{"doi":"10.1016/j.jaad.2023.04.048","title":"Epidemiology of implantation mycoses in the United States: An analysis of commercial insurance claims data, 2017 to 2021","abstract":"To the Editor: Implantation mycoses, such as eumycetoma, chromoblastomycosis (including phaeohyphomycotic abscesses), and other deep mycoses (eg, sporotrichosis, mucormycosis), constitute a diverse group of fungal neglected tropical diseases that usually develop after traumatic skin inoculation.1Queiroz-Telles F. Nucci M. Colombo A.L. Tobón A. Restrepo A. Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment.Med Mycol. 2011; 49: 225-236Crossref PubMed Google Scholar, 2Emery D. Denning D.W. The global distribution of actinomycetoma and eumycetoma.PLoS Negl Trop Dis. 2020; 14e0008397Crossref Scopus (39) Google Scholar, 3Gadre A. Enbiale W. Andersen L.K. Coates S.J. The effects of climate change on fungal diseases with cutaneous manifestations: a report from the International Society of Dermatology Climate Change Committee.J Clim Change Health. 2022; 6100156Google Scholar Although dermatologists frequently learn about these uncommon conditions during training, clinical exposure may be limited outside tropical regions. Baseline epidemiologic data on implantation mycoses might improve clinical recognition and are needed given the potential for climate change-related expansion of geographic range.3Gadre A. Enbiale W. Andersen L.K. Coates S.J. The effects of climate change on fungal diseases with cutaneous manifestations: a report from the International Society of Dermatology Climate Change Committee.J Clim Change Health. 2022; 6100156Google Scholar Therefore, we estimated prevalence and described features of US patients diagnosed with implantation mycoses during January 1, 2017 to December 31, 2021. We analyzed the Merative MarketScan Commercial and Medicare Supplemental databases, using International Classification of Diseases, 10th Revision codes to identify implantation mycosis patients and their underlying conditions (Supplementary Material, available via Mendeley at https://data.mendeley.com/datasets/6h34zp6mdr10.17632/6h34zp6mdr.1). For each mycosis, we estimated 5-year prevalence, stratifying by demographic features. Using a nested case-control study design, we performed logistic regressions to evaluate associations between each mycosis and underlying conditions, adjusting for age, sex, and region. During 2017 to 2021, among ∼45,000,000 unique patients, each implantation mycosis was diagnosed in <15 per 1,000,000 (Table I). Prevalence per 1,000,000 was highest for chromoblastomycosis (14.7), followed by sporotrichosis (12.4), mucormycosis (10.4), and eumycetoma (5.2). Across mycoses, prevalence generally increased with age and was highest among patients aged ≥65 years. Prevalence was higher among females versus males for sporotrichosis (13.1 vs 11.6) and eumycetoma (6.4 vs 4.0). Prevalence varied by region, with chromoblastomycosis highest in the Northeast (16.4), sporotrichosis highest in the South (14.7), mucormycosis highest in the West (11.9), and eumycetoma highest in the Midwest (5.8). Prevalence was higher in rural versus nonrural areas, except for eumycetoma (2.9 vs 5.5).Table IFive-y prevalence (per 1,000,000 patients) of fungal neglected tropical diseases affecting the skin in a large, commercially insured population—United States, 2017 to 2021∗Data are shown as no. (5-year prevalence per 1 million patients). Rhinosporidiosis, talaromycosis, and lobomycosis diagnoses were also examined, but because they were very uncommon (each diagnosed in <100 patients during the study period), these conditions were excluded from the analysis. Individual patients could have diagnosis codes for >1 mycosis (eg, sporotrichosis and mucormycosis); this occurred for <0.5% of patients. Individual patients could also have diagnosis codes for >1 subcategory of mycosis (eg, pulmonary mucormycosis and cerebral mucormycosis). For chromoblastomycosis and phaeohyphomycotic abscess, 64% had an International Classification of Diseases, 10th Revision (ICD-10) code for subcutaneous p","journal":"Journal of the American Academy of Dermatology","year":2023,"id":354812,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9609,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":982202,"name":"Dallas J. Smith","orcid":"0000-0001-5707-528X","position":1,"is_corresponding":false},{"id":468308,"name":"Kaitlin Benedict","orcid":"0000-0003-0458-2493","position":2,"is_corresponding":false},{"id":228017,"name":"Shawn R. Lockhart","orcid":"0000-0002-4383-5994","position":3,"is_corresponding":false},{"id":979996,"name":"Shari R. Lipner","orcid":"0000-0001-5913-9304","position":4,"is_corresponding":false},{"id":712810,"name":"Jeremy A.W. Gold","orcid":"0000-0002-5054-7616","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-19T01:13:11.976628Z","pmid":"37142095","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}