Coccidioidomycosis-Attributable Death in the United States: An Analysis of Cases Reported on Death Certificates, 2018–2023

Contemporary data on coccidioidomycosis death rates are sparse. Death certificate data for 2018-2023 from the US National Vital Statistics System were evaluated. Coccidioidomycosis deaths were identified using diagnosis codes B38.x listed anywhere on certificates. Deaths and age-adjusted mortality rates (AAMRs)/1,000,000 people, with 95% confidence intervals (CIs), were determined. We identified 1760 coccidioidomycosis-attributable deaths (AAMR = 0.75; 0.72-0.79). Most occurred in 55-74-year-olds (43.9%; corresponding AAMR = 1.72; 1.59-1.84). Males had a 2.69-fold increased AAMR versus females and American Indian or Alaska Native individuals had a 4.28-fold increased rate versus White individuals. Hispanics had a higher AAMR than the overall population (AAMR = 1.92; 1.76-2.08). AAMRs increased from 0.52 in 2019 to 0.79-0.94 in later years. Most (89.7%) death certificates were from endemic states, with Arizona having the highest AAMR. Seven hundred and thirteen certificates (40.5%) listed coccidioidomycosis as the primary cause of death, with 43.8% coded for pulmonary, 34.9% coded for disseminated, and 21.3% coded for unspecified coccidioidomycosis. Diabetes, COVID-19, and human immunodeficiency virus were more frequent on certificates with coccidioidomycosis versus without (RR range = 1.47-17.20). Mortality remained closely tied to demographic and geographic factors identified in prior studies, with county-level mapping revealing high-burden areas for targeted intervention. Coccidioidomycosis-attributable AAMRs rose over time, possibly influenced by concurrent COVID-19 infection. Only 40% of death certificates listed it as the primary cause, indicating that most patients experience chronic infection rather than death directly from the disease. These findings suggest the need for heightened clinical awareness of coccidioidomycosis, along with earlier diagnosis and prompt initiation of antifungal treatment in these high-risk groups.