Racial Differences in Clinical Phenotype and Hospitalization of Blastomycosis Patients.
Open accessAbstract
Background: Dimorphic fungal infections, such as blastomycosis, cause significant morbidity and mortality. Historically, blastomycosis studies have focused on non-Hispanic whites, which limits our understanding of the clinical presentation and outcomes for patients of other races and ethnicities. We evaluated whether clinical presentation and disease severity varied across racial and ethnic groups. Methods: Blastomycosis patients were identified from Marshfield Clinic Health System and data were abstracted from electronic medical records. Blastomyces genotyping was performed for cases with available isolates. Bivariate analyses (χ 2 tests/analysis of variance) assessed associations of race and/or ethnicity, Blastomyces spp, and hospitalization status with demographics and clinical presentation. Multivariable logistic regression was used to evaluate the association of race and/or ethnicity and hospitalization. Results: In total, 477 patients were included. Age differences were observed across race and ethnicity categories (P < .0001). Non-Hispanic whites were oldest (median, 48 years; interquartile range [IQR], 31–62) and Asians were youngest (26 years; IQR, 19–41). Non-Hispanic whites (55%) and African Americans (52%) had underlying medical conditions more frequently than Hispanic whites (27%) and Asians (29%). Odds of hospitalization were 2 to 3 times higher for Hispanic whites (adjusted odds ratio [aOR], 2.9; 95% confidence interval [CI], 1.2–1.7), American Indian or Alaska Native (AIAN) (aOR, 2.4; 95% CI, 1.0–5.5), and Asian (aOR, 1.9; 95% CI, 1.0–3.6) patients compared with non-Hispanic white patients. Ninety percent of Blastomyces dermatitidis infections occurred in non-Hispanic whites, whereas blastomycosis in Hispanic whites, AIAN, and Asian patients was frequently caused by Blastomyces gilchristii (P < .0001). Conclusions: Hispanic whites, AIAN, and Asian blastomycosis patients were younger and healthier but more frequently hospitalized. Patients in these racial and ethnic groups may need more aggressive treatment and closer therapeutic monitoring.
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The odds of hospitalization for blastomycosis were 2 to 3 times higher for Hispanic white, AI/AN, and Asian persons compared to non-Hispanic white persons.
“Furthermore, while non-Hispanic white persons were frequently older and had more underlying medical conditions compared to Hispanic white and Asian persons, the odds of hospitalization were 2 to 3 times higher for Hispanic white, AI/AN, and Asian persons [177].”
From Race and ethnicity: Risk factors for fungal infections? (2023) · cites this paper as [177]
Non-Hispanic white persons with blastomycosis were frequently older and had more underlying medical conditions compared to Hispanic white and Asian persons.
“Furthermore, while non-Hispanic white persons were frequently older and had more underlying medical conditions compared to Hispanic white and Asian persons, the odds of hospitalization were 2 to 3 times higher for Hispanic white, AI/AN, and Asian persons [177].”
From Race and ethnicity: Risk factors for fungal infections? (2023) · cites this paper as [177]
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- Authors
- Anderson, J. L., Frost, H. M., King, J. P., & Meece, J. K.
- Affiliations
- Marshfield Clinic Research Foundation (US)
- Denver Health Medical Center (US)
- Corresponding author
- Meece, Jennifer K
- Venue
- Open Forum Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-10-04
- Volume
- 6
- Issue
- 11
- Pages
- ofz438-ofz438
- ISSN
- 2328-8957 (ISSN-L)
- PMC
- PMC6824527
- OpenAlex
- W2978663653
- Cited by
- 12
- References
- 40
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 1
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Open Forum Infectious Diseases (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Marshfield Clinic Research Institute
- Topics
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Microbiology › Actinomycetales infections and treatment
- Keywords
- blastomycosis, racial and ethnic disparities, hospitalization, clinical phenotype, Blastomyces dermatitidis, dimorphic fungal infection, Hispanic whites, American Indian/Alaska Native patients, Asian patients, disease severity, age differences
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