Among inmates detained at two California prisons in 2011, black race and diabetes were associated with increased risk for coccidioidomycosis, according to study results published in Emerging Infectious Diseases.
These findings led to a court decision requiring the exclusion of black inmates and those with diabetes mellitus from these two prisons, which reported the highest coccidioidomycosis rates in the state.
Researchers evaluated rates of coccidioidomycosis at the prisons, identified as X and Y, which accounted for more than 80% of inmate cases in California. The researchers assessed the prison populations for their risks for developing primary disease, as well as severe and disseminated coccidioidomycosis. They calculated coccidioidomycosis incidence in terms of the proportion of the population at risk and the number of cases per person-years.
Prisons X and Y had an incidence of 6,934 and 3,799 cases per 100,000 population, respectively — one to two orders of magnitude greater than rates at six other prisons located in the three counties where coccidioidomycosis was endemic, according to the researchers. There were 7,530 and 3,880 coccidioidomycosis cases per 100,000 person-years at prisons X and Y, respectively.
The researchers found a significantly higher risk for primary coccidioidomycosis among black inmates aged 40 years or older vs. white inmates of the same age (OR=2; 95% CI, 1.5-2.8). Inmates with diabetes were at higher risk for severe pulmonary coccidioidomycosis, while black inmates were at higher risk for disseminated coccidioidomycosis.
These findings were the basis of a 2013 court order issued by the US District Court for the Northern District of California to exclude all inmates with diabetes and black inmates from prisons X and Y.
“We used the study results to improve the policies and practices for protecting California inmates from coccidioidomycosis and its most serious sequelae,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.