Hospital discharge data from 1980 to 1989 from the National Center for
Health Statistics, National Hospital Discharge Survey (NHDS), and two
commercially generated hospital discharge data sources (PAS and McAut
o) were analyzed to document nationally the increased rate of opportun
istic candidal infections among hospitalized patients in the 1980s and
to identify the major risk factors. National projections were made by
year. Age-, sex-, race-, and disease-specific denominators were gener
ated from NHDS data. ICD-9-CM codes derived from discharge diagnoses w
ere used to identify patients with oropharyngeal candidiasis, dissemin
ated candidiasis, human immunodeficiency virus (HIV) infection/AIDS, o
r malignancies and transplants. Between 1980 and 1989, rates of oropha
ryngeal candidiasis increased 4.7 times (from 0.34 to 1.6 cases per 1,
000 admissions per year), and the number of deaths among patients with
oropharyngeal candidiasis increased fivefold. Although the highest ra
tes were among pediatric patients (3 cases per 1,000 pediatric admissi
ons), the greatest rate increases were among 15- to 44-year-old patien
ts (13-fold) and males (fivefold). Between 1983 and 1989, the rates of
oropharyngeal candidiasis among patients with HIV infection/AIDS rose
more than 22 times (from 0.02 to 0.45 case per 1,000 admissions; NHDS
data). Over the whole decade, the rates of disseminated candidiasis i
ncreased 11 times (from 0.013 to 0.15 case per 1,000 admissions). Betw
een 1985 and 1989, the rate of this complication among patients with H
IV infection/AIDS increased 10-fold, compared with only a twofold rate
increase among patients with malignancies or transplants. The rate of
debilitating and life-threatening candidiasis among hospitalized pati
ents increased considerably over the 1980s. This rate increase was sig
nificant among patients with HIV infection/AIDS and patients undergoin
g transplantation or immunosuppressive therapy for malignancies.