title: Spatial epidemiology of blastomycosis hospitalizations: detecting clusters and identifying environmental risk factors.
abstract: Blastomycosis is a disease caused by endemic fungi that ranges from severe pulmonary or disseminated to mild or asymptomatic. Environmental factors associated with it are not well described throughout the endemic area. We used the intramural State Inpatient Database from the Agency for Healthcare Research and Quality and ArcMap GIS to identify geographic high-risk clusters of blastomycosis hospitalizations in 13 states in the US endemic regions (AR, IA, IL, IN, KY, LA, MI, MN, MO, MS, OH, TN, and WI). We then used logistic regression to identify risk factors associated with these high-risk clusters. We describe six clusters of counties in which there was an elevated incidence of blastomycosis hospitalizations. We identified maximum mean annual temperature, percentage of persons aged ≥65 years, and mercury and copper soil content as being associated with high-risk clusters. Specifically, the odds of a county being part of a high-risk cluster was associated with increasing percentage of population over age 65, decreasing maximum temperature, increasing mercury, and decreasing copper soil content. Healthcare providers should be aware of these high-risk areas so that blastomycosis can be included, as appropriate, in a differential diagnosis for patients currently or previously residing in these areas.
authors.affiliation: Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC seitza@niaid.nih.gov.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Seitz
authors.affiliation: Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Adjemian
authors.affiliation: Healthcare Cost Utilization Project, United States Agency for Healthcare Research and Quality, Rockville, Maryland.
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Steiner
authors.affiliation: Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: D Rebecca
authors.initials: DR
authors.lastname: Prevots
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001759:Blastomycosis / Q000453:epidemiology*; D002980:Climate; D016000:Cluster Analysis; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D062211:Spatio-Temporal Analysis; D019371:Topography, Medical; D014481:United States
keywords: Blastomyces dermatitidis; Blastomyces gilchristii; blastomycosis; epidemiology