Bartels Juliana G E, Camponuri Simon K, Snow Theo T, Bustamante Brittany L Morgan, Kane Natalie J, Reynolds Rose M, Lee Aidan, Hoffman Mark, White Theodore C, Remais Justin V, Head Jennifer R
Division of Environmental Health Sciences, University of California, Berkeley, Berkeley, CA.
Children's Mercy Research Institute, UMKC School of Medicine, Kansas City, MO.
medRxiv. 2025 Jun 6:2025.06.03.25328884. doi: 10.1101/2025.06.03.25328884.
Where surveillance data are limited, nationally-representative electronic health records allow for geographic, temporal, and demographic characterization of the fungal diseases blastomycosis and histoplasmosis.
We identified incident blastomycosis and histoplasmosis cases from 2013 to 2023 within Oracle EHR Real-World Data, which comprises 1.6 billion healthcare encounters nationally. To characterize geographic and temporal incidence rates, we used weighted generalized estimating equations adjusting for non-representativeness of EHR-reporting facilities. We computed standardized incidence rate ratios (sIRRs), which relay relative differences in standardized incidence rates among region, race/ethnicity, gender, and age subgroups and the national population.
National incidence rates in 2023 were 2.4 (95% CI: 1.6-3.5) and 1.9 times (95% CI: 1.6-2.2) rates in 2013, for blastomycosis and histoplasmosis, respectively. Blastomycosis incidence rates among Hispanic/Latino and non-Hispanic Black individuals were 60% (sIRR: 1.6 [95% CI: 1.0-2.4]) and 30% (sIRR: 1.3 [95% CI: 1.0-1.6]) higher than the standardized national incidence rate. Histoplasmosis incidence rates were elevated among non-Hispanic White patients (sIRR: 1.05 [95% CI: 1.02-1.08]). Standardized incidence rates of both diseases were higher among older and male patients and were elevated in the Upper Midwest (sIRR: blastomycosis: 5.1 [95% CI: 3.7-6.8]; histoplasmosis: 1.7 [95% CI: 1.5-1.9]) and Ohio Valley regions (sIRR: blastomycosis: 2.0 [95% CI: 1.7-2.3]; histoplasmosis: 2.3 [95% CI: 2.2-2.5], and increased in the Northern Rockies and Plains from 2013 to 2023.
This analysis revealed increasing incidence rates of blastomycosis and histoplasmosis and expansion outside of historically endemic regions, with notable differences in incidence by race/ethnicity, gender, and age.
在监测数据有限的情况下，全国代表性的电子健康记录有助于对芽生菌病和组织胞浆菌病这两种真菌疾病进行地理、时间和人口统计学特征分析。
我们在甲骨文电子健康记录真实世界数据中识别了2013年至2023年期间的芽生菌病和组织胞浆菌病确诊病例，该数据包含全国范围内16亿次医疗就诊信息。为了描述地理和时间发病率，我们使用加权广义估计方程来调整电子健康记录报告机构的非代表性。我们计算了标准化发病率比（sIRR），它反映了不同地区、种族/民族、性别和年龄亚组与全国人口之间标准化发病率的相对差异。
2023年芽生菌病和组织胞浆菌病的全国发病率分别是2013年的2.4倍（95%置信区间：1.6 - 3.5）和1.9倍（95%置信区间：1.6 - 2.2）。西班牙裔/拉丁裔和非西班牙裔黑人个体的芽生菌病发病率分别比全国标准化发病率高60%（sIRR：1.6 [95%置信区间：1.0 - 2.4]）和30%（sIRR：1.3 [95%置信区间：1.0 - 1.6]）。非西班牙裔白人患者的组织胞浆菌病发病率有所升高（sIRR：1.05 [95%置信区间：1.02 - 1.08]）。这两种疾病的标准化发病率在老年患者和男性患者中更高，并且在中西部上游地区（sIRR：芽生菌病：5.1 [95%置信区间：3.7 - 6.8]；组织胞浆菌病：1.7 [95%置信区间：1.5 - 1.9]）和俄亥俄河谷地区（sIRR：芽生菌病：2.0 [95%置信区间：1.7 - 2.3]；组织胞浆菌病：2.3 [95%置信区间：2.2 - 2.5]）也有所升高，并且从2013年到2023年在落基山脉北部和平原地区有所增加。
该分析揭示了芽生菌病和组织胞浆菌病的发病率在上升且超出了历史流行地区，在种族/民族、性别和年龄方面的发病率存在显著差异。
