Estimating Severe Coccidioidomycosis in California

We used hospital discharge data to estimate incidence and distribution of coccidioidomycosis-associated hospitalizations in California.For 1997-2002, the average annual rate of hospitalization was 3.67 per 100,000 population.County of residence, older age, black race, male sex, HIV infection, and pregnancy were strongly associated with increased risk for hospitalization.C occidioidomycosis is caused by the fungi Coccidi- oides immitis and C. posadasii, which are present in soil in disease-endemic areas.Data are sparse on frequency and incidence of severe coccidioidomycosis that requires hospitalization.In California, population increase, changing racial composition, and increasing numbers of immunocompromised persons may have affected the incidence and severity of disease in recent years.We used hospital discharge data to estimate frequency and incidence of hospitalization with coccidioidomycosis for California, including its counties and its demographic subgroups. The StudyWe examined the Inpatient Hospital Discharge Data Set from the California Offi ce of Statewide Health Planning and Development for 1997-2002 (1), which contains inpatient discharge diagnoses from all nonfederal hospitals in California.We abstracted all records with any International Classifi cation of Diseases, 9th edition (ICD-9), code for coccidioidomycosis (114-114.5 and 114.9, with 114.2 representing coccidioidal meningitis) and defi ned each record as a discrete hospitalization.From each record, we extracted year of admission, county of residence, age, race, ethnicity, sex, presence of HIV infection (ICD-9 codes 042 or V08), pregnancy status (ICD9 codes V22-V23.9 or 630-676.9),vital status at discharge, and record locator number (RLN) (available for 1997-2000 only).We obtained population estimates from California Department of Finance by county of residence, age, racialethnic group, and sex (2,3).Numbers of AIDS cases and estimates of the population with HIV were obtained from the California Department of Health Services (4).All statistical analysis was conducted by using Stata 8.