{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:41:24Z","timestamp":1777898484495,"version":"3.51.4"},"reference-count":41,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2015,5,1]],"date-time":"2015-05-01T00:00:00Z","timestamp":1430438400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective.<\/jats:title>\n                    <jats:p>Recent U.S. outbreaks of Legionnaires' disease (LD) underscore the virulent nature of this infectious pneumonia. To date, only a paucity of literature has described the mortality burden of LD. This study updates LD mortality using U.S. multiple-cause-of-death data from 2000\u20132010.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods.<\/jats:title>\n                    <jats:p>We calculated crude and age-adjusted rates for LD mortality for age, sex, race, state, Census region, and year. We conducted Poisson regression to assess seasonal and temporal trends. We generated matched odds ratios (MORs) to describe the association between LD-related deaths and other comorbid conditions listed on the death certificates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.<\/jats:title>\n                    <jats:p>We identified a total of 1,171 LD-related deaths during 2000\u20132010. The age-adjusted mortality rate remained relatively static from 2000 (0.038 per 100,000 population, 95% confidence interval [CI] 0.031, 0.046) to 2010 (0.040 per 100,000 population, 95% CI 0.033, 0.047). The absolute number increased from 107 to 135 deaths during this period, with adults \u226545 years of age having the highest caseload. Overall, LD mortality rates were 2.2 times higher in men than in women. White people accounted for nearly 83.3% of all LD-related deaths, but the age-adjusted mortality rates for black and white people were similar. Comorbid conditions such as leukemia (MOR=4.8, 95% CI 3.5, 6.6) and rheumatoid arthritis (MOR=5.6, 95% CI 3.3, 9.4) were associated with LD diagnosis on death certificates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion.<\/jats:title>\n                    <jats:p>Comorbid conditions that could lead to an immunocompromised state were associated with fatal LD on U.S. death certificates. Characterization of LD mortality burden and related comorbidities has practice implications for clinical medicine and public health surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/003335491513000309","type":"journal-article","created":{"date-parts":[[2017,4,10]],"date-time":"2017-04-10T08:26:22Z","timestamp":1491812782000},"page":"222-229","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Legionnaires' Disease and Associated Comorbid Conditions as Causes of Death in the U.S., 2000\u20132010"],"prefix":"10.1177","volume":"130","author":[{"given":"Ranjana N.","family":"Wickramasekaran","sequence":"first","affiliation":[{"name":"Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention, Los Angeles, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Sorvillo","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles (UCLA), Jonathan and Karin Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony","family":"Kuo","sequence":"additional","affiliation":[{"name":"Los Angeles County Department of Public Health, Division of Chronic Disease and Injury Prevention, Los Angeles, CA"},{"name":"University of California, Los Angeles (UCLA), Jonathan and Karin Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA"},{"name":"David Geffen School of Medicine at UCLA, Department of Family Medicine, Los Angeles, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,5,1]]},"reference":[{"key":"bibr1-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.15.3.506-526.2002"},{"key":"bibr2-003335491513000309","volume-title":"Control of communicable diseases manual","author":"Heymann DL","year":"2008","edition":"19"},{"key":"bibr3-003335491513000309","unstructured":"Centers for Disease Control and Prevention (US). Legionella: (Legionnaires' disease and Pontiac Fever) [cited 2013 Feb 8]. Available from: URL: http:\/\/www.cdc.gov\/legionella\/index.html."},{"key":"bibr4-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199709043371006"},{"key":"bibr5-003335491513000309","doi-asserted-by":"publisher","DOI":"10.3201\/eid1704.100446"},{"key":"bibr6-003335491513000309","volume-title":"Legionella and the prevention of legionellosis","author":"Bartram J","year":"2007"},{"key":"bibr7-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1994.00420210049006"},{"key":"bibr8-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1378\/chest.124.2.543"},{"key":"bibr9-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-7753(04)74604-7"},{"key":"bibr10-003335491513000309","volume-title":"Congress opens another VA hearing about Legionnaires' disease","year":"2013"},{"key":"bibr11-003335491513000309","unstructured":"Crane M, King D. Legionnaires' outbreak claims 2 more lives. The Columbus Dispatch 2013 Jul 26 [cited 2013 Oct 4]. Available from: URL: http:\/\/www.dispatch.com\/content\/stories\/local\/2013\/07\/24\/Two-more-deaths-blamed-on-Legionnaires-outbreak.html."},{"key":"bibr12-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268811002858"},{"key":"bibr13-003335491513000309","unstructured":"Centers for Disease Control and Prevention (US) WONDER. Multiple cause of death 1999\u20132012 [cited 2013 Jun 6]. Available from: URL: http:\/\/wonder.cdc.gov\/wonder\/help\/mcd.html."},{"key":"bibr14-003335491513000309","volume-title":"Instructions for classifying underlying cause of death part 2A","author":"National Center for Health Statistics (US)","year":"2010"},{"key":"bibr15-003335491513000309","volume-title":"International classification of diseases and related health problems\u201410th revision","author":"World Health Organization","year":"2011","edition":"4"},{"key":"bibr16-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwm037"},{"key":"bibr17-003335491513000309","unstructured":"National Center for Health Statistics (US). U.S. Census populations with bridged race categories [cited 2013 Jun 7]. Available from: URL: http:\/\/www.cdc.gov\/nchs\/nvss\/bridged_race.htm."},{"key":"bibr18-003335491513000309","unstructured":"National Center for Health Statistics (US). July 1, 2000\u2013July 2009 revised bridged-race intercensal population estimates. 2011 [cited 2015 Jan 7]. Available from: URL: http:\/\/www.cdc.gov\/nchs\/nvss\/bridged_race\/data_documentation.htm."},{"key":"bibr19-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9781139013567"},{"key":"bibr20-003335491513000309","volume-title":"SAS$: Version 9.3","author":"SAS Institute, Inc.","year":"2011"},{"issue":"6","key":"bibr21-003335491513000309","first-page":"101","volume":"52","author":"Goulding MR","year":"2003","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr22-003335491513000309","volume-title":"Census Brief C2010BR-09: The older population","author":"Werner CA","year":"2010"},{"key":"bibr23-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31819c9571"},{"key":"bibr24-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1086\/590557"},{"key":"bibr25-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1017\/S095026880800099X"},{"key":"bibr26-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268813003476"},{"key":"bibr27-003335491513000309","first-page":"811","volume":"135","author":"Hicks LA","year":"2007","journal-title":"Increased rainfall is associated with increased risk for legionellosis. Epidemiol Infect"},{"key":"bibr28-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1086\/498248"},{"issue":"32","key":"bibr29-003335491513000309","first-page":"1083","volume":"60","author":"Hicks LA","year":"2011","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr30-003335491513000309","doi-asserted-by":"crossref","unstructured":"Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K, Epidemiology and clinical management of Legionnaires' disease. Lancet Infect Dis 2014;1011\u201321.","DOI":"10.1016\/S1473-3099(14)70713-3"},{"key":"bibr31-003335491513000309","doi-asserted-by":"publisher","DOI":"10.15288\/jsa.1990.51.130"},{"key":"bibr32-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1300\/J069v19n04_02"},{"key":"bibr33-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1111\/j.1746-1561.1993.tb06150.x"},{"key":"bibr34-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.1990.tb03084.x"},{"key":"bibr35-003335491513000309","volume-title":"General principles of management of rheumatoid arthritis in adults","author":"Schur PH","year":"2014"},{"key":"bibr36-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes305"},{"key":"bibr37-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198511143132005"},{"key":"bibr38-003335491513000309","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-129-12-199812150-00005"},{"key":"bibr39-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(00)00314-0"},{"key":"bibr40-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199001000-00010"},{"key":"bibr41-003335491513000309","doi-asserted-by":"publisher","DOI":"10.1080\/19345747.2011.618213"}],"container-title":["Public Health Reports\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/003335491513000309","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/003335491513000309","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:32:06Z","timestamp":1777627926000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/003335491513000309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,5]]},"references-count":41,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2015,5]]}},"alternative-id":["10.1177\/003335491513000309"],"URL":"https:\/\/doi.org\/10.1177\/003335491513000309","relation":{},"ISSN":["0033-3549","1468-2877"],"issn-type":[{"value":"0033-3549","type":"print"},{"value":"1468-2877","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,5]]}}}