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Cited by 14Fungal Infections and StudiesIndigenous Health and EducationActinomycetales infections and treatment

Coccidioidomycosis Among American Indians and Alaska Natives, 2001–2014

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McCotter, Orion, Kennedy, Jordan, McCollum, Jeffrey, Bartholomew, Michael, Iralu, Jonathan, Jackson, Brendan R, Haberling, Dana, Benedict, Kaitlin·2019·Open Forum Infectious Diseases
DOI 10.1093/ofid/ofz052PMC PMC6411209
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Abstract

Background: American Indians and Alaska Natives (AI/ANs) may be uniquely vulnerable to coccidioidomycosis given the large population residing in the Southwestern United States. We describe coccidioidomycosis-associated hospitalizations and outpatient visits during 2001–2014 in the Indian Health Service (IHS) system and compare hospitalizations with data from the Agency for Healthcare Research and Quality’s National (Nationwide) Inpatient Sample (NIS). Methods: We identified hospitalizations in the IHS and the NIS and outpatient visits in the IHS using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 114.0–114.9. We calculated average annual hospitalization and outpatient visit rates per 1 000 000 population and used Poisson regression to calculate rate ratios (RRs) and 95% confidence intervals (CIs). We used multivariable logistic regression to assess factors associated with IHS hospitalization. Results: AI/ANs had the highest average annual hospitalization rate (58.0; 95% CI, 49.5–66.6) of any racial/ethnic group in the NIS, compared with 13.4 (95% CI, 12.7–14.2) for non-Hispanic whites. IHS data showed a hospitalization rate of 37.0; the median length of stay (interquartile range) was 6 (3–10) days. The average annual outpatient visit rate in IHS was 764.2, and it increased from 529.9 in 2001 to 845.9 in 2014. Male sex, age ≥65 years, diabetes, and extrapulmonary or progressive coccidioidomycosis were independently associated with increased risk for hospitalization. Twenty-four percent of patients had ICD-9-CM codes for community-acquired pneumonia in the 3 months before coccidioidomycosis diagnosis. Conclusions: AI/ANs experience high coccidioidomycosis-associated hospitalization rates, high morbidity, and possible missed opportunities for earlier diagnosis. Yearly trends in IHS data were similar to the general increase in hospitalizations and reported cases nationwide in the same period.

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  • Certain racial and ethnic groups, such as Asians (especially Filipinos) and black or African Americans, are more likely to develop severe and disseminated coccidioidomycosis.

    “It was observed that certain racial and ethnic groups were more likely to develop severe and disseminated coccidioidomycosis, such as Asians (especially Filipinos), and black or African Americans were reported to be at increased risk for coccidioidomycosis complications [148–150].”

    From Race and ethnicity: Risk factors for fungal infections? (2023) · cites this paper as [149]

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Authors
McCotter, O., Kennedy, J., McCollum, J., Bartholomew, M., Iralu, J., Jackson, B. R., Haberling, D., & Benedict, K.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Indian Health Service (US)
Corresponding author
McCotter, Orion
ORCID
Venue
Open Forum Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2019-03-01
Volume
6
Issue
3
Pages
ofz052-ofz052
ISSN
2328-8957 (ISSN-L)
DOI
10.1093/ofid/ofz052
PMC
PMC6411209
OpenAlex
W2921279186
Cited by
14
References
30
Citations by year
2025: 2 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 2
FWCI
1.90
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Open Forum Infectious Diseases (publishedVersion, public-domain)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Centers for Disease Control and Prevention
Topics
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
  • Health Sciences › Health Professions › General Health Professions › Indigenous Health and Education
  • Health Sciences › Medicine › Microbiology › Actinomycetales infections and treatment
Keywords
coccidioidomycosis, American Indians and Alaska Natives, hospitalization rates, outpatient visits, Indian Health Service, racial and ethnic disparities, risk factors, community-acquired pneumonia, length of hospital stay, southwestern United States

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