Epidemiology of Hospitalizations Associated with Invasive Candidiasis, United States, 2002-20121

Abstract

Invasive candidiasis is a major nosocomial fungal disease in the United States associated with high rates of illness and death. We analyzed inpatient hospitalization records from the Healthcare Cost and Utilization Project to estimate incidence of invasive candidiasis-associated hospitalizations in the United States. We extracted data for 33 states for 2002-2012 by using codes from the International Classification of Diseases, 9th Revision, Clinical Modification, for invasive candidiasis; we excluded neonatal cases. The overall age-adjusted average annual rate was 5.3 hospitalizations/100,000 population. Highest risk was for adults >65 years of age, particularly men. Median length of hospitalization was 21 days; 22% of patients died during hospitalization. Median unadjusted associated cost for inpatient care was $46,684. Age-adjusted annual rates decreased during 2005-2012 for men (annual change -3.9%) and women (annual change -4.5%) and across nearly all age groups. We report a high mortality rate and decreasing incidence of hospitalizations for this disease.

Keywords: Candida spp.; United States; candidemia; epidemiology; fungal infections; fungi; hospitalizations; incidence; invasive candidiasis; opportunistic infections.

Figure 1

Average annual invasive candidiasis−associated hospitalizations, United States, 2002−2012. Data were provided by State Inpatient Databases through the Healthcare Cost and Utilization Project maintained by the US Agency for Healthcare Research and Quality. Diagnoses were classified by using Agency for Healthcare Research and Quality clinical classification software (17) and multiple codes and ranges from the International Classification of Diseases, 9th Revision, Clinical Modification.

Figure 2

Annual rate of invasive candidiasis–associated hospitalizations by age, United States, 2002–2012. Neonates (<1 mo of age) were excluded from <1 population. Data were provided by State Inpatient Databases through the Healthcare Cost and Utilization Project maintained by the US Agency for Healthcare Research and Quality. Diagnoses were classified by using Agency for Healthcare Research and Quality clinical classification software (17) and multiple codes and ranges from the International Classification of Diseases, 9th Revision, Clinical Modification.

Figure 3

Average annual rate of invasive candidiasis–associated hospitalizations by age and sex, United States, 2002–2012. Neonates (<1 mo of age) were excluded from <1 population. Data were provided by State Inpatient Databases through the Healthcare Cost and Utilization Project maintained by the US Agency for Healthcare Research and Quality. Diagnoses were classified by using Agency for Healthcare Research and Quality clinical classification software (17) and multiple codes and ranges from the International Classification of Diseases, 9th Revision, Clinical Modification.

Figure 4

Average annual rate of invasive candidiasis–associated hospitalizations among older age groups (>50 years) by sex and race, United States, 2002–2012. Neonates (<1 mo of age) were excluded from <1 population. Data were provided by State Inpatient Databases through the Healthcare Cost and Utilization Project maintained by the US Agency for Healthcare Research and Quality. Diagnoses were classified by using Agency for Healthcare Research and Quality clinical classification software (17) and multiple codes and ranges from the International Classification of Diseases, 9th Revision, Clinical Modification.