Trends in Hospitalizations related to Aspergillosis and Mucormycosis in the United States, 2016 - 2021 Restricted; Files & ToC

Abstract

Background: Aspergillosis-related hospitalizations (A-RH) and mucormycosis-related hospitalizations (M-RH) pose significant clinical challenges due to their aggressive progression, high mortality, frequent readmissions, and substantial financial burden. While these infections can affect immunocompetent individuals, immunocompromised patients face particularly high hospitalization costs and mortality rates. The COVID-19 pandemic exacerbated this burden, as corticosteroid use increased the risk of COVID-19-associated aspergillosis (CAA) and COVID-19-associated mucormycosis (CAM), driving up hospitalization rates and in-hospital mortality.

Methods: We analyzed 2016–2021 National Inpatient Sample (NIS) discharge data using ICD-10 codes to estimate A-RH and M-RH rates, clinical subtypes, and associated comorbidities. Annual percentage changes (APC) were calculated using weighted least-squares regression on log-transformed rates. U.S. Census population estimates allowed calculation of rates with trend assessments and 95% confidence intervals.

Results: Between 2016 and 2021, an estimated 86,570 A-RHs and 8,565 M-RHs occurred. A-RH rates rose from 42.3 to 51.5 per million persons (APC = +2.4%; p = 0.2904), and M-RH rates rose from 3.8 to 5.8 (APC = +3.2%; p = 0.2033). In-hospital mortality increased significantly in 2021 for A-RH (26.8%; APC = +20.0%; p = 0.0363) and M-RH (24.7%; APC = +16.5%; p = 0.0162). Invasive aspergillosis and pulmonary mucormycosis showed significant increases (APC = +7.2%; p = 0.0005 and APC = +9.6%; p = 0.0111, respectively).

Underlying conditions associated with A-RH included COPD (33.1%), diabetes (27.9%), and HM (20.7%), while M-RH was associated with COPD (11.1%), diabetes (45.7%), and HM (31.2%). Among CAA-RH and CAM-RH cases during 2020–2021, diabetes was a major comorbidity, present in 42.2% and 63.1% of cases, respectively. COPD followed with 21% in CAA-RH and 14.3% in CAM-RH. In-hospital mortality during this period rose to 55.7% for CAA-RH and 52.4% for CAM-RH.

Conclusion: Rates of A-RH and M-RH continue to rise, along with in-hospital mortality and clinical subtypes. The COVID-19 pandemic has amplified these trends, extending risk to populations beyond traditionally recognized immunocompromised groups. These findings underscore the need for broader clinical awareness and preventive strategies.

Keywords: Invasive Mold Infections (IMI), Aspergillosis, Mucormycosis, COVID-19-associated fungal infections, hospitalization trends, immunocompromised population

Table of Contents

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	immunocompromised hospitalization trends Invasive mold infections Aspergillosis COVID-19-associated fungal infections Mucormycosis
Committee Chair / Thesis Advisor	Alex Edwards, Ph.D., Emory University
Committee Members	Jeremy Gold, MD, MS, Centers for Disease Control and Prevention Kaitlin Benedict, MPH, Centers for Disease Control and Prevention

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