title: Geographic distribution of endemic fungal infections among older persons, United States.
abstract: To investigate the epidemiology and geographic distribution of histoplasmosis, coccidioidomycosis, and blastomycosis in older persons in the United States, we evaluated a random 5% sample of national Medicare data from 1999 through 2008. We calculated national, regional, and state-based incidence rates and determined 90-day postdiagnosis mortality rates. We identified 776 cases (357 histoplasmosis, 345 coccidioidomycosis, 74 blastomycosis). Patient mean age was 75.7 years; 55% were male. Histoplasmosis and blastomycosis incidence was highest in the Midwest (6.1 and 1.0 cases/100,000 person-years, respectively); coccidioidomycosis incidence rate was highest in the West (15.2). On the basis of available data, for 86 (11.1%) cases, there was no patient exposure to a traditional disease-endemic area. Knowledge of areas where endemic mycosis incidence is increased may affect diagnostic or prevention measures for older adults at risk.
authors: University of Alabama at Birmingham, Birmingham, AL35294-0006, USA. jbaddley@uab.edu
authors: John W
authors: JW
authors: Baddley
authors: Kevin L
authors: KL
authors: Winthrop
authors: Nivedita M
authors: NM
authors: Patkar
authors: Elizabeth
authors: E
authors: Delzell
authors: Timothy
authors: T
authors: Beukelman
authors: Fenglong
authors: F
authors: Xie
authors: Lang
authors: L
authors: Chen
authors: Jeffrey R
authors: JR
authors: Curtis
mesh_terms: D000368:Aged; D001759:Blastomycosis / Q000453:epidemiology*; D003047:Coccidioidomycosis / Q000453:epidemiology*; D019353:Endemic Diseases; D005260:Female; D006660:Histoplasmosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology