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BACKGROUND: Coccidioidomycosis is a respiratory disease caused by inhalation of Coccidioides species spores from soil. In Arizona, despite increased reported coccidioidomycosis during 1990–2012 (from 5.2 to 198.8/100,000 persons), the age-adjusted mortality rate was unchanged at ~10.6 deaths/1,000,000 persons. We compared coccidioidomycosis-attributable deaths derived from death certificates with hospital discharge data to validate mortality surveillance.
METHODS: Arizona death certificate coccidioidomycosis-attributable deaths were defined as any coccidioidomycosis-related International Classification of Disease (10th rev.) (ICD-10) codes/text that included “coccidioidomycosis” or “valley fever” listed in causes or conditions contributing to death. Hospital discharge data coccidioidomycosis-attributable deaths were defined as deceased during hospitalization with a coccidioidomycosis ICD-9 diagnostic code; if not included among death certificate coccidioidomycosis-attributable deaths, a death certificate and coccidioidomycosis laboratory confirmation were required to confirm death and diagnosis of coccidiooidomycosis. We estimated total coccidioidomycosis-attributable deaths for 2008–2013 among Arizona residents by capture-recapture analysis. Hospital discharge data coccidioidomycosis-attributable deaths with matching death certificates were compared with those without matching death certificates.
RESULTS: During 2008–2013, a total of 530 reported death certificate coccidioidomycosis-attributable deaths (incidence: 13.6 deaths/1,000,000 persons) were reported compared with 580 hospital discharge data coccidioidomycosis-attributable deaths (incidence 14.9 deaths/1,000,000 persons). Of these 580 hospital discharge data coccidioidomycosis-attributable deaths, 251 (43%) were identified in death certificates. Capture-recapture estimated coccidioidomycosis-attributable deaths at 1223 (incidence 31.4 deaths/1,000,000). Comparing the hospital discharge data coccidioidomycosis-attributable deaths with (n=251) and without matching death certificates (n=329), 159 (63%) and 205 (62%) were male; 114 (45%) and 159 (48%) were aged ≥65 years; 114 (45%) and 152 (46%) were immunocompromised; and 68 (27%) and 64 (19%) had disseminated coccidioidomycosis, respectively. No differences were significant (p >.05).
CONCLUSIONS: Although unreported and reported coccidioidomycosis-attributable deaths did not differ significantly, coccidioidomycosis-attributable deaths are underreported two-fold on Arizona death certificates, demonstrating a need for education of death certifiers to document coccidioidomycosis mortality.