Volume 17, Number 9—September 2011
Research
Geographic Distribution of Endemic Fungal Infections among Older Persons, United States1
, Kevin L. Winthrop, Nivedita M. Patkar, Elizabeth Delzell, Timothy Beukelman, Fenglong Xie, Lang Chen, and Jeffrey R. Curtis
Table 1
Characteristics of Medicare beneficiaries with mycoses, United States, 1999–2008
| Characteristic | No. (%) patients |
|||
|---|---|---|---|---|
| Histoplasmosis, n = 357 | Coccidioidomycosis, n = 345 | Blastomycosis, n = 74 | Total, n = 1,913,247* | |
| Male sex | 180 (50.4) | 200 (58.1) | 42 (56.5) | 807,204 (42.2) |
| White race |
342 (95.8) |
62 (89.9) |
61 (82.4) |
1,679,198 (87.8) |
| Region | ||||
| Midwest | 169 (47.3) | 63 (18.3) | 29 (39.2) | 494,139 (25.8) |
| North | 24 (6.72) | 14 (4.0) | 2 (2.7) | 375,987 (19.7) |
| South | 145 (40.6) | 25 (7.25) | 41 (55.4) | 733,676 (38.4) |
| West |
19 (5.3) |
243 (70.4) |
2 (2.7) |
309,525 (16.2) |
| Rural location† |
137 (38.4) |
52 (15.1) |
34 (46.6) |
502,973 (26.3) |
| Concurrent medical conditions | ||||
| Chronic obstructive pulmonary disease | 142 (39.8) | 107 (31.0) | 21 (28.4) | 102,936 (5.4) |
| Diabetes mellitus | 71 (19.9) | 80 (23.2) | 20 (27.0) | 204,726 (10.7) |
| Solid malignancy | 67 (18.8) | 41 (11.9) | 20 (27.0) | 128,766 (6.7) |
| Hematologic malignancy‡ | 12 (3.4) | <11 | <11 | 13,393 (0.7) |
| Rheumatoid arthritis | 19 (5.3) | 21 (6.1) | 0 | 21,046 (1.1) |
| Chronic kidney disease‡ | 20 (5.6) | 25 (7) | <11 | 13,393 (0.7) |
| Neutropenia‡ |
<11 |
<11 |
<11 |
3,826 (0.2) |
| 90-day mortality§ | 35 (9.2) | 32 (9.3) | <11 | |
*Random national sample of 5% of Medicare beneficiaries with claims during 1999–2008; selected for cohort were those who were age >65 years at start of follow-up, had full Medicare coverage (parts A and B, not in a Medicare Advantage plan) for at least 13 consecutive months; lived in the 50 US states or Washington, DC; and did not have claims for any endemic mycosis during a 12-month period before the start of follow-up. Mean age of those with mycoses was 75.7 years.
†Rural residential status defined by linkage of 9-digit ZIP codes to the rural-urban commuting area code for the corresponding census block.
‡Per Centers for Medicare and Medicaid Services data use guidelines, cell sizes <11 cannot be shown.
§Those who died within 90 days after mycosis diagnosis.
1This research was presented in part at the 74th American College of Rheumatology Annual Meeting, November 7–11, 2010, Atlanta, Georgia, USA.