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. 2019 Mar 21;19(1):274.
doi: 10.1186/s12879-019-3901-y.

A population-based analysis of invasive fungal disease in haematology-oncology patients using data linkage of state-wide registries and administrative databases: 2005 - 2016

Jake C Valentine  1   2 , C Orla Morrissey  3   4 , Mark A Tacey  5 , Danny Liew  5 , Sushrut Patil  4 , Anton Y Peleg  3   6 , Michelle R Ananda-Rajah  3   7
Affiliations

A population-based analysis of invasive fungal disease in haematology-oncology patients using data linkage of state-wide registries and administrative databases: 2005 - 2016

Jake C Valentine et al. BMC Infect Dis. .

Abstract

Background: Little is known about the morbidity and mortality of invasive fungal disease (IFD) at a population level. The aim of this study was to determine the incidence, trends and outcomes of IFD in all haematology-oncology patients by linking Victorian hospital data to state-based registries.

Methods: Episodes of IFD complicating adult haematological malignancy (HM) and haematopoietic stem cell transplantation (HSCT) patients admitted to Victorian hospitals from 1st July 2005 to 30th June 2016 were extracted from the Victorian Admitted Episodes Dataset and linked to the date of HM diagnosis from the Victorian Cancer Registry and mortality from the Victorian Death Index. Descriptive analyses and regression modelling were used.

Results: There were 619,702 inpatient-episodes among 32,815 HM and 1,765 HSCT-patients. IFD occurring twelve-months from HM-diagnosis was detected in 669 (2.04%) HM-patients and 111 (6.29%) HSCT-recipients, respectively. Median time to IFD-diagnosis was 3, 5, 15 and 22 months in acute myeloid leukaemia, acute lymphoblastic leukaemia, Hodgkin lymphoma and multiple myeloma, respectively. Median survival from IFD-diagnosis was 7, 7 and 3 months for invasive aspergillosis, invasive candidiasis and mucormycosis, respectively. From 2005-2016, IFD incidence decreased 0.28% per 1,000 bed-days. Fungal incidence coincided with spring peaks on time-series analysis.

Conclusions: Data linkage is an efficient means of evaluating the epidemiology of a rare disease, however the burden of IFD is likely underestimated, arguing for better quality hospital level surveillance data to improve management strategies.

Keywords: Invasive fungal disease; data linkage; epidemiology; haematological malignancy; haematopoietic stem cell transplantation.

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Conflict of interest statement

Authors’ information

J.C.V. BBiomedSc(Hons), Ph.D. Candidate and Research Fellow, University of Melbourne, the Peter MacCallum Cancer Centre and the National Centre for Infections in Cancer; C.O.M. MB, BCh, FRACP, Grad Dip Clin Epi, Ph.D., Infectious Diseases Physician, Monash University and Alfred Health; M.A.T. MBiostat, BSc., Research Fellow and Biostatistician, Austin Health; D.L. MBBS (Hons), BMedSc, FRACP, Ph.D., CertHealthEcon, Professor of Clinical Outcomes Research; S.P. MBBS; FRACP, FRCPA, Haematologist, Alfred Health; A.Y.P. MBBS Ph.D. MPH FRACP, Infectious Diseases Physician, Monash University and Alfred Health; M.R.A.-R. MBBS (Hons) FRACP Ph.D., Infectious Diseases Physician, Monash University and Alfred Health.

Ethics approval and consent to participate

Written ethics approval was granted by the Alfred Health Human Research Ethics Committee (project number: 93/17). The need for informed consent was deemed unnecessary according to national regulations in accordance with the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research (2007 and updates) [43]. Administrative permission to access the raw data from the Victorian Data Linkages Unit was granted from Ms. Fiona Miles of the Monash University Advisory Board and Dr. Tsharni Zazryn of the Monash Research Office.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Overview of the probabilistic and stepwise deterministic linkage across administrative datasets held by the State Government of Victoria. IFD, invasive fungal disease; HM, haematological malignancy; HSCT, haematopoietic stem cell transplantation; VAED, Victorian Admitted Episodes Dataset
Fig. 2
Fig. 2
Prevalence of invasive fungal disease among cases by haematological malignancy or haematopoietic stem cell transplantation. ALL, acute lymphoblastic leukaemia; allo-HSCT, allogeneic haematopoietic stem cell transplantation; AML, acute myeloid leukaemia; auto-HSCT, autologous haematopoietic stem cell transplantation; CLL, chronic lymphocytic leukaemia; CML, chronic myeloid leukaemia; HL, Hodgkin-lymphoma; MM, multiple myeloma; NHL, non-Hodgkin lymphoma.
Fig. 3
Fig. 3
Overall distribution of time (months) to invasive fungal disease stratified by haematological malignancy and haematopoietic stem cell transplantation. ALL, acute lymphoblastic leukaemia; allo-HSCT, allogeneic-haematopoietic stem cell transplantation; AML, acute myeloid leukaemia; auto-HSCT, autologous-haematopoietic stem cell transplantation; CLL, chronic lymphoblastic leukaemia; CML, chronic myeloid leukaemia; HL, Hodgkin lymphoma; HM, haematological malignancy; IFD, invasive fungal disease; IQR, inter-quartile range; MM, multiple myeloma; NHL, non-Hodgkin lymphoma. Median [IQR] time (months) to IFD: ALL, 5 [2 – 12]; AML, 3 [1 – 10]; CLL, 19 [4 – 45]; CML, 12 [2 – 25]; HL, 15 [1 – 29]; MM, 22 [7 – 36]; NHL, 6 [2 -18]; allogeneic-HSCT, 4 [2 – 18]; autologous-HSCT, 7 [5 – 10]
Fig. 4
Fig. 4
Kaplan-Meier survival curves illustrating overall survival (months) from invasive fungal disease diagnosis between invasive aspergillosis (IA), invasive candidiasis (IC), mucormycosis and other invasive fungal disease. IFD, invasive fungal disease.
Fig. 5
Fig. 5
The quarterly incidence (financial years; %) of invasive fungal disease (IFD) in Victoria (2005 – 2016) along with a linear fitted values line. Black arrows indicate the spring months. Q, quarter
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