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Published on: March 22, 2012
Epidemiology of Aspergillosis Diagnoses in the U.S. using a National EHR Database, 2013-2023
Brittany L Morgan Bustamante1, Elijah G Martinez1, Aidan Lee2
1Division of Environmental Health Sciences, University of California, Berkeley, Berkeley, CA 94720.
Importance:
Aspergillosis is an under-recognized fungal infection associated with rising hospitalizations, concerns about antifungal resistance, and substantial morbidity and mortality in the U.S. Yet, national data on aspergillosis remain fragmented due to absence of centralized surveillance.
Objective:
To examine demographic and geographic variation and temporal trends in aspergillosis prevalence in the U.S. from 2013 to 2023; to assess how the COVID-19 pandemic influenced prevalence across population subgroups.
Design:
Retrospective cohort study using a large, national electronic health record (EHR) database.
Setting:
142 healthcare systems in the U.S. using Oracle Health EHR systems, encompassing disparate care settings.
Participants:
Adults aged 18 years and older who received care between January 1, 2013, and December 31, 2023. The cohort included over 76 million patients, and over 127 million person-years, with 20,764 aspergillosis diagnoses.
Exposures:
Calendar year, patient characteristics (age, sex, race, ethnicity, residence type), and state of residence. COVID-19 was treated as a time-varying exposure.
Main Outcomes And Measures:
Annual and overall prevalence of aspergillosis per 100,000 person-years; adjusted prevalence ratios (aPRs) by demographic group and state, estimated using quasi-Poisson and Bayesian spatiotemporal regression. COVID-19-related shifts in prevalence were assessed using estimated marginal means.
Results:
Between 2013 and 2023, aspergillosis prevalence increased 5% annually, peaking in 2022. Rhode Island had the highest aPR across all years; Utah the lowest. Prevalence was higher in males (aPR: 1.37), older adults (aPR for ≥65 vs. 18 to 34: 4.95), and urban residents (rural aPR: 0.86). Post-COVID-19, prevalence increased disproportionately among Hispanic or Latino patients and several racial minority groups. Suggestive trends of increasing prevalence were also observed among rural residents.
Conclusions And Relevance:
This study provides the most comprehensive national assessment to date of aspergillosis patterns in the U.S., revealing evidence of rising prevalence and emerging disparities shaped by the COVID-19 pandemic. Clinicians should consider regional and demographic risk patterns to support earlier diagnosis, guide antifungal treatment, and improve outcomes-especially among older adults and populations disproportionately affected by COVID-19. Clinicians practicing in rural or underserved areas should be particularly mindful of shifting risk profiles and advocate for improved diagnostic resources to reduce delays in care.
Insights
Aspergillosis prevalence in the U.S. rose 5% annually from 2013-2023, with disparities exacerbated by COVID-19. The study highlights increased risk in males, older adults, and urban populations, with emerging concerns for minority groups and rural residents.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health Surveillance
Background:
- Aspergillosis is an under-recognized fungal infection with significant morbidity and mortality in the U.S.
- Fragmented national data hinder comprehensive understanding and surveillance of aspergillosis trends.
- Rising hospitalizations and antifungal resistance underscore the need for updated prevalence data.
Purpose of the Study:
- To analyze demographic, geographic, and temporal trends in U.S. aspergillosis prevalence (2013-2023).
- To assess the impact of the COVID-19 pandemic on aspergillosis prevalence across different population subgroups.
- To identify disparities in aspergillosis prevalence based on patient characteristics and location.
Main Methods:
- Retrospective cohort study utilizing a large, national electronic health record (EHR) database.
- Inclusion of over 76 million adult patients from 142 U.S. healthcare systems (2013-2023).
- Analysis of prevalence using quasi-Poisson and Bayesian spatiotemporal regression, with COVID-19 as a time-varying exposure.
Main Results:
- Aspergillosis prevalence increased by 5% annually, peaking in 2022, with significant geographic variation.
- Higher prevalence observed in males, older adults (≥65 years), and urban residents.
- Post-COVID-19, prevalence disproportionately increased among Hispanic/Latino patients, racial minorities, and showed emerging trends in rural residents.
Conclusions:
- This study offers the most comprehensive national assessment of aspergillosis patterns, revealing rising prevalence and pandemic-driven disparities.
- Clinicians should consider regional and demographic risk factors for earlier diagnosis and improved outcomes, especially for vulnerable populations.
- Enhanced diagnostic resources and awareness are crucial for underserved areas and populations experiencing shifting risk profiles.
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