{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T01:01:20Z","timestamp":1793149280070,"version":"4.5.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 AI148336"],"award-info":[{"award-number":["R01 AI148336"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 AI176770"],"award-info":[{"award-number":["R01 AI176770"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01 AI173529"],"award-info":[{"award-number":["K01 AI173529"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014213","name":"National Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014213","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["T42 OH008429"],"award-info":[{"award-number":["T42 OH008429"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Where surveillance data are limited, nationally representative electronic health records allow for geographic, temporal, and demographic characterization of the fungal diseases blastomycosis and histoplasmosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified incident blastomycosis and histoplasmosis cases from 2013 to 2023 within Oracle EHR Real-World Data, which comprises 1.6 billion healthcare encounters nationally. To characterize spatiotemporal incidence trends, we used generalized estimating equations weighted for nonrepresentativeness of electronic health record\u2013reporting facilities. We computed standardized incidence rate ratios (sIRRs), which relay relative differences in standardized incidence rates between regions, race\/ethnicity, gender, and age subgroups and the national population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>National incidence rates in 2023 were 2.4 (95% confidence interval [CI]: 1.6\u20133.5) and 1.9 times (95% CI: 1.6\u20132.2) rates in 2013, for blastomycosis and histoplasmosis, respectively. Blastomycosis incidence rates among Hispanic or Latino and non-Hispanic Black individuals were 60% (sIRR: 1.6 [95% CI: 1.0\u20132.4]) and 30% (sIRR: 1.3 [95% CI: 1.0\u20131.6]) higher than the standardized national incidence rate. Histoplasmosis incidence rates were elevated among non-Hispanic White patients (sIRR: 1.05 [95% CI: 1.02\u20131.08]). Standardized incidence rates of both diseases were higher among older and male patients, were consistently elevated in the Upper Midwest and Ohio Valley regions, and increased greatly in the Northern Rockies and Plains from 2013 to 2023. We estimated high incidence in states (blastomycosis: Illinois, Kentucky, and West Virginia; histoplasmosis: Missouri, Iowa, and Oklahoma) that do not report to surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This analysis revealed increasing incidence rates of blastomycosis and histoplasmosis, with increasing diagnoses outside of historically endemic regions, and notable differences in incidence by race\/ethnicity, gender, and age.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiaf472","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T11:38:59Z","timestamp":1757417939000},"page":"e1048-e1059","source":"Crossref","is-referenced-by-count":6,"title":["Updating the Epidemiology of Blastomycosis and Histoplasmosis in the United States, Using National Electronic Health Record Data, 2013\u20132023"],"prefix":"10.1093","volume":"232","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0734-0667","authenticated-orcid":false,"given":"Juliana G E","family":"Bartels","sequence":"first","affiliation":[{"name":"Division of Environmental Health Sciences, University of California , Berkeley, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3787-170X","authenticated-orcid":false,"given":"Simon K","family":"Camponuri","sequence":"additional","affiliation":[{"name":"Division of Environmental Health Sciences, University of California , Berkeley, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo T","family":"Snow","sequence":"additional","affiliation":[{"name":"Division of Environmental Health Sciences, University of California , Berkeley, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0280-0904","authenticated-orcid":false,"given":"Brittany L Morgan","family":"Bustamante","sequence":"additional","affiliation":[{"name":"Division of Environmental Health Sciences, University of California , Berkeley, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0204-339X","authenticated-orcid":false,"given":"Natalie J","family":"Kane","sequence":"additional","affiliation":[{"name":"Children's Mercy Research Institute , Kansas City, Missouri ,","place":["USA"]},{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine , Kansas City, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3154-6802","authenticated-orcid":false,"given":"Rose M","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Children's Mercy Research Institute , Kansas City, Missouri ,","place":["USA"]},{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine , Kansas City, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1797-9766","authenticated-orcid":false,"given":"Aidan","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Letters and Sciences, University of California , Berkeley, Berkeley, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3140-6524","authenticated-orcid":false,"given":"Mark A","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Children's Mercy Research Institute , Kansas City, Missouri ,","place":["USA"]},{"name":"Department of Pediatrics, University of Missouri-Kansas City School of Medicine , Kansas City, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3229-1378","authenticated-orcid":false,"given":"Theodore C","family":"White","sequence":"additional","affiliation":[{"name":"School of Science and Engineering, University of Missouri\u2014Kansas City , Kansas City, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0223-4615","authenticated-orcid":false,"given":"Justin V","family":"Remais","sequence":"additional","affiliation":[{"name":"Division of Environmental Health Sciences, University of California , Berkeley, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1449-4171","authenticated-orcid":false,"given":"Jennifer R","family":"Head","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Michigan , 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