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Table 1.  

Fungal infections and risk conditions ICD-10 code No. cases diagnosed
Fungal infections    
   Aspergillosis B44 17,825
      Invasive B44.0, B44.1, B44.7 8,875
      Noninvasive B44.2, B44.8 4,210
   Candidiasis B37 457,080
      Invasive B37.1, B37.5, B37.6, B37.7 19,920
      Noninvasive B37.0, B37.2, B37.3, B37.4, B37.8 396,765
   Coccidioidomycosis B38 8,990
   Cryptococcosis B45 4,900
   Histoplasmosis B39 4,880
   Mucormycosis B46 1,370
   Pneumocystosis B59 9,725
   Other B35, B36, B40–B43, B47, B48 145,925
   Unspecified mycoses B49 15,540
Risk conditions    
   Asthma J45–J46 2,273,360
   Autoimmune conditions G35, G70, K90, L93, M05, M35 483,850
   Cancer C00–C97 2,869,790
   Chronic obstructive pulmonary disease J44 4,402,564
   Cirrhosis K74 468,950
   Cystic fibrosis E84 29,465
   Diabetes mellitus E10–E14 8,376,979
   End-stage renal disease D17 32,665
   HIV B20–B24 109,180
   Immunosuppressive disorders D80–D89 224,100
   Influenza J09–J11 276,950
   Myelodysplastic syndrome D46 82,170
   Neutropenia D70 194,870
   Osteomyelitis M86 385,450
   Pneumonia J12–J18 2,552,504
   Sepsis A40–A41 2,820,729
   Transplant history Z94 266,580
   Transplant complications T86 145,540
   Tuberculosis A16–A19 3,690

Table. Number of risk conditions and fungal infections diagnosed among hospitalized patients, United States, 2019*

*Data from ICD-10 codes listed in the Healthcare Cost and Utilization Project, 2019[20]. ICD-10, International Classification of Diseases, 10th Revision.


Demographic and Socioeconomic Factors Associated With Fungal Infection Risk, United States, 2019

  • Authors: Emily Rayens, PhD, MPH; Mary Kay Rayens, PhD, MS; Karen A. Norris, PhD
  • CME / ABIM MOC Released: 9/21/2022
  • Valid for credit through: 9/21/2023
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care clinicians, infectious disease specialists, and other clinicians who treat and manage patients at risk for fungal infections.

The goal of this activity is for learners to be better able to distinguish sociodemographic risk factors for fungal infection during hospitalization.

Upon completion of this activity, participants will:

  • Analyze the rate of hospitalizations with fungal infection, based on sex
  • Distinguish sociodemographic risk factors for aspergillosis
  • Evaluate patterns of fungal infections among hospitalized patients, based on race/ethnicity
  • Assess age as a risk factor for fungal infections among inpatients


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  • Emily Rayens, PhD, MPH

    University of Georgia
    Athens, Georgia

  • Mary Kay Rayens, PhD, MS

    University of Kentucky
    Lexington, Kentucky

  • Karen A. Norris, PhD

    University of Georgia
    Athens, Georgia

CME Author

  • Charles P. Vega, MD

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


    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.


  • Amy J. Guinn, BA, MA

    Emerging Infectious Diseases

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  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

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Demographic and Socioeconomic Factors Associated With Fungal Infection Risk, United States, 2019

Authors: Emily Rayens, PhD, MPH; Mary Kay Rayens, PhD, MS; Karen A. Norris, PhDFaculty and Disclosures

CME / ABIM MOC Released: 9/21/2022

Valid for credit through: 9/21/2023


Abstract and Introduction


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.


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.