Infectious Disease
Coccidioidomycosis hospital visits in Texas, 2011-2021 Heather Mayfield* Heather Mayfield Vanora Davila
Coccidioidomycosis, or Valley fever, is a fungal disease caused by the soil-dwelling fungi Coccidioides immitis and Coccidioides posadasii. Texas is estimated to be in the endemic range of Coccidioides posadasii but does not have mandatory reporting requirements for coccidioidomycosis. The lack of surveillance in Texas limits understanding of disease dynamics and may contribute to underreporting and underdiagnosis due to decreased awareness. This study estimated the demographic characteristics and geographic distribution of coccidioidomycosis hospital visits, assessed the prevalence rates of hospital visits for coccidioidomycosis, and examined how rates vary by demographic and geographic factors. We used Texas Health Care Information Collection hospital discharges between 2011-2021 among Texas residents with a coccidioidomycosis-related diagnosis code in the record (n=6049 records). Coccidioidomycosis hospital visits increased from 348 in 2011 to 709 in 2021. Most hospital visits for coccidioidomycosis occurred in those 46-64 years old (42.6%), male (55.5%), and Hispanic (48.4%). A 96-county area designated as the Valley fever region accounted for 65.2% of visits, while only accounting for 37.8% of Texas counties. More than 75% of visits were in the Moderate/Extreme illness severity category. We used negative binomial regression to calculate prevalence rate ratios of hospital visits by demographic and geographic groups. Our results suggest that geographic region, sex, and race/ethnicity are associated with increased rates of hospital visits for coccidioidomycosis. Prevalence rates for females were lower compared to males (PR=0.36, 95% CI:0.31-0.42). Compared to Hispanics, non-Hispanic Blacks (PR=1.25, 95% CI:1.01-1.56) had higher prevalence rates, and non-Hispanic Whites (PR=0.80, 95% CI:0.65-0.98) had lower rates. These results highlight the need for increased awareness, expanded surveillance, and continued monitoring of coccidioidomycosis in Texas.