Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Study Population
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Total Patients (% of Patients) |
---|---|
Age at Diagnosis | |
<18 | 147 (5.2%) |
18–35 | 430 (15.1%) |
36–45 | 490 (17.2%) |
46–55 | 689 (24.2%) |
56–65 | 751 (26.4%) |
>65 | 335 (11.8%) |
Sex | |
Male | 1418 (49.9%) |
Female | 1424 (50.1%) |
Enrollment time prior to index (years) | |
Mean | 4.6 |
Median | 3.5 |
Range | 1.0–16.9 |
Count ≤ 1.5 years | 348 (12.2%) |
Count ≤ 2 years | 668 (23.5%) |
Count ≤ 3 years | 1180 (41.5%) |
Count > 3 years | 1662 (58.5%) |
Region | |
Rural | 729 (25.7%) |
Urban | 2096 (73.8%) |
Missing | 17 (0.6%) |
Month of index diagnosis | |
January | 265 (9.3%) |
February | 266 (9.4%) |
March | 260 (9.1%) |
April | 241 (8.5%) |
May | 247 (8.7%) |
June | 231 (8.1%) |
July | 227 (8.0%) |
August | 219 (7.7%) |
September | 227 (8.0%) |
October | 214 (7.5%) |
November | 223 (7.8%) |
December | 222 (7.8%) |
Metric/Category | Count (Percentage of All Patients)/Mean | 95% CI (from Bootstrapping) |
---|---|---|
Number of missed opportunities | ||
0 | 487 (17.1%) | 431–542 (15.2–19.1%) |
>=1 | 2355 (82.9%) | 2300–2411 (80.9–84.8%) |
>=2 | 1960 (69.0%) | 1871–2045 (65.8–72.0%) |
>=3 | 1550 (54.5%) | 1435–1660 (50.5–58.4%) |
>=4 | 1159 (40.8%) | 1035–1282 (36.4–45.1%) |
>=5 | 825 (29.0%) | 705–946 (24.8–33.3%) |
Mean—Overall | 4.03 | 3.73–4.33 |
Mean—Outpatient | 3.48 | 3.21–3.74 |
Mean—Inpatient | 0.20 | 0.18–0.22 |
Mean—ED | 0.35 | 0.31–0.39 |
Duration of delays (days) | ||
>=0 | 2355 (100.0%) | 2300–2411 (NA) |
>=10 | 2116 (88.9%) | 2053–2166 (87.4–90.2%) |
>=20 | 1802 (75.7%) | 1718–1865 (73.3–77.7%) |
>=30 | 1475 (61.9%) | 1390–1555 (59.0–65.0%) |
>=40 | 1174 (49.7%) | 1065–1280 (45.6–53.4%) |
>=50 | 833 (35.2%) | 713–954 (30.4–39.7%)] |
>=60 | 477 (20.0%) | 463–492 (19.4–20.6%) |
>=70 | 401 (17.0%) | 279–517 (11.9–21.6%) |
>=80 | 117 (5.0%) | 61–175 (2.6–7.4%) |
>=90 | 28 (1.2%) | 17–53 (0.7–2.3%) |
Mean | 39.46 | 36.04–44.00 |
Variable | Adjusted Odds Ratio | 95% CI | p-Value |
---|---|---|---|
Weekend (visits that occurred on a Saturday or Sunday) | 1.855 | 1.514, 2.273 | <0.001 |
Female Sex | 0.984 | 0.900, 1.075 | 0.716 |
Age | |||
<18 | REF | REF | REF |
18–35 | 1.048 | 0.834, 1.316 | 0.689 |
36–45 | 1.142 | 0.911, 1.430 | 0.249 |
46–55 | 1.169 | 0.941, 1.453 | 0.159 |
56–65 | 1.192 | 0.959, 1.480 | 0.113 |
>65 | 1.279 | 1.010, 1.621 | 0.041 |
Settings visited | |||
Outpatient only | REF | REF | REF |
All three (inpatient, outpatient, and ED) | 0.158 | 0.102, 0.246 | <0.001 |
ED only | 6.784 | 3.892, 11.823 | <0.001 |
Inpatient only | 0.129 | 0.111, 0.151 | <0.001 |
Inpatient and ED | 0.149 | 0.110, 0.202 | <0.001 |
Inpatient and outpatient | 0.134 | 0.114, 0.158 | <0.001 |
Outpatient and ED | 2.898 | 1.836, 4.573 | <0.001 |
Urban vs. not urban | 1.019 | 0.920, 1.129 | 0.715 |
Asthma prior to change point | 1.161 | 0.983, 1.371 | 0.079 |
COPD prior to change point | 1.298 | 1.130, 1.491 | <0.001 |
ILD prior to change point | 1.591 | 0.811, 3.122 | 0.177 |
HIV prior to index | 0.845 | 0.670, 1.065 | 0.154 |
Chest CT prior to change point | 1.602 | 1.457, 1.761 | <0.001 |
Chest X-ray prior to change point | 2.363 | 2.126, 2.625 | <0.001 |
Respiratory antibiotics between change point and 1 day prior to index | 1.285 | 1.173, 1.408 | <0.001 |
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Miller, A.C.; Arakkal, A.T.; Koeneman, S.H.; Cavanaugh, J.E.; Thompson, G.R.; Baddley, J.W.; Polgreen, P.M. Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis. J. Fungi 2022, 8, 438. https://doi.org/10.3390/jof8050438
Miller AC, Arakkal AT, Koeneman SH, Cavanaugh JE, Thompson GR, Baddley JW, Polgreen PM. Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis. Journal of Fungi. 2022; 8(5):438. https://doi.org/10.3390/jof8050438
Chicago/Turabian StyleMiller, Aaron C., Alan T. Arakkal, Scott H. Koeneman, Joseph E. Cavanaugh, George R. Thompson, John W. Baddley, and Philip M. Polgreen. 2022. "Frequency and Duration of, and Risk Factors for, Diagnostic Delays Associated with Histoplasmosis" Journal of Fungi 8, no. 5: 438. https://doi.org/10.3390/jof8050438