title: Hospitalized burden and outcomes of coccidioidomycosis: A nationwide analysis, 2005-2012.
abstract: The incidence of coccidioidomycosis (CM) infection has increased over the last 20 years. We investigated recent trends of CM-associated hospitalization in the United States. patients with CM-associated hospitalization were identified from the Nationwide Inpatient Sample, 2005-2012. The outcomes of interest were the trend of annual hospitalization, in-hospital mortality, and independent risk factors for mortality. A total of 30,870 hospitalizations with CM (29,584 of adults; 1,286 of children) were identified. Over the 8-year study period, the number of hospitalizations for CM fluctuated but increased overall with successively higher peaks in 2009 and 2011. The annual median length of stay (LOS) shortened from 6 to 7 days in 2005-2010 to 4 days in 2011 and 5 days in 2012. The inflation-adjusted hospital charges were highest in 2006 then trended down by 21% in 2012. The in-hospital mortality declined from the highest level in 2005 (5.2%) to a low in 2010 (1.1%), then increased modestly in 2011 (1.9%) and 2012 (1.5%). Hospitalizations were identified in 46 states, with nearly half in Arizona (49.1%), followed by California (36.8%), Texas (3.3%), and Nevada (1.6%). Logistic regression analysis in adults revealed that in-hospital mortality was associated with age groups 61-70 years and >70 years (OR = 3.3 and 3.5, respectively. Ref: 18-30 years) and Charlson Index ≥1 (OR = 2.0-8.3). In children, males had lower risk for mortality than females (OR = 0.2). This study shows that CM-associated hospitalizations occur widely throughout the United States with an increasing admission trend; however, patient outcomes have improved and the cost of hospitalization has decreased.
authors.affiliation: Section of Infectious Diseases, Boston University, Boston Medical Center, Massachusetts, USA.
authors.forename: Ruihong
authors.initials: R
authors.lastname: Luo
authors.affiliation: Section of Infectious Diseases, Roseman University College of Medicine, Las Vegas, Nevada, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Greenberg
authors.affiliation: Comprehensive Digestive Institute of Nevada and Roseman University College of Medicine, Las Vegas, Nevada, USA.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Stone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003047:Coccidioidomycosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Coccidioidomycosis; epidemiology; hospitalization; outcomes; trend