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.
Summary
Blastomycosis and histoplasmosis incidence rates have increased two-fold in the United States from 2013 to 2023, including outside of historically endemic regions. Incidence rates varied by race and ethnicity, age, and gender.
