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Table 1.  

Characteristic All data ICD-9 data, 2010–2015q3† ICD-10 data, 2015q4–2016†
Babesiosis as 1 of all diagnoses 7,818 (100) 6,368 (100) 1,450 (100)
Primary diagnosis babesiosis 4,648 (59.5) 3,838 (60.2) 810 (55.9)
Demographic data
Age, y
      0–1 30 (0.4) 30 (0.5) NA
      18–44 831 (10.6) 641 (10.1) 190 (13.1)
      45–64 2583 (33.0) 2178 (34.2) 405 (27.9)
      ≥65 4374 (55.9) 3519 (55.3) 855 (59.0)
      Mean (SD) 64.7 (16.0) 64.5 (16) 65.7 (16.4)
      Median (IQR) 67 (55–77) 66 (55–76) 68.5 (55–78)
   Sex
      M 5,001 (64.0) 4,081 (64.1) 920 (63.4)
      F 2,817 (36.0) 2,287 (35.9) 530 (36.6)
   Race/ethnicity
      White 6,024 (80.1) 4,899 (80.2) 1,125 (79.8)
      African American 245 (3.3) 180 (3.0) 65 (4.6)
      Hispanic 503 (6.7) 403 (6.6) 100 (7.1)
      Asian/Pacific Islander 240 (3.2) 170 (2.8) 70 (5.0)
      Other 509 (6.7) 459 (7.5) 50 (3.5)
Hospital and temporal
   Admission month§   d  
      January 25 (0.8) 15 (0.8) 10 (0.7)
      February 60 (1.8) 25 (1.4) 35 (2.4)
      March 35 (1.1) 25 (1.4) 10 (0.7)
      April 51 (1.6) 41 (2.3) 10 (0.7)
      May 109 (3.3) 64 (3.5) 45 (3.1)
      June 371 (11.4) 171 (9.4) 200 (13.9)
      July 1,192 (36.5) 787 (43.1) 405 (28.1)
      August 762 (23.3) 437 (24.0) 325 (22.6)
      September 269 (8.2) 179 (9.8) 90 (6.3)
      October 80 (2.5) 20 (1.1) 60 (4.2)
      November 181 (5.5) 46 (2.5) 135 (9.4)
      December 130 (4.0) 15 (0.8) 115 (8)
   Elective vs. nonelective admissions
      Nonelective 7,452 (95.4) 6,067 (95.3) 1,385 (95.8)
      Elective 356 (4.6) 296 (4.7) 60 (4.2)
   Region of hospital¶
      Northeast 6,140 (86.0) 4,915 (86.4) 1,225 (84.5)
      Midwest 476 (6.7) 371 (6.5) 105 (7.2)
      South 375 (5.3) 295 (5.2) 80 (5.5)
      West 150 (2.1) 110 (1.9) 40 (2.8)
   Division subset of hospitals#
      New England: ME, NH, VT, MA, RI, CT 1,150 (44.1) 480 (41.4) 670 (46.2)
      Mid-Atlantic: NY, PA, NJ 1,115 (42.7) 560 (48.3) 555 (38.3)
      East North Central: WI, MI, IL, IN, OH 100 (3.8) 40 (3.4) 60 (4.1)
      West North Central: MO, ND, SE, NE, KS, MN, IA 65 (2.5) 20 (1.7) 45 (3.1)
      South Atlantic: DE, MD, DC, VA, WV, NC, SC, GA, FL 90 (3.4) 35 (3.0) 55 (3.8)
      East South Central: KY, TN, MS, AL 10 (0.4) ** 10 (0.7)
      West South Central: OK, TX, AR, LA 20 (0.8) ** 15 (1.0)
      Mountain: ID, MT, WY, NV, UT, CO, AZ, NM ** **
      Pacific: AK, WA, OR, CA, HI 55 (2.1) 20 (1.7) 35 (2.4)
   Hospital bed size**
      Small 2,159 (30.2) 1,659 (29.1) 500 (34.5)
      Medium 2,084 (29.2) 1,609 (28.3) 475 (32.8)
      Large 2,898 (40.6) 2,423 (42.6) 475 (32.8)
   Hospital teaching status**
      Rural 612 (8.6) 527 (9.3) 85 (5.9)
      Urban nonteaching 2,488 (34.8) 2,093 (36.8) 395 (27.2)
      Urban teaching 4,041 (56.6) 3,071 (54.0) 970 (66.9)

Table 1. Characteristics of hospitalized patients for whom babesiosis was listed as an admitting diagnoses, United States, 2010–2016*

*Values are no. (%) except as indicated. Data are from the NIS, which offers a representative sampling of US-based hospitals. Weighted national estimates are based on data that were collected by individual states and provided to AHRQ. Total number of weighted discharges in the US based on HCUP NIS: 37,352,013 (2010); 36,962,415 (2011); 36,484,846 (2012); 35,597,792 (2013); 35,358,818 (2014); 35,769,942 (2015); 35,675,421 (2016). In 2012, the NIS was redesigned to optimize national estimates. The nationwide statistics in HCUPnet for the years before 2012 were regenerated using new trend weights to permit longitudinal analysis. The regenerated data were posted to HCUPnet on July 2, 2014. HCUP notes that the statistics for the years before 2012 that are currently on HCUPnet will differ slightly from statistics obtained before that date. Information about the NIS redesign and trend weights is available at https://hcupnet.ahrq.gov. For more information about HCUP data. see http://www.hcup-us.ahrq.gov. AHRQ, Agency for Healthcare Research and Quality; HCUP, Healthcare Cost and Utilization Project; ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Revision; NA, not available; NIS, National Inpatient Sample. †Because of the transition from ICD-9 to ICD-10 in October 2015, the data represent 2 time periods. ICD-9 data reflect 2010 through the third quarter of 2015 (2015q3) and ICD-10 data represent the fourth quarter of 2015 (2015q4) through 2016. §Data for 2011–2014 not available. ¶2010 data not available. #Data available only for 2015 and 2016. **Statistics based on estimates with a relative SE (SE/weighted estimate) >0.30 or a total cell count <10 in the NIS are not reliable. These statistics are suppressed per HCUP policies.

Table 2.  

Disease severity and conditions All data, no. (%) ICD 9 data, 2010–2015q3,† no. (%) ICD10 data, 2015q4–2016,† no. (%)
APD-RG severity of illness
   Minor 376 (4.8) 316 (5.0) 60 (4.1)
   Moderate 2,863 (36.6) 2,318 (36.4) 545 (37.6)
   Major 3,660 (46.8) 2,990 (47.0) 670 (46.2)
   Extreme 914 (11.7) 744 (11.7) 170 (11.7)
APD-RG risk for death
   Minor 2,004 (25.6) 1,639 (25.7) 365 (25.2)
   Moderate 2,852 (36.5) 2,377 (37.3) 475 (32.8)
   Major 2,178 (27.9) 1,718 (27.0) 460 (31.7)
   Extreme 779 (10.0) 634 (10.0) 145 (10.0)
Concurrent conditions
   Decreased splenic function or asplenia 560 (7.2) 475 (7.1) 85 (5.9)
   HIV‡ 20 (0.3) 15 (0.2)
   Sickle cell disease 30 (0.4) 30 (0.5)
   Lyme disease (any diagnosis) 1,953 (25.0) 1,573 (24.7) 380 (26.2)
   Lyme disease (primary diagnosis) 276 (3.5) 221 (3.5) 55 (3.8)
   Anaplasmosis and ehrlichiosis 658 (8.4) 548 (8.6) 110 (7.6)
   Malaria 52 (0.7) 32 (0.5) 20 (1.4)
   Rocky Mountain spotted fever/rickettsial illness 25 (0.1) 20 (0.3) §
   Powassan virus disease, other tick-borne viral encephalitis § § §
   Relapsing fever § § §

Table 2. Disease severity, risk for death, and concurrent conditions in hospitalizations in which babesiosis was listed as an admitting diagnoses, United States, 2010–2016*

*Data are from the NIS, which offers a representative sampling of US-based hospitals. APR-DRG, All Patient Refined Diagnosis Related Group; HCUP, Healthcare Cost and Utilization Project; ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Revision; NIS, National Inpatient Sample. †Because of the transition from ICD-9-CM to ICD-10-CM in October 2015, the data represent 2 time periods. ICD-9 data reflect 2010 through the third quarter of 2015 (2015q3), and ICD-10 data represent the fourth quarter of 2015 (2015q4) through 2016. ‡Data from 2011–2014 not available. §Statistics that are based on estimates with a relative SE (SE/weighted estimate) >0.30 or a total cell count <10 in the NIS are not reliable. These statistics are suppressed per HCUP policies.

Table 3.  

Clinical outcome All data ICD-9 data, 2010–2015q3† ICD-10 data, 2015q4–2016†
Mortality, no. (%) 128 (1.6) 108 (1.7) 20 (1.4)
Length of stay, d
   Mean (SD) 5.8 (7.3) 5.8 (10.3) 5.8 (6.5)
   Median (IQR) 4 (3–7) 4 (2–6) 4 (3–7)
Total hospital charges for primary diagnosis of babesiosis‡
   Mean $36,850.51 $37,236.39 $36,464.62
   Aggregate national bill, USD $171,281,170 $142,911,768 $29,536,342
   Mean national bill per year, USD $24,468,739 $24,854,221 $23,629,074
Transfusion and apheresis use, no. (%)
   Erythrocyte transfusion 1560 (20.0) 1375 (21.6) 185 (12.8)
   Platelet transfusion 208 (2.7) 183 (2.9) 25 (1.7)
   Plasma transfused 88 (1.1) 78 (1.2) 10 (0.7)
   Erythrocyte exchange 80 (1.0) 75 (1.2) §
   Erythrocyte or plasma exchange 90 (1.2) 75 (1.2) 15 (1.0)
Complications, no. (%)
   Acute renal failure 1,594 (20.4) 1,209 (19) 385 (26.6)
   Respiratory failure 528 (6.8) 363 (5.7) 165 (11.4)
   Acute heart failure 270 (3.5) 200 (3.1) 70 (4.8)
   Disseminated intravascular coagulation 149 (1.9) 129 (2.0) 20 (1.4)

Table 3. Clinical outcomes and healthcare use in patients with babesiosis-associated hospitalizations, United States, 2010–2016*

*Data are from the NIS, which offers a representative sampling of US-based hospitals. Weighted national estimates are based on data that were collected by individual states and provided to AHRQ. Total number of weighted discharges in the United States based on HCUP NIS: 37,352,013 (2010); 36,962,415 (2011); 36,484,846 (2012); 35,597,792 (2013); 35,358,818 (2014); 35,769,942 (2015); 35,675,421 (2016). Statistics based on estimates with a relative SE (SE/weighted estimate) >0.30 or with SE 0 in the nationwide statistics (NIS, Nationwide Emergency Department Sample, and Kids’ Inpatient Database) are not reliable. In 2012, the National Inpatient Sample was redesigned to optimize national estimates. The nationwide statistics in HCUPnet for years before 2012 were regenerated using new trend weights to permit longitudinal analysis. The regenerated data were posted to HCUPnet on July 2, 2014. The statistics for years before 2012 currently on HCUPnet will differ slightly from statistics obtained before July 2, 2014. Information about the NIS redesign and trend weights is available at https://hcupnet.ahrq.gov. For more information about HCUP data, see http://www.hcup-us.ahrq.gov. ICD-9- International Classification of Diseases, Ninth Revision; ICD-10, International Classification of Diseases, Tenth Revision; HCUP, Healthcare Cost and Utilization Project; NIS, National Inpatient Sample. †Because of the transition from ICD-9-CM to ICD-10-CM in October 2015, the data represent 2 time periods. ICD-9 data reflect 2010 through the third quarter of 2015 (2015q3), and ICD-10 data represent the fourth quarter of 2015 (2015q4) through 2016. ‡Cost data were calculated for primary diagnosis only. ICD-9 charge data were obtained solely from HCUP (http://www.hcup-us.ahrq.gov). The aggregate national bill was determined by calculating the mean total charges per year multiplied by number of cases. §Statistics that are based on estimates with a relative SE (SE/weighted estimate) >0.30 or a total cell count <10 in the NIS are not reliable. These statistics are suppressed per HCUP policies.

CME / ABIM MOC

Epidemiology of Hospitalized Patients with Babesiosis, United States, 2010–2016

  • Authors: Evan M. Bloch, MBChB; Jonathan R. Day, MD, PharmD; Peter J. Krause, MD; Anne Kjemtrup, DVM, MPVM, PhD; Sheila F. O'Brien, PhD; Aaron A.R. Tobian, MD, PhD; Ruchika Goel, MD, MPH
  • CME / ABIM MOC Released: 1/20/2022
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 1/20/2023
Start Activity


Target Audience and Goal Statement

This activity is intended for infectious disease specialists, primary care physicians, and other physicians who care for patients at risk for babesiosis.

The goal of this activity is to assess the epidemiology of severe babesiosis in the US.

Upon completion of this activity, participants will:

  • Assess the pathology and outcomes of babesiosis
  • Distinguish the characteristics of patients with babesiosis
  • Analyze the most common season and geographic areas for babesiosis in the US
  • Identify the most common complication of babesiosis in the current study


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Medscape policies. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Evan M. Bloch, MBChB

    Johns Hopkins School of Medicine, Baltimore, Maryland

  • Jonathan R. Day, MD, PharmD

    University of Iowa Health Care, Iowa City, Iowa; SIU School of Medicine and Simmons Cancer Institute, Springfield, Illinois

  • Peter J. Krause, MD

    Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut

  • Anne Kjemtrup, DVM, MPVM, PhD

    California Department of Public Health, Sacramento, California

  • Sheila F. O'Brien, PhD

    Canadian Blood Services, Ottawa, Ontario, Canada

  • Aaron A.R. Tobian, MD, PhD

    Johns Hopkins School of Medicine, Baltimore, Maryland

  • Ruchika Goel, MD, MPH

    Johns Hopkins School of Medicine, Baltimore, Maryland; SIU School of Medicine and Simmons Cancer Institute, Springfield, Illinois

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Johnson & Johnson

Editor

  • Karen L. Foster, MA

    Copyeditor
    Emerging Infectious Diseases

    Disclosures

    Disclosure: Karen L. Foster, MA, has disclosed no relevant financial relationships.

CME Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Amanda Jett, PharmD, BCACP, has disclosed no relevant financial relationships.


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CME / ABIM MOC

Epidemiology of Hospitalized Patients with Babesiosis, United States, 2010–2016

Authors: Evan M. Bloch, MBChB; Jonathan R. Day, MD, PharmD; Peter J. Krause, MD; Anne Kjemtrup, DVM, MPVM, PhD; Sheila F. O'Brien, PhD; Aaron A.R. Tobian, MD, PhD; Ruchika Goel, MD, MPHFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC Released: 1/20/2022

Valid for credit through: 1/20/2023

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Abstract and Introduction

Babesia spp. are tickborne parasites that cause the clinical infection babesiosis, which has an increasing incidence in the United States. We performed an analysis of hospitalizations in the United States during 2010–2016 in which babesiosis was listed as a diagnosis. We used the National Inpatient Sample database to characterize the epidemiology of Babesia–associated admissions, reflecting severe Babesia-related disease. Over a 7-year period, a total of 7,818 hospitalizations listed babesiosis as a primary or secondary admitting diagnosis. Hospitalizations were seasonal (71.2% occurred during June–August) and situated overwhelmingly in the Northeast and Midwest. The patients were predominantly male and of advanced age, which is consistent with the expected epidemiology. Despite a higher severity of illness in more than (58.5%), the mortality rate was low (1.6%). Comparison with state reporting data suggests that the number of hospitalized persons with babesiosis increased modestly during the observation period.

Introduction

Babesia spp. are tickborne intraerythrocytic apicomplexan parasites responsible for the clinical infection babesiosis. Babesia microti, the leading cause of human babesiosis, is endemic in the northeastern and north-midwestern United States[1]. Although infection in immunocompetent adults may be mild or even subclinical, manifesting as a self-limiting viral-like illness (i.e., fever, headache, myalgia, fatigue), risk for severe disease and complications exists in certain patient populations (i.e., the very young, the elderly, persons with asplenia, and others with immunosuppression). Like Plasmodium parasites that cause malaria, Babesia spp. infect erythrocytes and induce hemolysis. Clinical complications include severe anemia, renal failure, cardiorespiratory failure, and death[1]. Babesia spp. also are readily transmissible by transfusion of infected erythrocytes. Given that anemia is the major indication for erythrocyte transfusion, coupled with the high proportion of patients at high risk for severe disease in the transfused population, transfusion-transmitted babesiosis has a death rate of ≈20%[1,2].

Reported cases of babesiosis and other tickborne diseases are increasing[3–5]. Postulated reasons for the increase include expansion of the geographic range of tick vector population, increase in deer (and consequent tick) populations, encroachment of humans into Babesia zoonotic habitats, climate change, and other ecologic changes that contribute to a rise in incidence of Babesia infection[6,7]. Babesiosis was designated a nationally notifiable disease in the United States in 2011, meaning that states where it was reportable were charged to voluntarily notify the Centers for Disease Control and Prevention (CDC) of cases. As of 2015, babesiosis was reportable in 33 states[8,9]. Although an increase in babesiosis cases has been reported, whether the increase includes primarily outpatients, hospitalized case-patients, or both is uncertain. To test whether hospitalized babesiosis patients are increasing, we analyzed hospitalizations in the United States in which babesiosis was listed as a diagnosis, using the National (Nationwide) Inpatient Sample (NIS) database, which offers a representative sampling of US-based hospitals. This analysis enabled characterization of the epidemiology of admissions, reflecting severe Babesia-related disease.