RSV vaccination uptake among adults aged 60 years and older in the United States during the 2023–2025 vaccination seasons

ABSTRACT

Older adults and adults with certain chronic conditions are at increased risk for severe respiratory syncytial virus (RSV) disease. In 2023, RSV vaccines first became available in the United States (US) for adults aged ≥60 years. This retrospective database analysis evaluated RSV vaccination uptake from August 2023–February 2025 using IQVIA’s open-source pharmacy (LRx) and medical (Dx) claims data. The study included US adults aged ≥60 years with ≥1 claim in 2023. For those without RSV vaccination in 2023, ≥1 claim was also required between January 2024–February 2025. Uptake was assessed as the number and percentage of eligible adults who received an RSV vaccine during the study period. Multivariable logistic regression modeling explored factors associated with RSV vaccination. Nearly 12.8 million adults aged ≥60 years (16.4%) received RSV vaccination between August 2023–February 2025. Uptake generally increased with age and was higher among those with ≥1 potential risk factor for severe RSV disease. Disparities in uptake were observed by race, ethnicity, and other social determinants of health. In multivariable analyses, odds of RSV vaccination were nearly 24 times higher for those who received ≥1 non-RSV vaccine from August 2023–February 2025 versus those who had not. Despite the increased risk of severe RSV disease among older adults and those with certain risk factors, relatively limited RSV vaccination uptake was observed during the 2023–2025 seasons, with disparities observed. Additional efforts are needed to support RSV prevention among those at highest risk and to ensure equitable access to vaccination.

Plain Language Summary

What is the context?

• Respiratory syncytial virus (RSV) can result in severe illness in adults aged 60 years and older, as well as adults with certain health conditions.

• RSV vaccines for use in adults aged 60 years and older became available in the United States (US) in 2023.

What is new?

• During the first two seasons of vaccine availability, only 16.4% of US adults aged 60 years and older received an RSV vaccination (August 2023–February 2025).

• The percentage of older adults receiving RSV vaccination was relatively low, even among adults with health conditions that place them at increased risk of severe RSV illness.

• Differences in uptake were found by race, ethnicity, and other patient characteristics.

What is the impact?

• Additional efforts are needed to ensure that adults aged 60 years and older are able to receive RSV vaccination.

Introduction

Respiratory syncytial virus (RSV) is a common cause of respiratory infections that can lead to severe disease in older adults and adults with certain risk factors such as chronic conditions or weakened immune systems.¹ The landmark study by Falsey et al. found that RSV infection occurred annually in 3–7% of healthy older adults (aged ≥65 years) and 4–10% of adults with chronic cardiopulmonary conditions (aged ≥21 years with congestive heart failure [CHF] or a chronic pulmonary condition).² After adjusting for underdetection, estimated annual incidence rates were approximately 267 RSV-related hospitalizations, 200 emergency department admissions, and 2,278 outpatient visits per 100,000 adults aged ≥65 years.³ Among adults aged ≥60 years who are hospitalized with RSV, 1-month and 12-month all-cause mortality post-hospitalization (unadjusted for background mortality) has previously been estimated at 8.6% and 25.8%, respectively.⁴

Certain chronic conditions are risk factors for severe RSV disease, including lung diseases (e.g., chronic obstructive pulmonary disease [COPD], asthma), cardiovascular diseases (e.g., CHF, coronary artery disease [CAD]), moderate/severe immune compromise, diabetes mellitus, neurologic or neuromuscular conditions, kidney disorders, liver disorders, and hematologic disorders.^5,6 As an example, the previous study by Branche et al. reported RSV-related hospitalization rates among adults aged ≥65 years that were 3.5–13.4 times higher among those with COPD, 3.8–6.5 times higher among those with CAD, and 2.4–6.4 times higher among those with diabetes compared to adults aged ≥65 years without each of these conditions.⁵

In May 2023, the United States (US) Food and Drug Administration (FDA) approved two RSV vaccines for the prevention of lower respiratory tract disease caused by RSV in adults aged ≥60 years (the adjuvanted recombinant subunit RSV prefusion F3 [RSVPreF3] vaccine, AREXVY and the RSV prefusion F [RSVpreF] vaccine, ABRYSVO).^7,8 In June 2023, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend that adults aged ≥60 years may receive one dose of an RSV vaccine, using shared clinical decision-making (SCDM).⁹ In 2024, a third RSV vaccine was FDA approved (the messenger ribonucleic acid [mRNA] RSV vaccine, mRESVIA) and the CDC’s ACIP voted in June 2024 to update their recommendations to specify vaccination among adults aged 60–74 years who are at increased risk for severe RSV disease and all adults aged ≥75 years.^6,10

The objective of this study was to evaluate RSV vaccination uptake among US adults aged ≥60 years during the first two seasons of vaccine availability (2023–2025). In addition to assessing RSV vaccination uptake overall and by subgroups of interest, the study also aimed to describe RSV vaccination coadministration, explore potential missed opportunities for RSV vaccination, and identify factors associated with RSV vaccination.

Methods

Study design

This retrospective database analysis evaluated RSV vaccination uptake among US adults aged ≥60 years from August 1, 2023–February 28, 2025. The study used IQVIA’s open-source pharmacy (LRx) and medical (Dx) claims data, with a subset of analyses using linked consumer attribute data. The study included US adults aged ≥60 years with ≥1 claim from January 1, 2023–December 31, 2023. For those without RSV vaccination in 2023, ≥1 claim was also required from January 1, 2024–February 28, 2025 to help ensure continued data availability for individuals in these open claims data. Although older adult RSV vaccines were first FDA-approved in May 2023 and the first ACIP recommendations related to their use were published on July 21, 2023, an initial query of the IQVIA databases found that there were only 3 claims for RSV vaccines in July 2023.⁹ As a result, the evaluation period for the study began on August 1, 2023 (i.e., the index date for all patients), and continued through February 28, 2025. The study included a baseline period, defined as the ≥12-month period prior to August 1, 2023, with baseline demographic, socioeconomic, and clinical characteristics measured including all available history. Uptake was assessed as the number and percentage of eligible adults who received an RSV vaccine during the evaluation period, with monthly and cumulative uptake reported. Patients’ follow-up ended at first RSV vaccination claim or was censored at the end of the study period, whichever was earlier. Because the study used open claims data, loss to follow-up (e.g., due to death or other reasons) could not be identified. As a result, all patients were censored at the end of the data period. Figure 1 provides a schematic of the study design.

Figure 1.

Study design schematic.

RSV = respiratory syncytial virus.

The study’s baseline period was defined as the ≥12-month period prior to August 1, 2023, with baseline characteristics measured including all available history.

Data source

The study used data from IQVIA’s open-source longitudinal pharmacy claims database (LRx) and medical claims database (Dx), with supplemental consumer attribute data from Experian. LRx and Dx claims data capture a large proportion of the US population and receive data from all payers, including commercial insurance, Medicare, and Medicaid. Claims are also included that are paid solely by patients (i.e., the data are not restricted to insured patients). LRx data cover an estimated 94% of the retail pharmacy channel and 58% of the long-term care pharmacy channel. Dx data primarily contain professional fee claims from over 870,000 healthcare professionals (HCPs) per month, capturing approximately 50–60% of all outpatient physician office claims; a small portion of services that occur in hospitals/non-outpatient facilities are reported in Dx from institutional fee claims.

For a subset of analyses, consumer attribute data on race and ethnicity, annual household income, and education were used from Experian’s national marketing database. These data are collected from a variety of public and proprietary sources (e.g., self-reported information, public records, purchase transaction information). LRx and Dx data were linked to the consumer attribute data using a patient tokenization engine that involves a hierarchical matching process that scores and compares tokens while controlling for missing data. The tokenization engine contains features aimed at minimizing false positives and false negatives, such as controlling for name changes via marriage.

Study population

To be eligible for participation in this study, patients were required to be aged ≥60 years as of 2023 (only year of birth is available in the IQVIA data) and have ≥1 LRx or Dx claim between January 1, 2023 through December 31, 2023. For those without RSV vaccination in 2023, ≥1 LRx or Dx claim was also required from January 1, 2024, through February 28, 2025. Patients were excluded if they received RSV vaccination prior to August 1, 2023, or if they had data quality issues (i.e., patients were required to have a valid year of birth, sex, region, and payer type from January 1, 2023, through February 28, 2025). For the main analyses, minimal patient eligibility criteria were applied to be able to maximize capture of real-world practices related to RSV vaccination. Additional details on inclusion criteria are provided in Supplemental Table S1.

Variables

RSV vaccination uptake was defined as the number and percentage of eligible adults who received an RSV vaccine during the study period, based on observed claims in LRx or Dx. Monthly and cumulative uptake were evaluated, with cumulative uptake further assessed by patient subgroups of interest (e.g., age, race and ethnicity, potential risk factors for severe RSV disease). Uptake was also assessed by specific time periods (August 1, 2023–February 29, 2024; March 1, 2024–July 31, 2024; and August 1, 2024–February 28, 2025). Data on race and ethnicity, annual household income, and education were only available among linked participants between the LRx/Dx and consumer attribute databases.

Risk factors for severe RSV disease included the following:

• Chronic pulmonary conditions: COPD, asthma, and other chronic pulmonary disease (e.g., interstitial lung disease)

• Chronic cardiovascular disease: heart failure (including cardiomyopathy, heart failure with preserved ejection fraction, and heart failure with reduced ejection fraction), CAD (including history of coronary artery bypass graft and myocardial infarction), cerebrovascular disease (including history of stroke or transient ischemic attack), and other chronic cardiovascular disease (e.g., atherosclerosis)

• Immunocompromised status (based on diagnosis codes and/or immunocompromising medications)

• Diabetes mellitus (type 1 or type 2)

• Chronic neurologic conditions: dementia (including Alzheimer’s disease and other types of dementia) and other chronic neurologic conditions (e.g., epilepsy)

• Chronic kidney disorders

• Chronic liver disorders

• Chronic hematologic disorders

• Frailty status

• Obesity: body mass index ≥30

Frailty status was determined by a diagnosis of age-related physical debility (International Classification of Diseases, Tenth Revision [ICD-10] diagnosis code of R54) or by a cumulated score of age and Charlson Comorbidity Index (CCI) that was ≥2.¹¹ For patient age, scores of 0, 1, and 2 were assigned to ages ≤75 years, 76–80 years, and ≥81 years, respectively. For CCI score (Dartmouth-Manitoba version), scores of 0 and 1 were assigned to CCI scores of ≤1 and ≥2, respectively.¹²

RSV vaccination uptake was evaluated by specific risk factors for severe RSV disease, as well as using aggregate measures (e.g., ≥1 pulmonary risk factor of interest, ≥1 risk factor of interest). In multivariable analyses, potential group residence was also included as a covariate. Potential group residence was assessed based on the presence of ≥1 pharmacy claim from a nursing home provider pharmacy, onsite pharmacy at nursing home or residential care facility (including prisons), nursing home provider pharmacy affiliated with retail chain, hybrid pharmacy (nursing home/retail), or community mental health center pharmacy.

Coadministration was evaluated among adults aged ≥60 years who received RSV vaccination and was defined as the number and percentage who received ≥1 other non-RSV vaccine (e.g., influenza vaccine, coronavirus disease 2019 [COVID-19] vaccine) on the same date as the RSV vaccine. Potential sequential administration was also explored and was defined as the receipt of a non-RSV vaccine within two weeks or within one month prior to or after RSV vaccination.

Potential missed opportunities for RSV vaccination were evaluated as the number and percentage of adults aged ≥60 years who received a non-RSV vaccination but never received an RSV vaccination.

Baseline characteristics were measured during all pre-index history. Key demographic and socioeconomic characteristics included age, sex, race and ethnicity, annual household income, educational attainment, urban/rural status, geographic region, pharmacy density (i.e., pharmacies per adult population based on census tract data), and Area Deprivation Index percentile.^13,14 Key clinical characteristics included presence of potential risk factors for severe RSV disease and CCI score. Additional details on RSV vaccination were also summarized (e.g., vaccination setting in pharmacy versus HCP office, payer type, patient copay).

Data analysis

RSV vaccination uptake was analyzed descriptively overall and by key subgroups of interest, with point estimates and 95% confidence intervals (CIs) reported. Patients’ follow-up ended at receipt of RSV vaccination or was censored at the end of the study period (whichever occurred first). In the study’s descriptive analyses, categorical measures are reported as the number and percentage of eligible patients in each category. Continuous variables are reported using mean, standard deviation (SD), and median. As relevant, continuous variables were also categorized into intervals. Differences in baseline characteristics between vaccinated and unvaccinated patients aged ≥60 years were evaluated as appropriate using standardized mean differences (SMDs) to better understand differences between these groups. SMD values >0.1 were considered significant. Cumulative RSV vaccination uptake by state was displayed visually in US heatmaps.

Two logistic regression models were developed to explore patient characteristics associated with the likelihood of RSV vaccination among the subset of patients linked to consumer attribute data who had ≥1 year of pre-index patient eligibility (defined as patient activity plus pharmacy and provider stability prior to August 1, 2023). The first model included the overall population of adults aged ≥60 years and the second model included adults aged ≥60 years with ≥1 potential risk factor for severe RSV disease. The dependent variable of RSV vaccination (yes versus no) was assumed to follow a binomial distribution. Covariates were selected based on prior experience and clinical judgment, excluding variables and adjusting the final list based on observed collinearity. Adjusted odds ratios (ORs) and 95% CIs for each covariate were estimated.

All analyses were based on observed claims data that were not projected to the full US population of adults aged ≥60 years. Analyses were conducted using SAS® Release 9.4 (SAS Institute Inc., Cary, NC).

Ethics statement

This study used de-identified data from existing sources and complied with all applicable laws regarding subject privacy. No direct subject contact or primary collection of individual human subject data occurred. Study results are presented in aggregate, omitting subject identification, therefore informed consent, ethics committee, or institutional review board approval was not required.

Results

Baseline characteristics

A total of 262,035,599 patients with ≥1 claim in 2023 (and ≥1 claim from January 1, 2024–February 28, 2025 for those not vaccinated in 2023) were identified in the LRx and Dx data. Of these patients, 77,925,739 patients were aged ≥60 years as of 2023 and met all other study eligibility criteria for inclusion in the main analyses.

Table 1 summarizes key baseline demographic and clinical characteristics overall and by receipt of RSV vaccination. In the overall sample, the mean (SD) age was 71.1 (7.7) years, 55.5% were female, and 78.9% were in urban areas. A total of 39.0% of patients resided in the South, 21.5% the West, 21.1% the Midwest, and 18.4% the Northeast. Mean (SD) CCI score was 2.3 (2.6). The sample included 65.6% of adults with ≥1 potential risk factor for severe RSV disease and 45.9% with ≥2 potential risk factors. The most common risk factors were cardiovascular disease (29.6%), diabetes mellitus (25.4%), and chronic pulmonary conditions (23.0%). Additional details on baseline characteristics overall and by RSV vaccination status are provided in the Supplement (Table S2).

Table 1.

Key baseline demographic and clinical characteristics of patients aged ≥60 years, overall and by RSV vaccination status.

Baseline characteristics	All eligible patients (N = 77,925,739)	Patients with RSV vaccination (N = 12,765,761)	Patients without RSV vaccination (N = 65,159,978)	SMDa
Demographic characteristics
Age, in years (mean, SD)b	71.1 (7.7)	73.2 (7.1)	70.7 (7.7)	0.33
Sex (n, %)
Male	34,714,490 (44.5%)	5,488,594 (43.0%)	29,225,896 (44.9%)	−0.04
Female	43,211,249 (55.5%)	7,277,167 (57.0%)	35,934,082 (55.1%)	0.04
Urban/rural status (n, %)
Urban	61,465,833 (78.9%)	10,316,809 (80.8%)	51,149,024 (78.5%)	0.06
Rural	16,459,906 (21.1%)	2,448,952 (19.2%)	14,010,954 (21.5%)	−0.06
US Census region (n, %)
Northeast	14,368,883 (18.4%)	2,267,041 (17.8%)	12,101,842 (18.6%)	−0.02
Midwest	16,450,031 (21.1%)	2,976,387 (23.3%)	13,473,644 (20.7%)	0.06
South	30,390,835 (39.0%)	4,529,377 (35.5%)	25,861,458 (39.7%)	−0.09
West	16,715,990 (21.5%)	2,992,956 (23.4%)	13,723,034 (21.1%)	0.06
Clinical characteristics
CCI score (mean, SD)	2.3 (2.6)	2.6 (2.7)	2.2 (2.6)	0.13
Presence of potential risk factors for severe RSV disease (n, %)
≥1 chronic pulmonary conditionc	17,900,881 (23.0%)	3,485,172 (27.3%)	14,415,709 (22.1%)	0.12
≥1 cardiovascular conditionc	23,045,018 (29.6%)	4,124,432 (32.3%)	18,920,586 (29.0%)	0.07
Immunocompromised	16,840,311 (21.6%)	3,528,795 (27.6%)	13,311,516 (20.4%)	0.17
Diabetes mellitus (type 1 or type 2)	19,787,192 (25.4%)	3,351,961 (26.3%)	16,435,231 (25.2%)	0.02
≥1 neurologic conditionc	6,300,386 (8.1%)	975,599 (7.6%)	5,324,787 (8.2%)	−0.02
Kidney disorder	13,450,864 (17.3%)	2,418,432 (18.9%)	11,032,432 (16.9%)	0.05
Liver disorder	5,702,382 (7.3%)	966,025 (7.6%)	4,736,357 (7.3%)	0.01
Hematologic disorder	14,823,859 (19.0%)	2,760,880 (21.6%)	12,062,979 (18.5%)	0.08
Frailty	5,955,284 (7.6%)	1,501,955 (11.8%)	4,453,329 (6.8%)	0.17
Obesity	16,775,897 (21.5%)	2,894,616 (22.7%)	13,881,281 (21.3%)	0.03
Number of potential risk factors for severe RSV disease (n, %)
0	26,768,338 (34.4%)	3,696,638 (29.0%)	23,071,700 (35.4%)	−0.14
≥1	51,157,401 (65.6%)	9,069,123 (71.0%)	42,088,278 (64.6%)	0.14
≥2	35,737,337 (45.9%)	6,607,865 (51.8%)	29,129,472 (44.7%)	0.14

CCI = Charlson Comorbidity Index; N/n = patient count; RSV = respiratory syncytial virus; SD = standard deviation; SMD = standardized mean difference; US = United States.

^aFor continuous variables, SMD was calculated as d = (x₁ − x₂)/√((s₁² + s₂²)/2) and for categorical variables, SMD was calculated as d = (p₁ − p₂)/√((p₁ (1 – p₁) + p₂ (1 – p₂))/2), where x and p denote the sample means and proportions in the groups, respectively, and s denotes the sample variances. SMD values >0.1 were considered significant.

^bAs of August 1, 2023.

^cSee Supplement for additional information on specific conditions of interest.

For subgroup analyses by race and ethnicity, annual household income, and educational attainment, 59.1% of patients (n = 46,077,745) had linked consumer attribute data. Baseline characteristics of patients linked to the consumer attribute database were generally similar to the overall population and are provided in the Supplement (Tables S3 and S4). Among patients with linked consumer attribute data, n = 16,799,689 had ≥1 year of pre-index patient eligibility and were included in multivariable regression analyses.

RSV vaccination uptake

Between August 1, 2023, and February 28, 2025, a total of 16.4% of patients aged ≥60 years received an RSV vaccination (12,765,761 of 77,925,739 eligible patients). Most of these vaccinations (98.8%) were received in pharmacies. Among patients who received the RSV vaccine at a pharmacy, 90.0% were administered at a national chain pharmacy. For HCP offices, the most common provider specialties on the RSV vaccination claim were family physician (44.4%) and internal medicine (33.6%). Approximately 66.6% of vaccinated older adults received the adjuvanted RSVPreF3 vaccine (AREXVY), 33.2% received the RSVpreF vaccine (ABRYSVO), and 0.2% received the mRNA RSV vaccine (mRESVIA). By month of vaccination, 18.8% of RSV vaccinations were received in October 2023, with 14.8% received in November 2023 and 13.3% received in September 2023. A total of 71.8% of RSV vaccinations were received between August 1, 2023–February 29, 2024, 7.0% were received between March 1, 2024–July 31, 2024, and 21.2% were received between August 1, 2024–February 28, 2025. Additional details on RSV vaccination characteristics and vaccination uptake by month and time period are provided in the Supplement (Tables S5 and S6).

Figure 2 presents cumulative RSV vaccination uptake by select demographic and socioeconomic characteristics. By age, uptake ranged from a low of 8.1% among adults aged 60–64 years to a high of 23.3% among adults aged 75–79 years (Figure 2(a) and Supplemental Table S7). Uptake by race and ethnicity was lower among non-Hispanic Black (14.0%) and Hispanic (14.7%) adults as compared with non-Hispanic White (19.9%) and non-Hispanic Asian (21.8%) adults (Figure 2(b) and Supplemental Table S8). RSV vaccination uptake increased with increasing annual household income (ranging from 15.0% for <$25,000 to 23.3% for ≥$150,000) and with increasing educational attainment (ranging from 17.4% among adults who had completed high school to 26.1% among adults who had completed graduate school) (Figure 2(c,d), and Supplemental Table S8). In urban areas, RSV vaccination uptake was 16.8% versus 14.9% in rural areas (Supplemental Table S8).

Figure 2.

RSV vaccination uptake by (a) age, (b) race and ethnicity, (c) annual household income, and (d) educational attainment.

RSV = respiratory syncytial virus.

Regionally, RSV vaccination uptake was lowest in the South (14.9%) and highest in the Midwest (18.1%) (Supplemental Table S9). By state, RSV vaccination uptake was highest in Washington (23.5%), Colorado (22.7%), and Vermont (22.1%) and lowest in Mississippi (9.7%), Louisiana (11.6%), and Alabama (12.4%) (Figure 3(a) and Supplemental Table S10). Figure 3 also provides heatmaps of RSV vaccination uptake among adults aged 60–74 years with ≥1 potential risk factor for severe RSV disease and adults aged ≥75 years to align with the ACIP’s updated RSV vaccination recommendations that were published in August 2024⁶ (Figure 3(b,c), and Supplemental Table S10). Nationally, RSV vaccination uptake among adults aged 60–74 years with ≥1 potential risk factor for severe RSV disease and adults aged ≥75 years were 15.3% and 21.3%, respectively.

Figure 3.

RSV vaccination uptake by state among (a) all adults aged ≥60 years, (b) adults aged 60–74 years with ≥1 risk factor for severe RSV disease, and (c) adults aged ≥75 years.

RSV = respiratory syncytial virus.

RSV vaccination uptake by state also presented in Supplemental Table S10.

RSV vaccination uptake was higher among adults with potential risk factors for severe RSV disease (17.7% among adults with ≥1 potential risk factor versus 13.8% for those without any observed risk factors) (Supplemental Table S11). By specific risk factors for severe RSV disease, the highest uptake (25.2%) was observed for frail adults, followed by adults with asthma (21.9%) and adults who were immunocompromised (21.0%) (Figure 4 and Supplemental Table S12). Risk factors with the lowest RSV vaccination uptake were dementia (14.2%) and other neurologic conditions (16.3%).

Figure 4.

RSV vaccination uptake by potential risk factors for severe RSV disease.

CAD = coronary artery disease; COPD = chronic obstructive pulmonary disease; RSV = respiratory syncytial virus.

RSV vaccination coadministration with non-RSV vaccinations

RSV vaccination uptake was 31.2% among patients who received any non-RSV vaccination during the study period (Supplemental Table S13). RSV vaccination uptake was highest for those who received a COVID-19 vaccine (43.8%), followed by influenza vaccine (32.7%).

Of the 12,765,761 patients aged ≥60 years who received RSV vaccination, 47.3% (n = 6,042,112) received same-day coadministration with ≥1 non-RSV vaccine (Supplemental Table S14). Most of these same-day coadministrations (70.2%) were with 1 other non-RSV vaccine, with the remaining 29.8% receiving a same-day coadministration with ≥2 non-RSV vaccines. Among all RSV vaccinations, 27.4% had a same-day coadministration with an influenza vaccine and 22.6% with a COVID-19 vaccine. In sensitivity analyses evaluating sequential administration, 58.4% of RSV vaccinations were administered within 2 weeks and 69.0% were administered within 1 month of a non-RSV vaccine (before or after). Additional details on RSV vaccine coadministrations and sequential administrations are provided in Supplemental Table S14.

Potential missed opportunities for RSV vaccination

A total of 38,808,626 patients aged ≥60 years received ≥1 non-RSV vaccine between August 1, 2023, through February 28, 2025. Of these patients 26,702,376 (68.8%) did not receive an RSV vaccine, representing potential missed opportunities for RSV vaccination (Supplemental Table S15). Among the 33,176,041 patients aged ≥60 years who received the influenza vaccine over the study period, 67.3% did not receive an RSV vaccine. Rates of potential missed opportunities were lower (56.2%) for adults who received a COVID-19 vaccine and higher (86.3%) for adults who received some other non-RSV vaccine (i.e., not influenza or COVID-19 vaccines). Potential missed opportunities for RSV vaccination were observed across subgroups by key demographic and socioeconomic characteristics (Supplemental Table S15) and by potential risk factors for severe RSV disease (Supplemental Table S16). As an example, among adults aged ≥60 years with ≥1 potential risk factor for severe RSV disease, nearly 18.4 million potential missed opportunities for RSV vaccination were identified.

Factors associated with likelihood of RSV vaccination

Figure 5 presents results from two multivariable logistic regression models exploring characteristics associated with the likelihood of RSV vaccination among adults linked to consumer attribute date who had ≥1 year of pre-index patient eligibility (also presented in Supplemental Table S17). The first model included all adults aged ≥60 years (n = 16,799,689) and the second model included adults aged ≥60 years with ≥1 potential risk factor for severe RSV disease (n = 14,425,367).

Figure 5.

Multivariable logistic regression results of factors associated with likelihood of RSV vaccination among (a) all patients aged ≥60 years (N = 16,799,689) and (b) patients aged ≥60 years with ≥1 risk factor for severe RSV disease (N = 14, 425,367).

CCI = Charlson Comorbidity Index; CI = confidence interval; N = patient count; RSV = respiratory syncytial virus.

Models were conducted among subsets of patients with linkage to consumer attribute data. Results are shown here for key characteristics; full results are available in Supplemental Table S17.

Among adults aged ≥60 years, the odds of RSV vaccination were nearly 24 times higher for those who received ≥1 non-RSV vaccine during the study period versus those who had not (OR: 23.55; 95% CI: 23.42–23.69). Adults in older age groups had higher odds of RSV vaccination as compared with adults aged 60–64 years, with ORs ranging from 1.03 (95% CI: 1.03–1.04) for those aged 65–69 years to 1.53 (95% CI: 1.52–1.54) for those aged 75–79 years. Higher odds were also observed among those with Medicare versus commercial insurance (OR: 2.98; 95% CI: 2.97–2.99), with lower odds among those with “other” type of insurance (OR: 0.54; 95% CI: 0.53–0.54). Increasing odds of RSV vaccination were observed with higher levels of annual household income and educational attainment. As an example, odds of RSV vaccination were 1.42 times higher (95% CI: 1.42–1.43) among adults in the highest annual income bracket (≥$150,000) versus adults in the lowest bracket (<$25,000). Compared with non-Hispanic White adults, odds of RSV vaccination were lower among Hispanic (OR: 0.73; 95% CI: 0.73–0.74), non-Hispanic Black (OR: 0.85; 95% CI: 0.85–0.86), and non-Hispanic Asian (OR: 0.93; 95% CI: 0.92–0.94) adults. Presence of ≥1 chronic pulmonary condition was the clinical risk factor with the highest observed OR (1.26; 95% CI: 1.26–1.27) versus those without pulmonary condition(s).

Results were similar among adults aged ≥60 years with ≥1 potential risk factor for severe RSV disease (Figure 5 and Supplemental Table S17).

Discussion

This study evaluated RSV vaccination uptake among US adults aged ≥60 years during the first two seasons of vaccine availability (2023–2025). Between August 2023 through February 2025, only 16.4% of all eligible adults, or approximately 12.8 million adults received an RSV vaccination. Although relatively low uptake was observed across all subgroups evaluated, uptake generally increased with age and was higher for patients with potential risk factors for severe RSV disease (compared to those without any risk factors). Uptake varied by region/state and was slightly higher for those living in urban versus rural areas. Disparities in RSV vaccination uptake were observed by race and ethnicity, annual household income, and education level. Specifically, uptake was lower among non-Hispanic Black and Hispanic adults as compared with non-Hispanic White and non-Hispanic Asian adults. Uptake increased with increasing annual household income and educational attainment.

Multivariable regression results evaluating characteristics associated with RSV vaccination were consistent with the study’s descriptive findings. Across the study’s two multivariable models, race and ethnicity, annual household income, and education level were consistently associated with RSV vaccination, with lower odds of RSV vaccination for non-Hispanic Black and Hispanic adults versus non-Hispanic White adults, and higher odds of RSV vaccination with increasing income and education. The largest OR in multivariable models was observed for adults who had received ≥1 other non-RSV vaccine during the study period. Other factors associated with RSV vaccination among patients aged ≥60 years included age, insurance type, region, and the presence of certain potential risk factors for severe RSV disease.

Estimated numbers of older adult RSV vaccinations from the current study are consistent with publicly available CDC estimates that are also based on IQVIA data analyses but that are projected to the full population of US older adults.¹⁵ By March 1, 2025, the CDC estimated that a total of 14.4 million RSV vaccinations had been administered to the full population of US adults aged ≥60 years, as compared with the estimated 12.8 million RSV vaccinations observed in the current study through February 28, 2025 (based on observed claims that are not projected to the full population). Although the CDC does not report the percentage of adults aged ≥60 years who received an RSV vaccination from their IQVIA analyses,¹⁵ percentage uptake estimates are available elsewhere. In an analysis of Medicare fee-for-service administrative claims data, the CDC estimated that 21.0% of beneficiaries aged ≥65 years who were enrolled in Part D plans were vaccinated by June 29, 2024.¹⁶ This higher estimate may be partially due to the increased likelihood of RSV vaccination among adults with Medicare insurance versus commercial insurance that was found in the current study’s regression analyses. Other estimates of older adult RSV vaccination uptake are available based on self-reported survey data.^17–19 However, higher uptake estimates from these sources should be interpreted taking into account potential selection bias, relatively smaller study samples, and social desirability bias (where respondents may be more likely to be vaccinated versus non-respondents and/or more likely to respond to questions in ways that would be viewed favorably by others).¹⁸ Measurement error is also possible when RSV vaccination status is self-reported instead of based on vaccination claims or electronic health records.¹⁸

Across this study and previous studies, older adult RSV vaccination uptake in the first two seasons of vaccine availability was relatively low in comparison to the high percentage of older adults with potential risk factors for severe RSV disease. In the current study, more than 65% of adults aged ≥60 years had ≥1 potential risk factor for severe RSV disease. During the 2023–2024 season, RSV vaccination was recommended using SCDM,⁹ a type of recommendation that CDC’s ACIP uses for certain vaccines, indicating that HCPs should discuss the given vaccine with a patient to make a joint decision. The low uptake of RSV vaccines during 2023–2024 may have been in part driven by challenges in implementing SCDM recommendations in real-world practice.²⁰ Low RSV vaccination uptake may also reflect the gradual adoption of these new vaccines in real-world practice, which may be further hampered by vaccine hesitancy and fatigue generally, as well as RSV-related knowledge gaps among HCPs and older adults.^21,22

Ahead of the 2024–2025 season, ACIP’s recommendations were revised to remove SCDM and recommend RSV vaccination among all adults aged ≥75 years and adults aged 60–74 years at increased risk of severe RSV disease.⁶ While these new recommendations may help with SCDM-related challenges, identifying patients who are at increased risk may continue to be difficult, particularly in pharmacy settings. The current study found that RSV vaccination uptake slowed considerably during the 2024–2025 season, with only 21.2% of all RSV vaccinations received between August 2024–February 2025.

Disparities in RSV vaccination uptake that were observed in the current study are consistent with uptake disparities previously reported for other adult vaccines.^23–26 The Social Ecological Model provides a framework for better understanding potential reasons for these disparities, which likely include a range of individual, interpersonal, community, and environmental factors.²⁷ As examples, at the individual-level, differences in RSV disease and vaccination-related knowledge, attitudes, and beliefs, as well as general health literacy, insurance status, healthcare use, and vaccine acceptance may be contributing to disparities in uptake. Differences in the quantity and quality of HCP recommendations for RSV vaccination (interpersonal), demographic compositions of healthcare settings (community), and healthcare resource availability (environmental) may be among other factors further contributing to RSV vaccination disparities. Given these disparities, additional efforts are needed to support equitable access to RSV vaccination among adults aged ≥60 years. Interventions that have addressed multiple levels of the Social Ecological Model have previously been effective in reducing disparities in adult vaccination.²⁷ RSV-related education campaigns among HCPs and patients and community outreach could help to raise awareness on the burden of RSV disease, importance of prevention, and observed disparities in vaccination uptake. Although the current study found that more than 47% of RSV vaccinations were coadministered with other vaccines on the same day, the study’s analysis of potential missed opportunities for vaccination indicates additional opportunities for coadministration. Despite the need for multilevel interventions, a recent literature review found that few studies have evaluated community- and environmental-level interventions to improve disparities in adult vaccination, highlighting the need for further work in this area.²⁷

When interpreting study results, several limitations should be considered. First, although the open-source claims data used in this study have broad coverage of the US, they do not contain patient enrollment information. Some patient healthcare encounters could be missed in the data, resulting in a potential underestimation of the numerator and/or denominator for RSV vaccination uptake. Some patients also may not be matched across all healthcare encounters, resulting in potential duplicate patients within the data that may overestimate the denominator of eligible patients and potentially contribute to lower uptake estimates as compared with other sources. To capture the largest population possible and ensure recent activity, patients were required to have ≥1 claim in 2023; among those not vaccinated in 2023, patients were also required to have ≥1 claim from January 1, 2024 through the end of the evaluation period.

Although minimal exclusion criteria were applied in the current analysis, missing data are still possible, particularly for patients receiving care outside of the network of pharmacies and providers contributing to the data source, which may vary by state and/or payer. Additionally, missing data from the open-source claims may have resulted in measurement errors for certain covariates (e.g., missed claims for comorbidities of interest). Although it is possible that comorbidities were not captured for some patients due to the lack of available claims with these diagnoses, it is unclear how this may have impacted comorbidity-specific uptake estimates. These patients with missed comorbidities may have been more likely or less likely to receive RSV vaccination as compared to patients with identified comorbidities. Misclassification of comorbidities and risk factors for severe RSV disease may also vary by specific comorbidities and risk factors (e.g., frailty and dementia diagnoses may be inconsistent in claims-based data.^28–31) Eligible patients were identified based on age as of 2023 because exact date of birth is not available in the data. The data also do not contain information on loss of follow-up (e.g., due to death or other reasons), resulting in all patients being censored at the end of the data period. Requiring claims activity for study inclusion may have resulted in the exclusion of healthier patients who do not use medical and/or pharmacy services. Determining cohort eligibility in part based on the presence of claims during the evaluation period may have introduced bias.

The study provides unprojected estimates of RSV vaccination uptake and may not fully represent RSV vaccination patterns and/or patients in the US. Because the Dx data are largely sourced from professional fee claims, medical services reported through institutional fee claims are underrepresented, limiting visibility into inpatient activity. However, the number of patients receiving RSV vaccinations in hospital settings was expected to be low, with most patients expected to receive vaccinations in a pharmacy or HCP office. With coverage of the retail pharmacy channel being most robust and coverage of medical claims being limited to primarily outpatient professional claims, the results of this study may be more generalizable to patients vaccinated in a pharmacy setting and less generalizable to patients vaccinated in an HCP office setting. This limitation is likely small given that RSV vaccines are covered under Medicare Part D and, as a result, are primarily administered in pharmacies. Although vaccinations were not projected to the full US population and do not capture adults who were vaccinated after February 2025, results provide important insights into vaccination uptake and its disparities during the first two seasons of vaccine availability, with multivariable regression models further providing robust estimates of factors associated with RSV vaccination. Further research could compare how RSV vaccination uptake during these first two seasons compares to uptake estimates for other new vaccines in the US, to also better understand the challenges and best practices in vaccinating eligible patients.

Conclusions

This study found relatively low RSV vaccination uptake among US adults aged ≥60 years during the first two seasons of vaccine availability. By the end of February 2025, only 16.4% of eligible adults had received an RSV vaccination, with suboptimal uptake observed across all ages and evaluated risk factors. Additional efforts are needed to support RSV prevention among adults aged ≥60 years who are at highest risk. Disparities in RSV vaccination uptake by race, ethnicity, and other social determinants of health also suggest that more work is needed to ensure equitable access to RSV vaccines.

Biography

Elizabeth M. La, PhD, is a Director in the US Health Economics and Outcomes Research team for Vaccines at GSK. Her current research focuses on the burden of respiratory syncytial virus (RSV) disease in adults aged ≥60 years and adults who are at increased risk of severe RSV disease, as well as the potential impact of RSV vaccination in reducing disease burden. Prior to joining GSK, Dr. La was an Associate Director of Health Economics at RTI Health solutions, conducting research across a number of therapeutic areas, including infectious and vaccine-preventable diseases. Dr. La has more than 15 years of experience conducting and managing health economics and outcomes research studies. Before working at RTI Health Solutions, Elizabeth obtained her PhD in Health Policy and Management at the University of North Carolina at Chapel Hill. Her research has been published in several peer-reviewed journals, including Vaccine, Pharmacoeconomics, and Human Vaccines & Immunotherapeutics, and presented at various professional conferences.

Funding Statement

GlaxoSmithKline foundation funded this study (GSK study identifier: VEO-000828 and VEO-001086) and was involved in all stages of study conduct, including analysis of the data. GSK also took in charge all costs associated with the development and publication of this manuscript.

Disclosure statement

EL and DS are employees of and hold financial equities in GSK. CM, MY, and CC are employees of IQVIA, which received funding from GSK for the conduct of this study. CM is a Pfizer stockholder. The authors declare no other financial and non-financial relationships and activities.

Data availability statement

The data that support the findings of this study are available from IQVIA, but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available.

Ethics

This article is based on an analysis of existing retrospective, de-identified data and did not involve any primary data collection or contact with human participants. As such, it did not require ethics review and approval.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/21645515.2025.2535755.

Trademark

AREXVY is a trademark owned by or licensed to GSK.

ABRYSVO is a trademark of Pfizer.

mRESVIA is a trademark of Moderna.