A population-based analysis of invasive fungal disease in haematology-oncology patients using data linkage of state-wide registries and administrative databases: 2005 - 2016

Abstract

BackgroundLittle is known about the morbidity and mortality of invasive fungal disease (IFD) at a population level. The aim of this study was to determine the incidence, trends and outcomes of IFD in all haematology-oncology patients by linking Victorian hospital data to state-based registries.MethodsEpisodes of IFD complicating adult haematological malignancy (HM) and haematopoietic stem cell transplantation (HSCT) patients admitted to Victorian hospitals from 1st July 2005 to 30th June 2016 were extracted from the Victorian Admitted Episodes Dataset and linked to the date of HM diagnosis from the Victorian Cancer Registry and mortality from the Victorian Death Index. Descriptive analyses and regression modelling were used.ResultsThere were 619,702 inpatient-episodes among 32,815 HM and 1,765 HSCT-patients. IFD occurring twelve-months from HM-diagnosis was detected in 669 (2.04%) HM-patients and 111 (6.29%) HSCT-recipients, respectively. Median time to IFD-diagnosis was 3, 5, 15 and 22 months in acute myeloid leukaemia, acute lymphoblastic leukaemia, Hodgkin lymphoma and multiple myeloma, respectively. Median survival from IFD-diagnosis was 7, 7 and 3 months for invasive aspergillosis, invasive candidiasis and mucormycosis, respectively. From 2005-2016, IFD incidence decreased 0.28% per 1,000 bed-days. Fungal incidence coincided with spring peaks on time-series analysis.ConclusionsData linkage is an efficient means of evaluating the epidemiology of a rare disease, however the burden of IFD is likely underestimated, arguing for better quality hospital level surveillance data to improve management strategies.Electronic supplementary materialThe online version of this article (10.1186/s12879-019-3901-y) contains supplementary material, which is available to authorized users.

A population‐based analysis of attributable hospitalisation costs of invasive fungal diseases in haematological malignancy patients using data linkage of state‐wide registry and costing databases: 2009‐2015

“…Over the six‐year study period, total attributable hospitalisation costs were stable ( P = .90) with increases in IA ( P = .63) and other IFD ( P = .88) balanced against a decrease in invasive candidiasis related costs ( P = .08) with none reaching statistical significance likely due to small numbers of matched pairs. A 0.28% decrease in IFD incidence in the companion epidemiological study corroborates institutional studies from two major Victorian transplant centres suggesting that improvements in supportive care like antifungal prophylaxis have affected IFD incidence.…”

“…The implications of our findings underscore the importance of ALL as a HM subgroup associated with high IFD treatment‐related costs. Further, Valentine et al demonstrated that the prevalence of IFD in ALL patients is high (11%) as compared to AML (9.42%) and auto‐HSCT (4.83%) patients. These data are a compelling argument for better preventative strategies including mould‐active antifungal prophylaxis that are as yet unresolved in patients with ALL …”

“…[8][9][10] Data linkage is an efficient means of evaluating the costs and epidemiology of IFD in haematology-oncology patients at a population level. 7,11 A population-based analysis of IFD in Australia from 1995 to 1999 showed that invasive candidiasis was more common than invasive aspergillosis, representing 0.36% and 0.03% of all acute hospital discharges, respectively. However, this study excluded the second-most populous state in Australia, namely Victoria, with a population of 6.50 million residents.…”

Linking administrative data sets of inpatient infectious diseases diagnoses in far North Queensland: a cohort profile

“…Australian infectious diseases cohort studies have involved: organ specific infections such as respiratory viral infections, 13 infections such as Q fever 12 and S. aureus bacteraemia 14 as well as specific patients such as asplenics 16 and haematology-oncology. 17 The value of Australian patient cohorts for infectious diseases research is further shown by the multiple studies deriving from the 45 and up study of ageing, 18 Triple I Western Australian birth cohort 15 and Victorian Post-Splenectomy Registry. 19 There are inherent limitations of retrospective databases defined by ICD-10-AM codes.…”

Classification performance of administrative coding data for detection of invasive fungal infection in paediatric cancer patients

“…However, these are complex and require detailed case review. Administrative coding data possess potentially favourable attributes for simplified surveillance [9], including standardised classification and availability of specific codes for yeast and mould infections [4,10]. In Australia, the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) are a monohierarchical, codified, medical lexicon used for coding inpatient diagnoses and is a commonly used ontology to inform activity-based funding models [11].…”