Monday, December 4, 2023
| 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.
| 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.
| 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.
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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.
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.
