Malaria-Related Hospitalizations in the United States, 2000-2014

Abstract

Few data are available on the burden of malaria hospitalization in the United States. Study of malaria using hospital-based data can better define the impact of malaria and help inform prevention efforts. U.S. malaria cases identified from hospitalization discharge records in the 2000-2014 Nationwide Inpatient Sample were examined. Frequencies and population rates were reported by demographics, infecting species, clinical, financial, institutional, geographic, and seasonal characteristics, and disparities were identified. Time trends in malaria cases were assessed using negative binomial regression. From 2000 to 2014, there were an estimated 22,029 malaria-related hospitalizations (4.88 per 1 million population) in the United States, including 182 in-hospital deaths and 4,823 severe malaria cases. The rate of malaria-related hospitalizations did not change significantly over the study period. The largest number of malaria-related hospitalizations occurred in August. Malaria-related hospitalizations occurred disproportionately among patients who were male, black, or 25-44 years of age. Plasmodium falciparum accounted for the majority of malaria-related hospitalizations. On average, malaria patients were hospitalized for 4.36 days with charges of $25,789. Patients with a malaria diagnosis were more often hospitalized in the Middle Atlantic and South Atlantic census divisions, urban teaching, private not-for-profit, and large-bed-size hospitals. Malaria imposes a substantial disease burden in the United States. Enhanced primary and secondary prevention measures, including strategies to increase the use of pretravel consultations and prompt diagnosis and treatment are needed.

Figure 1.

Number and rate of malaria hospitalizations in the United States, Nationwide Inpatient Sample, 2000–2014. All numbers are national estimates based on weighted frequencies.

Figure 2.

Number of malaria-related hospitalizations in the United States, by month, Nationwide Inpatient Sample, 2000–2014. All numbers are national estimates based on weighted frequencies and nonmissing data.

Figure 3.

Rate of malaria-related hospitalizations in the United States, by division, Nationwide Inpatient Sample, 2000–2014. All numbers are national estimates based on weighted frequencies.