Methods: Discharge records for hospital admissions between 2008 and 2014 with an ICD-9-CM discharge diagnosis code for coccidioidal meningitis (114.2) were obtained from all non-federal facilities in Arizona. Concurrent immunosuppressive conditions (diabetes, HIV/AIDS, pregnancy) were also identified using ICD-9 codes. Demographic characteristics were defined using the initial hospitalization. Analyses were performed using SAS 9.3.
Results: There were 1,251 hospitalizations associated with coccidioidal meningitis among 623 patients during the study period. The average annual hospitalization rate was 2.74 admissions per 100,000 person-years. No statistically significant temporal trend was observed. Seventy percent (n=433) of patients were male. The mean age at first admission was 47 years. The hospitalization rate among black persons was 4.85 times higher than that in whites (95% CI: 3.29, 7.13). In-hospital mortality was relatively rare: 31 (5%) patients died. Forty three percent of patients (n=267) had a concurrent condition: 20% (n=126) of patients had a diagnosis of HIV/AIDS, and 23% (n=146) had a diagnosis of diabetes. The median length of stay was six days. Sixty one percent of hospitalizations (n=381) involved an ICU stay. Readmission was common (41%) and more likely among black patients (RR 1.63; 95% CI: 1.15, 2.31) and diabetic patients (RR 1.41; 95% CI: 1.07, 1.87).
Conclusion: Hospitalization associated with coccidioidal meningitis is uncommon in Arizona. Although rarely fatal, the burden of severe, chronic disease is substantial.
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