Analysis of a nationally representative sample of electronic health record (EHR) data shows aspergillosis diagnoses increased by more than 5% annually in the United States from 2013 through 2023, US researchers reported late last week in Open Forum Infectious Diseases.

Aspergillosis is an infection caused by breathing in spores of Aspergillus, a common mold that’s ubiquitous indoors and outdoors. While most people don’t get sick from inhaling Aspergillus, it can cause severe and deadly infections in people who have lung disease or are immune-compromised (such as cancer patients and organ transplant recipients), with an overall death rate of 20%. Recent data also raise concerns that rising resistance to antifungal medications is making treatment more difficult.

Globally, there are an estimated 250,000 invasive aspergillosis and more than 3 million chronic pulmonary aspergillosis cases annually, but US trends are unclear because of the lack of surveillance for the disease. Previous studies of Aspergillus-associated infections in the United States have been limited to specific forms of the disease, inpatient populations, or high-risk groups, according to a team led by researchers from the University of California, Berkeley.

“This study aims to provide updated, population-wide estimates of aspergillosis diagnoses in U.S. adults using a large, multi-state electronic health record (EHR) dataset spanning various care settings,” they wrote.

Findings could aid diagnosis, surveillance

Using EHR data from a health insurance database covering more than 76 million US patients across 142 health systems, the researchers identified 20,764 aspergillosis cases from 2013 through 2023, for a population-based prevalence of 15.26 diagnoses per 100,000 person-years. Prevalence rose by 5.3% each year prior to the COVID-19 pandemic and peaked at 18.04 diagnoses per 100,000 person-years in 2022. 

Aspergillosis prevalence was highest in Rhode Island, which substantially exceeded the national average each year, and lowest in Utah. Diagnosis was higher among men than women (adjusted prevalence ratio [aPR], 1.37), adults aged 65 and older compared with adults aged 18 to 24 years (aPR, 4.95), and urban residents versus rural residents (rural aPR, 0.86). 

While White patients were more likely to be diagnosed as having aspergillosis in the years prior to the emergence of COVID-19, prevalence increased disproportionately among Hispanic or Latino groups and other racial minority groups after the onset of the COVID pandemic.

“These differences may reflect variations in baseline health, access to timely diagnosis and treatment, or the disproportionate impact of COVID-19,” the authors wrote.

“These findings may aid earlier clinical recognition, especially among groups not traditionally considered high-risk, and support efforts to expand diagnostic access and improve fungal disease surveillance,” they concluded.