McCotter Orion, Kennedy Jordan, McCollum Jeffrey, Bartholomew Michael, Iralu Jonathan, Jackson Brendan R, Haberling Dana, Benedict Kaitlin
Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
Open Forum Infect Dis. 2019 Mar 11;6(3):ofz052. doi: 10.1093/ofid/ofz052. eCollection 2019 Mar.
American Indians and Alaska Natives (AI/ANs) may be uniquely vulnerable to coccidioidomycosis given the large population residing in the Southwestern United States. We describe coccidioidomycosis-associated hospitalizations and outpatient visits during 2001-2014 in the Indian Health Service (IHS) system and compare hospitalizations with data from the Agency for Healthcare Research and Quality's National (Nationwide) Inpatient Sample (NIS).
We identified hospitalizations in the IHS and the NIS and outpatient visits in the IHS using (ICD-9-CM) codes 114.0-114.9. We calculated average annual hospitalization and outpatient visit rates per 1 000 000 population and used Poisson regression to calculate rate ratios (RRs) and 95% confidence intervals (CIs). We used multivariable logistic regression to assess factors associated with IHS hospitalization.
AI/ANs had the highest average annual hospitalization rate (58.0; 95% CI, 49.5-66.6) of any racial/ethnic group in the NIS, compared with 13.4 (95% CI, 12.7-14.2) for non-Hispanic whites. IHS data showed a hospitalization rate of 37.0; the median length of stay (interquartile range) was 6 (3-10) days. The average annual outpatient visit rate in IHS was 764.2, and it increased from 529.9 in 2001 to 845.9 in 2014. Male sex, age ≥65 years, diabetes, and extrapulmonary or progressive coccidioidomycosis were independently associated with increased risk for hospitalization. Twenty-four percent of patients had ICD-9-CM codes for community-acquired pneumonia in the 3 months before coccidioidomycosis diagnosis.
AI/ANs experience high coccidioidomycosis-associated hospitalization rates, high morbidity, and possible missed opportunities for earlier diagnosis. Yearly trends in IHS data were similar to the general increase in hospitalizations and reported cases nationwide in the same period.
鉴于大量美国印第安人和阿拉斯加原住民（AI/ANs）居住在美国西南部，他们可能特别容易感染球孢子菌病。我们描述了2001年至2014年期间印第安卫生服务（IHS）系统中与球孢子菌病相关的住院和门诊情况，并将住院情况与医疗保健研究与质量局的全国（全美）住院患者样本（NIS）数据进行比较。
我们使用国际疾病分类第九版临床修订本（ICD-9-CM）编码114.0 - 114.9确定IHS和NIS中的住院情况以及IHS中的门诊情况。我们计算了每100万人口的年均住院率和门诊就诊率，并使用泊松回归计算率比（RRs）和95%置信区间（CIs）。我们使用多变量逻辑回归评估与IHS住院相关的因素。
在NIS中，AI/ANs的年均住院率最高（58.0；95% CI，49.5 - 66.6），而非西班牙裔白人的年均住院率为13.4（95% CI，12.7 - 14.2）。IHS数据显示住院率为37.0；中位住院时间（四分位间距）为6（3 - 10）天。IHS的年均门诊就诊率为764.2，且从2001年的529.9增至2014年的845.9。男性、年龄≥65岁、糖尿病以及肺外或进行性球孢子菌病与住院风险增加独立相关。24%的患者在球孢子菌病诊断前3个月有社区获得性肺炎的ICD-9-CM编码。
AI/ANs经历了与球孢子菌病相关的高住院率、高发病率以及可能存在的早期诊断错失机会。IHS数据的年度趋势与同期全国住院和报告病例的总体增加情况相似。
