Abstract and Introduction

Abstract

Fungal infections cause substantial rates of illness and death. Interest in the association between demographic factors and fungal infections is increasing. We analyzed 2019 US hospital discharge data to assess factors associated with fungal infection diagnosis, including race and ethnicity and socioeconomic status. We found male patients were 1.5–3.5 times more likely to have invasive fungal infections diagnosed than were female patients. Compared with hospitalizations of non-Hispanic White patients, Black, Hispanic, and Native American patients had 1.4–5.9 times the rates of cryptococcosis, pneumocystosis, and coccidioidomycosis. Hospitalizations associated with lower-income areas had increased rates of all fungal infections, except aspergillosis. Compared with younger patients, fungal infection diagnosis rates, particularly for candidiasis, were elevated among persons ≥65 years of age. Our findings suggest that differences in fungal infection diagnostic rates are associated with demographic and socioeconomic factors and highlight an ongoing need for increased physician evaluation of risk for fungal infections.

Introduction

Fungal pathogens cause millions of deaths and tens of millions of infections globally every year^[1]. Fungal infections are primarily opportunistic, causing moderate to severe disease in immunocompromised patients. Fungal infections also are associated with increased illness rates and substantial healthcare costs, resulting in $6.7 billion in hospitalization costs in the United States in 2018^[2]. In addition, fungal infections doubled the average length and cost of hospital stays and risk for death among patients with ≥1 associated risk condition^[2]. Despite the considerable medical and economic burden of fungal infections, standardized diagnostic and treatment guidelines are lacking.

The risk for serious fungal infection continues to move away from HIV-associated infections^[3], and increasingly affect patients with certain underlying conditions, including chronic obstructive pulmonary disease (COPD)^[4], cirrhosis^[5], cystic fibrosis^[6], diabetes^[7,8], influenza^[9,10], and tuberculosis^[11]. Increased infection rates also have been reported among persons being treated for asthma^[12,13], autoimmune disorders^[14,15], and cancer^[16], and among transplant recipients^[17].

Interest in the effects of race and ethnicity and socioeconomic status on fungal infections and associated patient outcomes has increased^[18,19], especially because diagnosed fungal infections have increased since 2010^[3]. Previous studies documented the relationship between health disparities and fungal infections^[18,19], but not as a main analytic focus, and studies across multiple fungal pathogens are lacking. We describe diagnosed fungal infections and associated risk conditions by key demographic variables, including race and ethnicity and socioeconomic status.