{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:38:29Z","timestamp":1792798709593,"version":"4.5.0"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T00:00:00Z","timestamp":1736899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The epidemiology of allergic bronchopulmonary aspergillosis (ABPA) in the United States is not well-described. To estimate national ABPA prevalence among patients with asthma or cystic fibrosis, characterize ABPA testing practices, and describe ABPA clinical features, treatment, and 6-month outcomes. We used the 2016\u20132022 Merative\u2122 MarketScan\u00ae Commercial\/Medicare and Multi-State Medicaid Databases to identify cohorts of patients with 1) asthma, 2) cystic fibrosis (CF), and 3) ABPA. We calculated ABPA prevalence per 10,000 patients with asthma or CF, assessed diagnostic testing for ABPA among patients with severe asthma, and described features of patients with ABPA using diagnosis and procedure codes. The overall ABPA prevalence among patients with asthma was 2.8\/10,000 (Commercial\/Medicare) and 1.0\/10,000 (Medicaid). ABPA prevalence increased with asthma severity (Commercial\/Medicare: mild 1.3, moderate 9.3, severe 70.6, Medicaid: mild 0.3, moderate 2.4, severe 32.4). Among patients with CF, ABPA prevalence was 183.7\/10,000 (Commercial\/Medicare) and 134.6\/10,000 (Medicaid). Among patients with severe asthma, 10.3% (Commercial\/Medicare) and 7.4% (Medicaid) received total immunoglobulin E testing, which is recommended for ABPA diagnosis. Among all patients with ABPA (Commercial\/Medicare: n = 1,564, Medicaid: n = 410), ABPA treatments included inhaled corticosteroids (&gt;70%), systemic corticosteroids (&gt;62%), and antifungals (&gt;18%). Patients with ABPA and Medicaid were more likely to experience hospitalization (45.1% vs. 22.5% of patients with Commercial\/Medicare insurance) and respiratory failure (18.5% vs. 10.9%). This analysis provides initial estimates of national ABPA prevalence. Further studies could identify potential barriers to ABPA testing and investigate potential factors affecting payer-related differences in ABPA burden.<\/jats:p>","DOI":"10.1371\/journal.pone.0317054","type":"journal-article","created":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T18:35:13Z","timestamp":1736966113000},"page":"e0317054","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Prevalence and features of allergic bronchopulmonary aspergillosis, United States, 2016\u20132022"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0458-2493","authenticated-orcid":true,"given":"Kaitlin","family":"Benedict","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy A. W.","family":"Gold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Toda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,15]]},"reference":[{"issue":"4","key":"pone.0317054.ref001","doi-asserted-by":"crossref","first-page":"2400061","DOI":"10.1183\/13993003.00061-2024","article-title":"Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis\/mycoses","volume":"63","author":"R Agarwal","year":"2024","journal-title":"European Respiratory Journal"},{"issue":"4","key":"pone.0317054.ref002","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciw326","article-title":"Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America","volume":"63","author":"TF Patterson","year":"2016","journal-title":"Clinical Infectious Diseases"},{"key":"pone.0317054.ref003","unstructured":"Cystic Fibrosis Foundation. Allergic Bronchopulmonary Aspergillosis Clinical Care Guidelines [10\/3\/2024]. Available from: https:\/\/www.cff.org\/medical-professionals\/allergic-bronchopulmonary-aspergillosis-clinical-care-guidelines."},{"issue":"4","key":"pone.0317054.ref004","doi-asserted-by":"crossref","first-page":"361","DOI":"10.3109\/13693786.2012.738312","article-title":"Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults","volume":"51","author":"DW Denning","year":"2013","journal-title":"Med Mycol"},{"issue":"6","key":"pone.0317054.ref005","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1016\/j.jaip.2023.04.009","article-title":"Prevalence of Aspergillus Sensitization and Allergic Bronchopulmonary Aspergillosis in Adults With Bronchial Asthma: A Systematic Review of Global Data","volume":"11","author":"R Agarwal","year":"2023","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"2","key":"pone.0317054.ref006","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1378\/chest.63.2.177","article-title":"Allergic Bronchopulmonary Aspergillosis is Not Rare: With a Note on Preparation of Antigen for Immunologic Tests.","volume":"63","author":"JH Hoehne","year":"1973","journal-title":"Chest"},{"issue":"2","key":"pone.0317054.ref007","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/ACI.0000000000000971","article-title":"Epidemiology of the relationship between allergic bronchopulmonary aspergillosis and asthma","volume":"24","author":"M Maule","year":"2024","journal-title":"Curr Opin Allergy Clin Immunol"},{"key":"pone.0317054.ref008","article-title":"Is the Prevalence of Allergic Bronchopulmonary Aspergillosis Greater in Severe Asthma?","author":"IS Sehgal","year":"2024","journal-title":"The Journal of Allergy and Clinical Immunology: In Practice"},{"issue":"1","key":"pone.0317054.ref009","doi-asserted-by":"crossref","first-page":"ofw268","DOI":"10.1093\/ofid\/ofw268","article-title":"Trends in Hospitalizations Related to Invasive Aspergillosis and Mucormycosis in the United States, 2000\u20132013.","volume":"4","author":"S Vallabhaneni","year":"2017","journal-title":"Open Forum Infect Dis."},{"issue":"3","key":"pone.0317054.ref010","doi-asserted-by":"crossref","first-page":"e255","DOI":"10.1093\/cid\/ciac489","article-title":"Increased Deaths From Fungal Infections During the Coronavirus Disease 2019 Pandemic\u2014National Vital Statistics System, United States, January 2020\u2013December 2021","volume":"76","author":"JAW Gold","year":"2022","journal-title":"Clinical Infectious Diseases"},{"key":"pone.0317054.ref011","doi-asserted-by":"crossref","first-page":"843763","DOI":"10.1155\/2011\/843763","article-title":"Allergic Bronchopulmonary Aspergillosis in Asthma and Cystic Fibrosis","volume":"2011","author":"AP Knutsen","year":"2011","journal-title":"Clinical and Developmental Immunology"},{"issue":"3","key":"pone.0317054.ref012","doi-asserted-by":"crossref","first-page":"232","DOI":"10.4103\/0970-2113.135762","article-title":"A questionnaire-based study on the role of environmental factors in allergic bronchopulmonary aspergillosis","volume":"31","author":"R Agarwal","year":"2014","journal-title":"Lung India"},{"issue":"10","key":"pone.0317054.ref013","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.3201\/eid2810.220391","article-title":"Demographic and Socioeconomic Factors Associated with Fungal Infection Risk, United States, 2019","volume":"28","author":"E Rayens","year":"2022","journal-title":"Emerging Infectious Disease journal"},{"issue":"6","key":"pone.0317054.ref014","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.jaci.2009.04.030","article-title":"Asthma disparities in urban environments","volume":"123","author":"T. 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