV-1 patients, the data set showed that patients that were ages 0-18 years old had a statistically significant increased prevalence than individuals older than 18 years of age. The greatest increase was seen in those 0-6 months old, with a range of 5.17 – 25.5 times the incidence of those >18 years old. Among HSV-2 patients, the data set displays a significantly decreased risk of contraction for those 0-18 years old than those older than 18 years. The most prominent confidence interval was in those 6 months – 18 years old, with values between 0.0729 – 0.256 times less than those older than 18 years. Among HHV-6 patients, the data set demonstrates that patients in the age range of 6 months-18 years have a higher incidence of HSV-6, ranging from 1.00 – 4.97 times the incidence of those that are older than 18 years.
Conclusions: Inpatient trends among HSV-1, HSV-2, and HSV-6 show statistical significance (p<0.05) among age cohorts during the regression analysis. Of note, the data reporting on HSV-6 infections show unique trends in an area of little literature compared to its HSV cohorts. Under the assumption that private payer status is indicative of a higher socioeconomic status than patients utilizing government insurance, the data support the notion that patients with higher socioeconomic status could be more prone to acquiring an HHV-6 infection. However, the sample size for patients with HHV-6 was not large enough for these findings to be conclusive. Further studies should be pursued utilizing a larger and more balanced HHV-6 population.