{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T11:51:26Z","timestamp":1791805886038,"version":"4.3.4"},"posted":{"date-parts":[[2023,11,16]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":23,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2023,11,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>\n                    Group A\n                    <jats:italic>Streptococcus<\/jats:italic>\n                    (GAS) causes an estimated 5.2 million outpatient visits for pharyngitis annually in the United States (U.S.) with incidence peaking in winter, but the annual spatiotemporal pattern of GAS pharyngitis across the U.S. is poorly characterized.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used outpatient claims data from individuals with private medical insurance between 2010-2018 to quantify GAS pharyngitis visit rates across U.S. census regions, subregions, and states. We evaluated seasonal and age-based patterns of geographic spread and the association between school start dates and the summertime upward inflection in GAS visits.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The South had the most visits per person (yearly average 39.11 visits per 1000 people, 95% CI: 36.21-42.01), and the West had the fewest (yearly average 17.63 visits per 1000 people, 95% CI: 16.76-18.49). Visits increased earliest in the South and in school-age children. Differences in visits between the South and other regions were most pronounced in the late summer through early winter. Visits peaked earliest in central southern states, in December to January, and latest on the coasts, in March. The onset of the rise in GAS pharyngitis visits correlated with, but preceded, average school start times.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The burden and timing of GAS pharyngitis varied across the continental U.S., with the South experiencing the highest overall rates and earliest onset and peak in outpatient visits. Understanding the drivers of these regional differences in GAS pharyngitis will help in identifying and targeting prevention measures.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>The incidence of streptococcal pharyngitis varies across the U.S., with highest rates in the South and lowest in the West. On average, the yearly summer increase in cases begins in the South and progresses outwards to adjacent states.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2023.11.16.23298647","type":"posted-content","created":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T03:25:14Z","timestamp":1700191514000},"source":"Crossref","is-referenced-by-count":1,"title":["Spatiotemporal Trends in Group A Streptococcal Pharyngitis in the United States"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-9276","authenticated-orcid":false,"given":"Madeleine C.","family":"Kline","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6000-8387","authenticated-orcid":false,"given":"Stephen M.","family":"Kissler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilith K.","family":"Whittles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4884-6609","authenticated-orcid":false,"given":"Michael L.","family":"Barnett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5646-1314","authenticated-orcid":false,"given":"Yonatan H.","family":"Grad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2023112000100783000_2023.11.16.23298647v1.1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa529"},{"key":"2023112000100783000_2023.11.16.23298647v1.2","unstructured":"Pharyngitis (Strep Throat): Information For Clinicians | CDC (2023). https:\/\/www.cdc.gov\/groupastrep\/diseases-hcp\/strep-throat.html."},{"key":"2023112000100783000_2023.11.16.23298647v1.3","doi-asserted-by":"publisher","DOI":"10.1177\/20499361221132101"},{"key":"2023112000100783000_2023.11.16.23298647v1.4","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000004111"},{"key":"2023112000100783000_2023.11.16.23298647v1.5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1005382"},{"key":"2023112000100783000_2023.11.16.23298647v1.6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1004591"},{"key":"2023112000100783000_2023.11.16.23298647v1.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.250"},{"key":"2023112000100783000_2023.11.16.23298647v1.8","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jit828"},{"key":"2023112000100783000_2023.11.16.23298647v1.9","unstructured":"Real World Evidence | Merative https:\/\/www.merative.com\/real-world-evidence."},{"key":"2023112000100783000_2023.11.16.23298647v1.10","unstructured":"Clinical Classifications Software (CCS) for ICD-10-PCS (beta version) https:\/\/hcup-us.ahrq.gov\/toolssoftware\/ccs10\/ccs10.jsp."},{"key":"2023112000100783000_2023.11.16.23298647v1.11","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis629"},{"key":"2023112000100783000_2023.11.16.23298647v1.12","unstructured":"Census Regions and Divisions of the United States."},{"key":"2023112000100783000_2023.11.16.23298647v1.13","unstructured":"Kyle Walker and Matt Herman (2023). tidycensus: Load US Census Boundary and Attributable Data as \u201ctidyverse\u2019 and \u2018sf\u2019-Ready Data Frames. 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