{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:08:42Z","timestamp":1783703322140,"version":"3.55.0"},"posted":{"date-parts":[[2025,6,6]]},"group-title":"Epidemiology","reference-count":39,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,6,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/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 geographic and temporal incidence rates, we used weighted generalized estimating equations adjusting for non-representativeness of EHR-reporting facilities. We computed standardized incidence rate ratios (sIRRs), which relay relative differences in standardized incidence rates among region, 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% CI: 1.6-3.5) and 1.9 times (95% CI: 1.6-2.2) rates in 2013, for blastomycosis and histoplasmosis, respectively. Blastomycosis incidence rates among Hispanic\/Latino and non-Hispanic Black individuals were 60% (sIRR: 1.6 [95% CI: 1.0-2.4]) and 30% (sIRR: 1.3 [95% CI: 1.0-1.6]) higher than the standardized national incidence rate. Histoplasmosis incidence rates were elevated among non-Hispanic White patients (sIRR: 1.05 [95% CI: 1.02-1.08]). Standardized incidence rates of both diseases were higher among older and male patients and were elevated in the Upper Midwest (sIRR: blastomycosis: 5.1 [95% CI: 3.7-6.8]; histoplasmosis: 1.7 [95% CI: 1.5-1.9]) and Ohio Valley regions (sIRR: blastomycosis: 2.0 [95% CI: 1.7-2.3]; histoplasmosis: 2.3 [95% CI: 2.2-2.5], and increased in the Northern Rockies and Plains from 2013 to 2023.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This analysis revealed increasing incidence rates of blastomycosis and histoplasmosis and expansion outside of historically endemic regions, with notable differences in incidence by race\/ethnicity, gender, and age.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>Blastomycosis and histoplasmosis incidence rates have increased two-fold in the United States from 2013 to 2023, including outside of historically endemic regions. Incidence rates varied by race and ethnicity, age, and gender.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.06.03.25328884","type":"posted-content","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T21:20:20Z","timestamp":1749244820000},"source":"Crossref","is-referenced-by-count":1,"title":["Updating the epidemiology of blastomycosis and histoplasmosis in the United States, using national electronic health record data, 2013 - 2023"],"prefix":"10.64898","author":[{"given":"Juliana G.E.","family":"Bartels","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon K.","family":"Camponuri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo T.","family":"Snow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany L.","family":"Morgan Bustamante","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie J.","family":"Kane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose M.","family":"Reynolds","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aidan","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hoffman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore C.","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0223-4615","authenticated-orcid":false,"given":"Justin V.","family":"Remais","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer R.","family":"Head","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2025060905352410000_2025.06.03.25328884v1.1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2203.151117"},{"key":"2025060905352410000_2025.06.03.25328884v1.2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2704.204078"},{"key":"2025060905352410000_2025.06.03.25328884v1.3","doi-asserted-by":"crossref","unstructured":"McTaggart, L. 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