The Burden of Hospital Illness Associated with Disseminated Versus Isolated Pulmonary Coccidioidomycosis in the United States

There are scarce data comparing inpatient mortality, length of stay (LOS) and all-cause hospital costs in disseminated coccidioidomycosis (DCM) vs. isolated pulmonary coccidioidomycosis (IPCM). We assessed the burden of hospital illness associated with DCM versus IPCM. This study was performed using National Inpatient Sample data from 2019 to 2021. DCM was defined as having a primary International Classification of Diseases—Tenth Revision (ICD-10) code for coccidioidal meningitis, a non-primary code for coccidioidal meningitis in the presence of a primary code for a meningitis complication or a procedure code depicting the need for a meningitis-related procedure, or a primary code for DCM without a code for unspecified disease. IPCM was defined as a primary code for pulmonary coccidioidomycosis without codes for DCM or unspecified disease. Multivariable regression was used to compare the odds of in-hospital mortality, LOS and all-cause hospital costs (2023 US$) for DCM versus IPCM, after covariate adjustment. A total of 6195 hospitalizations were identified, 2305 for DCM and 3890 for IPCM. Patients experiencing a DCM hospitalization had a 19.7% incidence of concomitant pulmonary coccidioidomycosis. Coccidioidal meningitis constituted 81.3% of all DCM hospitalizations, of which 78.1% received a meningitis-related procedure or were admitted for a meningitis complication. DCM was associated with an increased odds of death (odds ratio = 2.76, 95% confidence interval [CI] = 1.26–6.04) versus IPCM. DCM was associated with a longer mean hospital LOS (4.51 days, 95%CI = 3.39–5.63) and higher mean all-cause costs ($20,008, 95%CI = $15,313–$24,704) versus IPCM. DCM hospitalizations were associated with higher odds of inpatient mortality, longer LOS, and higher costs versus IPCM.