Assessing the Burden of Hospitalizations Due to Neurocysticercosis in the United States, 2003-2012

BACKGROUND: Neurocysticercosis (NCC), brain infection with Taenia solium larval cysts, causes substantial neurologic morbidity around the world. To assess the impact of NCC in the United States, we reviewed hospitalization discharge data contained in the Nationwide Inpatient Sample for years 2003-2012. Our objective was to evaluate the frequency and total charges for hospitalizations due to NCC in the United States and to compare these against other tropical diseases of potential importance in the US. 

METHODS: We analyzed hospital discharge data contained in the Nationwide Inpatient Sample (NIS) for the years 2003 through 2012. We used two different case definitions in this analysis. We used a conservative case definition to report hospitalizations related to NCC, which required the ICD-9-CM code for cysticercosis (123.1) in any of fifteen available diagnostic fields and a supporting diagnostic or procedural code associated with a clinical manifestation of neurologic disease in any of the first five diagnostic or procedural fields. The second case definition facilitated comparison of hospitalizations for cysticercosis against the 16 other neglected tropical diseases (NTD’s) and malaria. This definition included hospitalizations with an ICD-9-CM diagnostic code for cysticercosis (123.1) in any of the first fifteen diagnosis fields, but did not require additional supportive diagnostic or procedural codes for the case definition cysticercosis or any of the other diseases in the comparative analysis. 

RESULTS: There were an estimated 18,584 NCC hospitalizations with charges totaling over $908 million USD. The risk of hospitalization was highest among Hispanics (2.5 per 100,000 population), a rate 35 times higher than that for the non-Hispanic White population. Nearly three-quarters of all hospitalized NCC cases were Hispanic. Males and people between the ages of 20-44 had increased risk compared to their counterparts. There were nearly twice as many hospitalizations and three times the associated charges for cysticercosis compared to malaria. Hospitalizations and charges for cysticercosis were higher than for all of the other NTDs we evaluated combined. 

CONCLUSIONS: NCC is an increasing public health concern in the United States, especially among Hispanics, and imparts a significant economic burden on the healthcare system. Since Hispanics are the largest minority group in the US and among its fastest growing populations, the impact of NCC in the US is likely to increase substantially in the coming years. The markedly higher number of hospitalizations and associated charges related to cysticercosis compared to other NTD’s in the US merits attention and further exploration.