SAN DIEGO – The incidence of hospitalizations associated with invasive candidiasis decreased between 2007 and 2012, but both elderly and black patients remain at greatest risk for the infection, according to an analysis of national data.
“It’s been noted previously that the incidence of neonatal candidiasis seems to be going down, but we wanted to focus on older populations,” Sara Strollo, M.P.H., a trainee in the division of intramural research at the National Institute of Allergy and Infectious Diseases, Rockville., Md., said in an interview at an annual scientific meeting on infectious diseases.
Doug Brunk/Frontline Medical News
Sara Strollo
For the study, which is the first of its kind, Ms. Strollo and her associates analyzed data from the State Inpatient Database from the Agency for Healthcare Research and Quality, which represents 97% of all community hospital discharges. They excluded neonatal cases.
The age-adjusted annual incidence of hospitalizations associated with invasive candidiasis ranged from 4.3 to 6.0 per 100,000 persons between 2002 and 2012. The incidence increased from 2002-2005, was stable through 2007, and decreased significantly between 2007 and 2012 -- by 6.7% among men and by 7.4% among women.
The highest incidence of hospitalization for invasive candidiasis occurred among the oldest age groups and among men. For example, compared with persons aged 50-64, the average annual incidence among those over age 80 years old was 2.6-fold higher among women (7.6 vs. 19.7 per 100,000 persons) and 3.9-fold higher among men (7.6 vs. 30 per 100,000 persons).
The researchers also found that among persons older than 50 years of age, black men and women had more than a two-fold higher incidence, compared with white men and women (23.7 vs. 11.7 per 100,000 persons and 22 vs. 10.4 per 100,000 persons, respectively).
During the overall study period, Ms. Strollo and her associates observed a nearly three-fold variation in the average annual incidence of hospital discharges for candidiasis per 100,000 persons, from 2.7 in Oregon to 7.2 in Florida. States with the highest incidence were Florida, Maryland, Missouri, Michigan, California, and Texas, but temporal trends were similar across states and no clear regional patterns among states were observed.
The investigators limited their analysis to 24 states with continuous reporting from 2002 through 2012, which represents 65% of the United States population. The researchers extracted records for discharges where ICD-9 codes for invasive candidiasis were listed in the primary or secondary discharge fields, including disseminated candidiasis (112.5), candidal endocarditis (112.81), and candidal meningitis (112.83). Age, gender, hospitalization year, and state data were extracted, and U.S. Census Bureau data were used as the denominator for state hospitalization incidence and trends. Poisson regression was used to assess significance of trends.
IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no financial disclosures.