Document Type

Article

Publication Date

3-2026

Identifier

DOI: 10.1093/ofid/ofag094; PMCID: PMC12973174

Abstract

BACKGROUND: Aspergillosis is a fungal infection associated with rising hospitalizations and substantial morbidity and mortality. In the United States, data remain fragmented due to the absence of centralized surveillance. This study aimed to evaluate demographic, geographic, and temporal trends in aspergillosis diagnoses across the United States and evaluate changes in those patterns following the emergence of COVID-19.

METHODS: We conducted a retrospective cohort study using electronic health record data from 142 US healthcare systems (Oracle Health), including adults aged ≥18 years who received care between 2013 and 2023. The cohort included over 76 million patients and 127 million person-years. Aspergillosis prevalence was calculated using post-stratification weights. Adjusted prevalence ratios (aPRs) were estimated via quasi-Poisson and Bayesian spatiotemporal regression. COVID-19-related shifts were evaluated using estimated marginal means.

RESULTS: From 2013 to 2023, aspergillosis prevalence increased by 5% annually, peaking in 2022. Rhode Island had the highest state-level aPR; Utah the lowest. Diagnosis was higher among males (aPR 1.37), older adults (≥65 years vs 18-24 years: aPR 4.95), and urban residents (rural aPR 0.86). Following the emergence of COVID-19, prevalence increased disproportionately among Hispanic or Latino patients and several racial minority groups. A nonsignificant upward trend was also observed among rural residents.

CONCLUSIONS: This study provides a comprehensive national assessment of aspergillosis diagnosis patterns in the United States, revealing rising prevalence and shifts in affected populations following the emergence of COVID-19. 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.

Journal Title

Open Forum Infect Dis

Volume

13

Issue

3

First Page

094

Last Page

094

PubMed ID

41816001

Keywords

COVID-19 impacts; aspergillosis; electronic health records (EHR); fungal disease; real-world data

Comments

This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.

Publisher's Link: https://academic.oup.com/ofid/article/13/3/ofag094/8501127

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