Updating the epidemiology of blastomycosis and histoplasmosis in the United States, using national electronic health record data, 2013 - 2023

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Introduction: Where surveillance data are limited, nationally-representative electronic health records allow for geographic, temporal, and demographic characterization of the fungal diseases blastomycosis and histoplasmosis. Methods: We identified incident blastomycosis and histoplasmosis cases from 2013 to 2023 within Oracle EHR Real-World Data, which comprises 1.6 billion healthcare encounters nationally. To characterize geographic and temporal incidence rates, we used weighted generalized estimating equations adjusting for non-representativeness of EHR-reporting facilities. We computed standardized incidence rate ratios (sIRRs), which relay relative differences in standardized incidence rates among region, race/ethnicity, gender, and age subgroups and the national population. Results: National incidence rates in 2023 were 2.4 (95% CI: 1.6-3.5) and 1.9 times (95% CI: 1.6-2.2) rates in 2013, for blastomycosis and histoplasmosis, respectively. Blastomycosis incidence rates among Hispanic/Latino and non-Hispanic Black individuals were 60% (sIRR: 1.6 [95% CI: 1.0-2.4]) and 30% (sIRR: 1.3 [95% CI: 1.0-1.6]) higher than the standardized national incidence rate. Histoplasmosis incidence rates were elevated among non-Hispanic White patients (sIRR: 1.05 [95% CI: 1.02-1.08]). Standardized incidence rates of both diseases were higher among older and male patients and were elevated in the Upper Midwest (sIRR: blastomycosis: 5.1 [95% CI: 3.7-6.8]; histoplasmosis: 1.7 [95% CI: 1.5-1.9]) and Ohio Valley regions (sIRR: blastomycosis: 2.0 [95% CI: 1.7-2.3]; histoplasmosis: 2.3 [95% CI: 2.2-2.5], and increased in the Northern Rockies and Plains from 2013 to 2023. Discussion: This analysis revealed increasing incidence rates of blastomycosis and histoplasmosis and expansion outside of historically endemic regions, with notable differences in incidence by race/ethnicity, gender, and age.

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