Epidemiological trends and clinical outcomes of cryptococcosis in a medically insured population in the United States: a claims-based analysis from 2017 to 2019

Daniel B Chastain; Qian Zhang; Xianyan Chen; Henry N Young; Carlos Franco-Paredes; Jose Tuells; George R Thompson 3rd; Andrés F Henao-Martínez

doi:10.1177/20499361241244967

Epidemiological trends and clinical outcomes of cryptococcosis in a medically insured population in the United States: a claims-based analysis from 2017 to 2019

Ther Adv Infect Dis. 2024 Apr 18:11:20499361241244967. doi: 10.1177/20499361241244967. eCollection 2024 Jan-Dec.

Authors

Daniel B Chastain¹, Qian Zhang², Xianyan Chen³, Henry N Young⁴, Carlos Franco-Paredes^{5

6}, Jose Tuells⁷, George R Thompson 3rd⁸, Andrés F Henao-Martínez⁹

Affiliations

¹ Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, 1000 Jefferson Street, Albany, GA 31701, USA.
² Department of Statistics, University of Georgia Franklin College of Arts and Sciences, Athens, GA, USA.
³ Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, GA, USA.
⁴ Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA.
⁵ Hospital Infantil de México, Federico Gómez, México City, México.
⁶ Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, USA.
⁷ Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain.
⁸ Department of Medicine, Division of Infectious Diseases, and the Department of Medical Microbiology and Immunology, University of California, Davis Medical Center, Sacramento, CA, USA.
⁹ Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.

Abstract

Background: Emerging risk factors highlight the need for an updated understanding of cryptococcosis in the United States.

Objective: Describe the epidemiological trends and clinical outcomes of cryptococcosis in three patient groups: people with HIV (PWH), non-HIV-infected and non-transplant (NHNT) patients, and patients with a history of solid organ transplantation.

Methods: We utilized data from the Merative Medicaid Database to identify individuals aged 18 and above with cryptococcosis based on the International Classification of Diseases, Tenth Revision diagnosis codes from January 2017 to December 2019. Patients were stratified into PWH, NHNT patients, and transplant recipients according to Infectious Diseases Society of America guidelines. Baseline characteristics, types of cryptococcosis, hospitalization details, and in-hospital mortality rates were compared across groups.

Results: Among 703 patients, 59.7% were PWH, 35.6% were NHNT, and 4.7% were transplant recipients. PWH were more likely to be younger, male, identify as Black, and have fewer comorbidities than patients in the NHNT and transplant groups. Notably, 24% of NHNT patients lacked comorbidities. Central nervous system, pulmonary, and disseminated cryptococcosis were most common overall (60%, 14%, and 11%, respectively). The incidence of cryptococcosis fluctuated throughout the study period. PWH accounted for over 50% of cases from June 2017 to June 2019, but this proportion decreased to 47% from July to December 2019. Among the 52% of patients requiring hospitalization, 61% were PWH and 35% were NHNT patients. PWH had longer hospital stays. In-hospital mortality at 90 days was significantly higher in NHNT patients (22%) compared to PWH (7%) and transplant recipients (0%). One-year mortality remained lowest among PWH (8%) compared to NHNT patients (22%) and transplant recipients (13%).

Conclusion: In this study, most cases of cryptococcosis were PWH. Interestingly, while the incidence remained relatively stable in PWH, it slightly increased in those without HIV by the end of the study period. Mortality was highest in NHNT patients.

Keywords: HIV; cryptococcosis; cryptococcus; epidemiology; fungi.

Plain language summary

Epidemiological trends of cryptococcosis in the US The epidemiology and outcomes of cryptococcosis across the United States have not been recently examined. This study analyzed an insured population from 2017 to 2019 and revealed a relatively stable incidence of cryptococcosis among people with HIV, while concurrently demonstrating a slightly increased incidence among individuals without HIV. Notably, mortality rates were highest among non-HIV-infected and non-transplant patients.