Risk factors for severe malaria among hospitalized patients in the United States, 2000-2014

Diana Khuu; Mark L Eberhard; Benjamin N Bristow; Marjan Javanbakht; Lawrence R Ash; Shira C Shafir; Frank J Sorvillo

doi:10.1016/j.idh.2018.01.002

Risk factors for severe malaria among hospitalized patients in the United States, 2000-2014

Infect Dis Health. 2018 Jun;23(2):93-106. doi: 10.1016/j.idh.2018.01.002. Epub 2018 Feb 14.

Authors

Diana Khuu¹, Mark L Eberhard², Benjamin N Bristow³, Marjan Javanbakht⁴, Lawrence R Ash⁵, Shira C Shafir⁶, Frank J Sorvillo⁷

Affiliations

¹ Department of Epidemiology, University of California at Los Angeles, Fielding School of Public Health, 650 Charles Young Drive South, Box 951772, Los Angeles, CA 90095, USA. Electronic address: dkhuu@ucla.edu.
² Centers for Disease Control and Prevention, Center for Global Health, Division of Parasitic Diseases & Malaria, Parasitic Diseases Branch, 1600 Clifton Road Atlanta, GA 30329-4027, USA. Electronic address: mle1@cdc.gov.
³ Department of Epidemiology, University of California at Los Angeles, Fielding School of Public Health, 650 Charles Young Drive South, Box 951772, Los Angeles, CA 90095, USA. Electronic address: benbristowmd@gmail.com.
⁴ Department of Epidemiology, University of California at Los Angeles, Fielding School of Public Health, 650 Charles Young Drive South, Box 951772, Los Angeles, CA 90095, USA. Electronic address: javan@ucla.edu.
⁵ Department of Epidemiology, University of California at Los Angeles, Fielding School of Public Health, 650 Charles Young Drive South, Box 951772, Los Angeles, CA 90095, USA. Electronic address: larryash@ucla.edu.
⁶ Department of Epidemiology, University of California at Los Angeles, Fielding School of Public Health, 650 Charles Young Drive South, Box 951772, Los Angeles, CA 90095, USA. Electronic address: sshafir@ucla.edu.
⁷ Department of Epidemiology, University of California at Los Angeles, Fielding School of Public Health, 650 Charles Young Drive South, Box 951772, Los Angeles, CA 90095, USA.

PMID: 38715309
DOI: 10.1016/j.idh.2018.01.002

Abstract

Background: Factors associated with the development of severe malaria have not been well described for cases occurring in the United States (US).

Methods: Severe malaria hospitalizations data from the 2000-2014 Nationwide Inpatient Sample were analyzed. Frequencies were reported by demographic, clinical, species, financial, geographic, and institutional characteristics, and trends and disparities were identified. Logistic regression models were used to identify potential predictors for severe disease among those with malaria.

Results: From 2000 to 2014, there were an estimated 4823 severe malaria cases, representing 21.9% of all malaria-related hospitalizations, including 182 severe malaria deaths. Severe malaria was most common among inpatients who were male, Black, aged 45-64 years, and hospitalized in the South Atlantic division of the US. Older age was associated with higher odds of severe malaria, cerebral malaria, ARDS, severe anemia, and renal failure. Males had higher odds of developing renal failure and jaundice, while females had higher odds of developing severe anemia. HIV infection was associated with increased odds of severe malaria, severe anemia, and renal failure.

Conclusion: Primary and secondary prevention measures, such as pre-travel consultations, chemoprophylaxis, and early diagnosis and treatment, should be emphasized and improved among high-risk prospective travelers to malaria endemic countries.

Keywords: Hospitalization; Malaria; Travel-associated infections.

Published by Elsevier B.V.