Opportunistic candidiasis: an epidemic of the 1980s

Hospital discharge data from 1980 to 1989 from the National Center for Health Statistics, National Hospital Discharge Survey (NHDH), and two commercially generated hospital discharge data sources (PAS and McAuto) were analyzed to document nationally the increased rate of opportunistic candidal infections among hospitalized patients in the 1980s and to identify the major risk factors. National projections were made by year. Age-, sex-, race-, and disease-specific denominators were generated from NHDS data. ICD-9-CM codes derived from discharge diagnoses were used to identify patients with oropharyngeal candidiasis, disseminated candidiasis, human immunodeficiency virus (HIV) infection/AIDS, or malignancies and transplants. Between 1980 and 1989, rates of oropharyngeal candidiasis increased 4.7 times (from 0.34 to 1.6 cases per 1,000 admissions per year), and the number of deaths among patients with oropharyngeal candidiasis increased fivefold. Although the highest rates were among pediatric patients (3 cases per 1,000 pediatric admissions), the greatest rate increases were among 15- to 44-year-old patients (13-fold) and males (fivefold). Between 1983 and 1989, the rates of oropharyngeal candidiasis among patients with HIV infections/AIDS rose more than 22 times (from 0.02 to 0.45 case per 1,000 admissions; NHDS data). Over the whole decade, the rates of disseminated candidiasis increased 11 times (from 0.013 to 0.15 case per 1,000 admissions). Between 1985 and 1989, the rate of this complication among patients with HIV infection/AIDS increased 10-fold, compared with only a twofold rate increase among patients with malignancies or transplants. The rate of debilitating and life-threatening candidiasis among hospitalized patients increased considerably over the 1980s. This rate increase was significant among patients with HIV infection/AIDS and patients undergoing transplantation or immunosuppressive therapy for malignancies.