Malaria-Related Hospitalizations in the United States, 2000–2014

Abstract

Few data are available on the burden of malaria hospitalization in the United States. Study of malaria using hospital-based data can better define the impact of malaria and help inform prevention efforts. U.S. malaria cases identified from hospitalization discharge records in the 2000-2014 Nationwide Inpatient Sample were examined. Frequencies and population rates were reported by demographics, infecting species, clinical, financial, institutional, geographic, and seasonal characteristics, and disparities were identified. Time trends in malaria cases were assessed using negative binomial regression. From 2000 to 2014, there were an estimated 22,029 malaria-related hospitalizations (4.88 per 1 million population) in the United States, including 182 in-hospital deaths and 4,823 severe malaria cases. The rate of malaria-related hospitalizations did not change significantly over the study period. The largest number of malaria-related hospitalizations occurred in August. Malaria-related hospitalizations occurred disproportionately among patients who were male, black, or 25-44 years of age. accounted for the majority of malaria-related hospitalizations. On average, malaria patients were hospitalized for 4.36 days with charges of $25,789. Patients with a malaria diagnosis were more often hospitalized in the Middle Atlantic and South Atlantic census divisions, urban teaching, private not-for-profit, and large-bed-size hospitals. Malaria imposes a substantial disease burden in the United States. Enhanced primaryand secondary prevention measures, including strategies to increase the use of pretravel consultations and prompt diagnosis and treatment are needed.

Management of Travel-Related Infectious Diseases in the Emergency Department

“…Patients with signs of severe malaria likely need admission to an intensive care unit. Those with no previous history of malaria, immunocompromised patients, children less than five, and pregnant women are at the highest risk for developing severe disease or rapid deterioration, and admission should be strongly considered [2,13,14].…”

“…Whether or not to pursue further testing should be based on clinical judgment and will likely include a shared decision-making conversation with the patient. Stool testing in the ED is reasonable when patients present with severe diarrhea, bloody or mucoid stools, antibiotics in preceding 8-12 weeks, systemic illness, or symptom lasting longer than [10][11][12][13][14] Consider admission for those patients with laboratory evidence of severe dehydration, acute kidney injury, need for electrolyte replacement and inability to tolerate orals, or systemic illness.…”

A Deadly Wait for U.S. Health Insurance Coverage—Sitting on the Couch with Malaria

“…14 From 2000 to 2014, it was estimated that there were approximately 1,469 malaria-related hospitalizations annually, 22% were considered severe infections and 0.8% resulted in deaths, with an average cost of hospitalization of $25,789. 2 This suggests that malaria-associated health-care costs for inpatient care alone were roughly 38 million dollars annually.…”

“…5 If we assume there are 1,500 hospitalizations annually, that 82% of cases are acquired in Africa, and about half of travelers are not treated with malaria prophylaxis and at risk for infection, the risk of U.S. hospitalization is 0.5% on return. 1,2,7 This suggests that the per capita cost of hospital care for the untreated travelers from Africa is approximately $127.00, distributed over all at-risk travelers. Note that this excludes many of the standard costs economic studies include in cost-effectiveness studies, such as time lost from work and costs for treatment outside of the hospital.…”

“…1 Malaria is associated with high morbidity and mortality, with 182 inhospital deaths and 4,823 severe malaria cases in the United States between 2000 and 2014. 2 Herein, we present a case of severe malaria whose delay in seeking care, due to lack of health insurance, almost cost him his life. Primary prevention before, during, and after travel and knowledge of treatment options are areas that need strengthening to prevent tropical diseases in the United States.…”