Aspergillosis diagnoses in the United States rose by more than 5% annually between 2013 and 2023, according to research published last week in Open Forum Infectious Diseases. The findings highlight a growing public health concern as the fungal infection, while typically mild, can be severe and even fatal for individuals with compromised immune systems.
Aspergillosis is caused by inhaling spores of Aspergillus, a mold commonly found both indoors and outdoors. While most individuals experience no ill effects, the infection can lead to serious illness in those with underlying lung conditions or weakened immune defenses, including cancer patients and organ transplant recipients. The overall mortality rate associated with aspergillosis is approximately 20%, researchers noted.
The study, led by researchers at the University of California, Berkeley, analyzed electronic health record (EHR) data from a health insurance database encompassing over 76 million US patients across 142 health systems. Researchers identified 20,764 aspergillosis cases during the ten-year period, resulting in a population-based prevalence of 15.26 diagnoses per 100,000 person-years. The rate of increase was 5.3% annually before the COVID-19 pandemic, peaking at 18.04 diagnoses per 100,000 person-years in 2022.
Geographic disparities in diagnosis were as well observed. Aspergillosis prevalence was significantly higher in Rhode Island compared to the national average, while Utah reported the lowest rates. Men were diagnosed with aspergillosis more frequently than women (adjusted prevalence ratio of 1.37) and older adults (aged 65 and older) were nearly five times more likely to receive a diagnosis than younger adults (aged 18 to 24) with an adjusted prevalence ratio of 4.95. Urban residents also exhibited a higher diagnosis rate than those in rural areas (rural aPR, 0.86).
The study also revealed shifts in prevalence among racial and ethnic groups. While White patients were more frequently diagnosed prior to the COVID-19 pandemic, the researchers observed a disproportionate increase in diagnoses among Hispanic or Latino individuals and other racial minority groups following the pandemic’s onset. The authors suggest these differences may be linked to variations in underlying health conditions, access to healthcare, or the impact of COVID-19 itself.
The Centers for Disease Control and Prevention (CDC) notes that aspergillosis is not currently a reportable disease in the United States, making it difficult to determine the exact number of cases. Data from 2014 indicated nearly 15,000 aspergillosis-associated hospitalizations, incurring an estimated cost of $1.2 billion. A 2017 study published in PubMed found that hospitalizations related to invasive aspergillosis and mucormycosis – another fungal infection – increased between 2000 and 2013.
Researchers emphasize that the findings could improve clinical recognition of aspergillosis, particularly among traditionally under-recognized groups, and support efforts to expand diagnostic access and enhance fungal disease surveillance. Concerns are also growing regarding increasing resistance to antifungal medications, potentially complicating treatment efforts.
Globally, an estimated 250,000 cases of invasive aspergillosis and over 3 million cases of chronic pulmonary aspergillosis occur annually, according to available data.
