# P-1931. Aspergillosis-Attributable Death in the United States: Analysis of Death Certificate Data

## TL;DR

This study analyzed death certificates in the U.S. to estimate the mortality rate from aspergillosis, finding that it is higher than previously reported and most common in older males and those with certain comorbidities.

## Contribution

The study provides the first comprehensive analysis of aspergillosis-attributable death in the U.S. using recent death certificate data.

## Key findings

- The age-adjusted mortality rate for aspergillosis was 2.43 per 1,000,000 people.
- Most aspergillosis deaths occurred in individuals aged 65 or older and in males.
- Comorbidities like hematologic malignancies and chronic lung disease were more common in aspergillosis-related deaths.

## Abstract

Studies have evaluated mycoses-related death certificates but data on aspergillosis-attributable death is sparse. We characterized death certificates listing aspergillosis as a cause of death across demographic and comorbidity strata.

We analyzed data from the United States National Vital Statistics System for 2018-2024. Aspergillosis-attributable death was identified by the presence of ≥1 International Classification of Diseases-10th Revision diagnosis code of B44.x listed anywhere on a death certificate. We present age-adjusted mortality rates (AAMRs)/1,000,000 people with 95% confidence intervals (CI) for aspergillosis deaths and stratified them by demographics. Risk ratios (RR) were used to compare AAMRs across strata and the proportion of aspergillosis vs. non-aspergillosis death certificates listing key comorbidities.

There were 7063 aspergillosis deaths (AAMR: 2.43, 95%CI 2.37-2.49/1,000,000) (Table 1). Of these, 1551 (22.0%) death certificates had aspergillosis listed as the underlying (primary) cause (AAMR: 0.53, 95%CI 0.54-0.56) (Figure 1). Codes for “invasive aspergillosis disease” (B44.0, B44.1, B44.7) were most frequent (n=4880, 69.1%); specifically, the code for “other pulmonary aspergillosis” (B44.1, n=4292, 60.7%). Unspecified aspergillosis (B44.9) was listed on 2139 certificates. Nearly 60% of aspergillosis deaths occurred in ≥65-year-olds (RR: 23.48, 95%CI 20.02-27.54), and 59.6% in males vs. females (RR: 1.64, 95%CI 1.50-1.80). Race and ethnicity were not associated with differences in AAMR. AAMRs varied widely across states (Figure 2). Hematologic malignancy, hematopoietic cell and solid organ transplant, neutropenia, human immunodeficiency virus, COVID-19 and chronic lung disease were more likely present on death certificates of those with vs. without aspergillosis (Table 2).

The AAMR for aspergillosis was 2.43 (95%CI 2.37-2.49)/1,000,000, higher than previously reported rates. Sex and geography impacted AAMRs. Despite available antifungals, AAMRs have not declined. Most certificates listed “other pulmonary aspergillosis” and those with hematologic malignancies, COVID-19 and chronic lung disease were at highest risk.

Craig I. Coleman, PharmD, F2G Inc.: Advisor/Consultant|F2G Inc.: Grant/Research Support Belinda Lovelace, PharmD, MS, MJ, F2G Inc.: Employee Thomas J. Walsh, MD, PhD (Hon), FIDSA, FAAM, FECMM, Allergan: Grant/Research Support|Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Basilea: Advisor/Consultant|F2G Inc.: Advisor/Consultant|F2G Inc.: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Karyopharm: Advisor/Consultant|Lediant: Advisor/Consultant|Lediant: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Partner Therapeutics: Advisor/Consultant|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Statera: Advisor/Consultant|T2 Biosystems: Advisor/Consultant|T2 Biosystems: Grant/Research Support|Viosera: Grant/Research Support