Incidence, Duration, and Risk Factors for Diagnostic Delays Associated with Dengue: A Population-Based Study

Aaron C Miller; Alan T Arakkal; Joseph E Cavanaugh; Philip M Polgreen; Judy A Streit

doi:10.4269/ajtmh.25-0019

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Incidence, Duration, and Risk Factors for Diagnostic Delays Associated with Dengue: A Population-Based Study

Journal article

Peer reviewed

Incidence, Duration, and Risk Factors for Diagnostic Delays Associated with Dengue: A Population-Based Study

Aaron C Miller, Alan T Arakkal, Joseph E Cavanaugh, Philip M Polgreen and Judy A Streit

The American journal of tropical medicine and hygiene, Vol.113(4), pp.857-864

10/01/2025

DOI: 10.4269/ajtmh.25-0019

PMCID: PMC12493126

PMID: 40675144

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https://pmc.ncbi.nlm.nih.gov/articles/PMC12493126/View

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Abstract

Dengue is an important cause of systemic febrile illness among international travelers. Because signs and symptoms are similar to other infectious illnesses, dengue may not be promptly considered when patients seek care. We conducted a retrospective cohort study of patients diagnosed with dengue in the United States from 2001 to 2021 using the Merative MarketScan Research databases, a large collection of health insurance records. We identified patients diagnosed with dengue and enrolled ≥180 days before diagnosis. We then compared the frequency of visits with signs/symptoms compatible with dengue during the 14 days before diagnosis with a control period 15-180 days before diagnosis. We conducted a bootstrap-based analysis to estimate duration, frequency, and potential risk factors for missed diagnostic opportunities. We identified 5,992 cases of dengue. We found that 3,090 (51.6%) patients had one or more health care visits before diagnosis with characteristic signs/symptoms of dengue recorded. We estimated that 22.8% (95% CI: 21.3-24.4) experienced one or more missed opportunities for diagnosis, and the average duration of diagnostic delay was 4.02 (95% CI: 3.67-4.43) days. Potential missed diagnostic opportunities were less likely to occur at visits with an infectious disease consult but were more likely to occur during weekend visits and visits involving an antibiotic or opioid prescription. Diagnostic delays for dengue may be common, with almost a quarter of patients in our sample potentially experiencing a missed diagnostic opportunity. Future work should aim to improve timeliness of diagnosis and identify patient populations at greatest risk for delay.

Details

Title: Subtitle: Incidence, Duration, and Risk Factors for Diagnostic Delays Associated with Dengue: A Population-Based Study
Creators: Aaron C Miller - University of Iowa
Alan T Arakkal - University of Iowa
Joseph E Cavanaugh - University of Iowa
Philip M Polgreen - University of Iowa
Judy A Streit - University of Iowa
Resource Type: Journal article
Publication Details: The American journal of tropical medicine and hygiene, Vol.113(4), pp.857-864
DOI: 10.4269/ajtmh.25-0019
PMID: 40675144
PMCID: PMC12493126
NLM abbreviation: Am J Trop Med Hyg
ISSN: 1476-1645
eISSN: 1476-1645
Publisher: AMER SOC TROP MED & HYGIENE
Grant note: Agency for Healthcare Research and Quality: R01HS027375
Financial support: This work was supported by the Agency for Healthcare Research and Quality (Grant no. R01HS027375 to A. C. Miller, A. T. Arakkal, J. E. Cavanaugh, and P. M. Polgreen) . The funding agency did not play a direct role in the study analysis or manuscript construction.
Language: English
Electronic publication date: 07/17/2025
Date published: 10/01/2025
Academic Unit: Statistics and Actuarial Science; Infectious Diseases; Epidemiology; Biostatistics; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984848117702771

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