6/5/2015. Coccidioidomycosis: An Underreported Cause of Death Arizona, Capture-Recapture

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1 No. Cases per 100,000 Population No. s per 1,000,000 Population 6/5/2015 : An Underreported Cause of Arizona, Jefferson Jones, MD MPH Arizona Department of Health Services Incidence Rate and Mortality Rate* of Arizona, Incidence rate Mortality rate *Using underlying cause of on the certificate Year Objectives To validate cocci mortality surveillance that used the underlying cause of on certificates by comparing it with mortality estimates by using additional sources Source A Source A Capture-Recapture in Both Source A & B Source B Source B Capture-Recapture for Capture-Recapture for Any cause of 1

2 Capture-Recapture for Capture-Recapture for Any cause of Any cause of 1. Died during hospitalization 2. certificate WITHOUT cocci as cause of 3. Cocci ICD-9 code for discharge diagnosis AND 4. Laboratory confirmation in state database Capture-Recapture for n = n = 560 Any cause of 1. Died during hospitalization 2. certificate WITHOUT cocci as cause of 3. Cocci ICD-9 code for discharge diagnosis AND 4. Laboratory confirmation in state database Certificate s n = 530 Capture-Recapture for Estimated total of cocci-associated s: 1,181 s n = 560 Certificate s n = 530 Capture-Recapture for = 45% s n = 560 Method -Associated Mortality Rate by Method Arizona, Mean Annual Mortality Rate per 100,000 Population Capture-recapture 3.0 Ref discharge data Any cause of on certificate Only underlying cause of on certificate Rate Ratio 2

3 Limitations discharge database is administrative However, confirmed patients and diagnosis Started validation study using medical records State database used for laboratory confirmation incomplete prior to 2012 Possibly led to underestimation Capture-recapture sources not independent Calculated number of s underestimated Recommendations Use hospital discharge data in addition to certificate data for cocci mortality Include training on certification of Medical schools Residency programs Medical boards Acknowledgments Arizona Department of Health Services Ken Komatsu Shane Brady Mohammed Khan Aisha Rafiq CDC Kris Bisgard Maricopa County Department of Health Services Rebecca Sunenshine Lia Koski Jigna Narang Tammy Sylvester Source A Capture Recapture Formula Source B Not Included Included Total Included N AB 279 N A Not Included 309?????? Total N B??? Estimated Total = N A+1 x (N B +1) (N AB +1) 1 certificates Provides cause of Source of state and national mortality statistics Determines research and public health funding priorities Measures health status trends Causes of on certificates frequently inaccurate Only 59% of causes of on certificates matched a hospital discharge diagnosis Only 47% of autopsy-derived causes of included in certificate data Training on documenting cause of uncommon 8% of attending physicians 24% of resident physicians 3

4 Documenting Cause of Incomplete Cause of Documentation A. Immediate cause of B. Condition leading to line A C. Condition leading to line B D. Condition leading to line C Other significant conditions contributing to but not resulting in the underlying causes given above Underlying cause of determined by algorithm A. Pulmonary arrest B. C. D. Did Coccidoidomycosis Contribute to per Documentation? Did Coccidoidomycosis Contribute to per Documentation? A. Pulmonary arrest B. C. End stage COPD D. A. Adult respiratory distress syndrome B. Klebsiella Sepsis C. D. Multiple Logistic Regression Source A Cocci included in certificate Cocci not included in certificate Compared by Demographics Disseminated vs Pulmonary Comorbidities Significant Risk Factors for Included as Cause of not Adjusted Risk Factor Disseminated disease 68 (27) 41 (13) 1.7 ( ) HIV 31 (12) 14 (5) 2.3 ( ) 4

5 Age Sex Race/Ethnicity Risk Factors Not Found to Be Significant for Included as Cause of Immunocompromised Status Malignancy Underlying lung disease Diabetes Location Location of Disease not Pulmonary 171 (68) 221 (72) Ref Disseminated/ meningitis 68 (27) 41 (13) 0.5 ( ) Chronic 6 (2) 14 (5) 1.8 ( ) Unspecified 6 (2) 33 (11) 4.3 ( ) Risk Factors for Omitted as Cause of not Age in Years <25 14 (6) 6 (2) 0.4 ( ) (49) 143 (47) ref (41) 135 (44) 1.1 ( ) (5) 25 (8) 1.8 ( ) Risk Factors for Sex Omitted as Cause of not Sex Male 159 (63) 195 (63) Ref Female 92 (37) 114 (37) 1.0 ( ) Differences Among s Race and Ethnicity not Race / Ethnicity American Indian 12 (5) 23 (7) 1.5 ( ) Non-Hispanic Black 20 (8) 25 (8) 1.0 ( ) Hispanic 51 (20) 41 (13) 0.6 ( ) Non-Hispanic White 160 (64) 204 (66) ref Other 8 (3) 16 (5) 1.6 ( ) Location Type of Disease not Pulmonary 171 (68) 221 (72) ref Disseminated/ meningitis 68 (27) 41 (13) 0.5 ( ) Chronic 6 (2) 14 (5) 1.8 ( ) Unspecified 6 (2) 33 (11) 4.3 ( ) 5

6 Risk Factor Risk Factors Risk for Factors Omitted as Cause of not HIV Positive 31 (12) 14 (5) 0.3 ( ) Immunocompromised 130 (52) 149 (48) 0.9 ( ) Malignancy 42 (17) 74 (24) 1.6 ( ) Chronic Lung Disease 67 (27) 105 (34) 1.4 ( ) Diabetes 70 (28) 95 (31) 1.1 ( ) 6