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Frequency and Duration of Diagnostic Delays Associated with Coccidioidomycosis and Risk Factors for Missed Diagnoses, United States
Journal article   Open access   Peer reviewed

Frequency and Duration of Diagnostic Delays Associated with Coccidioidomycosis and Risk Factors for Missed Diagnoses, United States

Desmond D Barber, Alan T Arakkal, George R Thompson, John W Baddley, Joe E Cavanaugh, Aaron C Miller and Philip M Polgreen
Emerging infectious diseases, Vol.32(5), pp.697-706
05/01/2026
DOI: 10.3201/eid3205.251421
PMID: 42116233
url
https://doi.org/10.3201/eid3205.251421View
Published (Version of record) Open Access

Abstract

Diagnosis of coccidioidomycosis is challenging and requires a high index of clinical suspicion. We estimated the incidence and duration of, and risk factors associated with, diagnostic delays and missed opportunities in the diagnosis of coccidioidomycosis. We conducted a retrospective analysis of health insurance claims data in the United States during 2001-2022 included in the Merative MarketScan Databases. Using a case-crossover design and a bootstrapping approach, we estimated the number of excess visits for coccidioidomycosis-related symptoms before diagnosis. We also evaluated potential factors associated with delay. We estimated that almost 60% of patients experienced >1 missed opportunity for diagnosis; the average diagnostic delay was 29.69 (95% CI 28.25-31.18) days. Missed opportunities were predominantly observed in outpatient settings (73%) and were significantly associated with older age, rural residence, underlying pulmonary conditions, and prescriptions for antibiotics or inhalers. Diagnostic delays for coccidioidomycosis are common, and addressing such delays could improve clinical outcomes.Diagnosis of coccidioidomycosis is challenging and requires a high index of clinical suspicion. We estimated the incidence and duration of, and risk factors associated with, diagnostic delays and missed opportunities in the diagnosis of coccidioidomycosis. We conducted a retrospective analysis of health insurance claims data in the United States during 2001-2022 included in the Merative MarketScan Databases. Using a case-crossover design and a bootstrapping approach, we estimated the number of excess visits for coccidioidomycosis-related symptoms before diagnosis. We also evaluated potential factors associated with delay. We estimated that almost 60% of patients experienced >1 missed opportunity for diagnosis; the average diagnostic delay was 29.69 (95% CI 28.25-31.18) days. Missed opportunities were predominantly observed in outpatient settings (73%) and were significantly associated with older age, rural residence, underlying pulmonary conditions, and prescriptions for antibiotics or inhalers. Diagnostic delays for coccidioidomycosis are common, and addressing such delays could improve clinical outcomes.

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