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Public Awareness of Invasive Fungal Diseases — United States, 2019

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Public Awareness of Invasive Fungal Diseases — United States, 2019 Morbidity and Mortality Weekly Report Public Awareness of Invasive Fungal Diseases — United States, 2019 Kaitlin Benedict, MPH1; Noelle Angelique M. Molinari, PhD1; Brendan R. Jackson, MD1 Fungal diseases range from minor skin and mucous mem- analyses were conducted using SAS survey procedures (version brane infections to life-threatening disseminated disease. The 9.4; SAS Institute). No personally identifying information was estimated yearly direct health care costs of fungal diseases included in the data file provided to CDC.* exceed $7.2 billion (1). These diseases are likely widely under- Fewer than one third of participants (31.1%) had ever heard diagnosed (1,2), and improved recognition among health care of any of the fungal diseases listed on the survey. Awareness providers and members of the public is essential to reduce was lowest for blastomycosis (4.1%), followed by aspergillosis delays in diagnoses and treatment. However, information (5.1%), histoplasmosis (7.5%), coccidioidomycosis (7.6%), about public awareness of fungal diseases is limited. To guide cryptococcosis (9.0%), and candidiasis (24.6%) (Table 1). public health educational efforts, a nationally representative Persons aware of one fungal disease were more likely to be online survey was conducted to assess whether participants had aware of others (i.e., awareness was correlated among dis- ever heard of six invasive fungal diseases. Awareness was low eases, p<0.001). Female sex, higher educational level, and and varied by disease, from 4.1% for blastomycosis to 24.6% increased number of prescription medications were associ- for candidiasis. More than two thirds (68.9%) of respondents ated with awareness in the multivariable models for all 6 had never heard of any of the diseases. Female sex, higher fungal diseases (Table 2). Specifically, females were more than education, and increased number of prescription medications three times as likely to be aware of candidiasis (AOR = 3.40, were associated with awareness. These findings can serve as a 95% CI = 2.8–4.1, p<0. 001) compared with males. Each baseline to compare with future surveys; they also indicate that additional prescription medication was associated with continued strategies to increase public awareness about fungal 6%–11% increased odds of awareness (all p<0.01). Non-White diseases are needed. or multiracial respondents had lower odds of awareness of Porter Novelli’s Fall 2019 ConsumerStyles survey was used candidiasis (AOR = 0.68, p<0.001) and coccidioidomycosis to ask, “Have you ever heard of the following infections?” (AOR = 0.60, p<0.05) compared with White respondents. Possible answers were aspergillosis, Candida infection or Residence in the West was associated with significantly candidiasis, coccidioidomycosis (“Valley fever”), Cryptococcus higher odds of coccidioidomycosis awareness (AOR = 2.87, infection, blastomycosis, histoplasmosis, or none of these. The p<0.001) compared with residence in the Midwest. Likelihood online survey was sent to a nationally representative sample of of blastomycosis awareness was lower for respondents in the 4,677 participants aged ≥18 years who were part of the market Northeast (AOR = 0.52, 95%CI = 0.29–0.91) and the South research and consulting firm Ipsos’ KnowledgePanel. Panel (AOR = 0.44, 95% CI = 0.27–0.72) than in the Midwest. members were randomly recruited by mail using address-based Discussion probability-based sampling and were provided with a laptop or tablet computer and Internet access if needed; 3,624 completed Public awareness of fungal diseases is low, a concerning the survey, for a response rate of 77.5%. Data were weighted finding because these diseases are associated with substantial to adjust for sampling design and nonresponse to be represen- illness, death, and economic cost, although their true burden tative of the U.S. adult population based on the Consumer remains largely unquantified (1,2). Primary prevention of fun- Population Survey benchmarks for sex, age, race/ethnicity, gal diseases can be challenging, particularly for those acquired education, U.S. Census region, household income, home via inhalation from the natural environment. Therefore, aware- ownership status, metropolitan area status, and Internet access. ness is critical to help prevent severe disease, because early Descriptive and bivariate analyses were used to identify diagnosis and treatment can prevent incorrect treatment and potential factors associated with awareness using simple improve outcomes. For example, knowledge of coccidioido- weighted logistic regression of awareness of each fungal dis- mycosis before seeking health care has been associated with ease by various sociodemographic and health care utilization faster diagnosis (3). characteristics. Multivariate weighted logistic regression was * CDC licensed these data from Porter Novelli Public Services. Although Porter estimated to derive adjusted odds ratios (AORs); p-values Novelli Public Services and its vendors are not subject to CDC IRB review, <0.05 were considered statistically significant. Measures of they do adhere to all professional standards and codes of conduct set forth by goodness of fit assessed included Akaike Information Criterion, the Council of American Survey Research Organizations. Respondents are informed that their answers are being used for market research and they may Max-scaled R-squared, and McFadden’s pseudo R-squared. All refuse to answer any question at any time. US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / September 25, 2020 / Vol. 69 / No. 38 1343 Morbidity and Mortality Weekly Report TABLE 1. Characteristics of respondents who reported ever having heard of certain fungal infections — Porter Novelli Fall ConsumerStyles Survey, United States, 2019 Weighted no. (%) Candida infection or Coccidioidomycosis Cryptococcus Characteristics Full sample Aspergillosis candidiasis (Valley fever) infection Blastomycosis Histoplasmosis Total 3,624 (100) 184 (5.1) 881 (24.6) 273 (7.6) 321 (9.0) 148 (4.1) 268 (7.5) Sex Male 1,756 (48.4) 69 (4.0)† 251 (14.4)* 114 (6.5)† 137 (7.9)§ 66 (3.8) 107 (6.2)† Female 1,868 (51.6) 115 (6.2) 631 (34.1) 159 (8.6) 184 (10) 82 (4.5) 161 (8.7) Age (yrs) 18–29 771 (21.3) 26 (3.4) 119 (15.8)* 44 (5.8)† 56 (7.4) 21 (2.8) 36 (4.8)* 30–44 894 (24.7) 44 (5.0) 202 (22.9)* 56 (6.3)† 80 (9.0) 38 (4.3) 52 (5.9)* 45–59 906 (25.0) 51 (5.7) 244 (27.1)* 71 (7.8)† 93 (10.3) 44 (4.9) 71 (7.9)* ≥60 1,052 (29.0) 63 (6.0) 316 (30.2)* 103 (9.8)† 93 (8.9) 45 (4.3) 109 (10.4)* Race White 2,815 (77.7) 148 (5.3) 720 (25.9)† 226 (8.1)§ 253 (9.1) 119 (4.3) 223 (8.0)§ Non-White or 809 (22.3) 36 (4.5) 162 (20.2)† 47 (5.8)§ 68 (8.5) 30 (3.7) 45 (5.7)§ multiracial Ethnicity Non-Hispanic 3038 (83.8) 162 (5.4) 739 (24.6) 226 (7.5) 273 (9.1) 134 (4.5)§ 240 (8.0)† Hispanic 586 (16.2) 22 (3.8) 142 (24.3) 47 (8.0) 48 (8.2) 14 (2.4)§ 28 (4.8)† Education Less than high 390 (10.7) 11 (2.9)* 48 (12.4)* 28 (7.4)† 13 (3.4)* 11 (2.9)† 21 (5.6)* school High school 1,038 (28.7) 28 (2.8)* 199 (19.5)* 46 (4.5)† 56 (5.5)* 22 (2.1)† 46 (4.5)* Some college 1,024 (28.3) 51 (5.0)* 268 (26.4)* 84 (8.2)† 102 (10.0)* 44 (4.3)† 76 (7.5)* Bachelor’s degree 1,172 (32.3) 94 (8.0)* 367 (31.6)* 115 (9.9)† 150 (12.9)* 72 (6.2)† 124 (10.7)* or higher Have a child aged 982 (27.1) 38 (3.9)§ 248 (25.6) 67 (6.9) 90 (9.3) 40 (4.1) 58 (6.0)§ <18 years MSA category Nonmetropolitan 491 (13.6) 18 (3.7) 104 (21.4) 24 (5.0)† 28 (5.8)† 21 (4.3) 38 (7.9) Metropolitan 3133 (86.4) 166 (5.4) 778 (25.1) 249 (8.0)† 293 (9.5)† 128 (4.1) 230 (7.4) Census region¶ Northeast 643 (17.7) 34 (5.3) 170 (26.9) 29 (4.5)* 46 (7.3) 23 (3.6)* 33 (5.1)† Midwest 755 (20.8) 39 (5.2) 187 (25.0) 52 (7.0)* 69 (9.2) 54 (7.2)* 78 (10.4)† South 1,367 (37.7) 67 (4.9) 320 (23.6) 56 (4.2)* 132 (9.7) 37 (2.7)* 103 (7.6)† West 860 (23.7) 44 (5.2) 205 (24.2) 136 (16.0)* 75 (8.8) 34 (4.1)* 55 (6.5)† Characteristic Mean (range) Mean (standard error) Age in years 47 (18–94) 55 (1.0)§ 56 (0.5)* 57 (0.9)† 54 (0.8) 54 (1.2) 57 (0.9)† No. of health care 5 (0–368) 6 (0.6) 6 (0.2) 6 (0.5) 6 (0.4) 5 (0.6) 6 (0.5) provider visits in the last 12 mos No. of prescription 2 (0–36) 3 (0.2)† 3 (0.1)* 3 (0.2)† 3 (0.2)† 3 (0.3)† 3 (0.2)* medications Household $72,106 $83,971 $77,999 $76,925 $78,699 $80,397 $82,051 income** (<$5,000 to ≥$250.000) ($3,972)† ($2,449)* ($3,137)† ($2,960)† ($4,621)† ($2,457)† Abbreviation: MSA = metropolitan statistical area. * p<0.001. † p<0.005. § p<0.10 for F-test. P value for the F-test for significant effect of variable overall, equivalent to t-test for dichotomous and continuous variables. ¶ Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming.
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