Health Equity Priorities for Fungal Diseases

CDC’s Mycotic Diseases Branch encourages more research to understand fungal disease disparities while recognizing the need for urgent action to address inequities in social determinants of health that worsen these disparities.

Fungi cause many types of illnesses, some of which are life-threatening. Although fungal diseases can affect anyone, people with conditions that weaken the immune system have the greatest risk of severe illness and death.

Fungal diseases disproportionately affect different groups of people in terms of sex, race, ethnicity, and occupation.1,2,3 For example, people from some racial and ethnic groups, including Black, American Indian or Alaska Native, and Hispanic persons, have had higher rates of fungal deaths compared with other groups, especially during the COVID-19 pandemic.2

These disparities are likely driven in large part by inequities in the social determinants of health—conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.

Social determinants of health may directly predispose some people to fungal diseases, contributing to disparities in disease burden and outcomes. For example, people who perform certain types of outdoor work might be more likely to inhale illness-causing fungal spores.4-6 Inequities in the social determinants of health may also indirectly contribute to disparities in the risk for acquiring or having a poor outcome from a fungal disease. For example, communities with inadequate access to nutritious food and high-quality healthcare might have a higher rate of uncontrolled diabetes, a risk factor for several severe fungal diseases.

CDC’s Mycotic Diseases Branch is committed to decreasing health disparities and promoting health equity by leading and supporting efforts to reduce the burden of fungal diseases and improve outcomes for people from groups that are disproportionately affected. Policies and programs that address underlying inequities in the social determinants of health will likely play the most important role in decreasing disparities in fungal diseases and other infectious conditions. Increased data collection and implementation of strategies to improve fungal disease diagnosis and treatment may also help decrease the burden of fungal diseases on disproportionately affected groups.

Mycotic Diseases Branch priorities for addressing health inequities related to fungal diseases

Priority 1: Improve data

Data can catalyze change. High-quality data on the epidemiology of fungal diseases could provide useful information to guide the prevention, diagnosis, and treatment of fungal diseases in disproportionately affected groups. Researchers should ensure that data collected on fungal diseases include geographically and demographically diverse populations.

Priority 2: Develop strategies and interventions that serve groups disproportionately affected by fungal disease

Certain strategies might help decrease the burden of fungal diseases and save lives, particularly among disproportionately affected groups. For example, clinician education about groups with a higher risk of severe fungal disease can improve practices for screening, diagnosis, and treatment. Improving laboratory capacity to detect fungal diseases and antifungal drug resistance, and ensuring equitable access to such testing, might also improve patient outcomes. Public awareness campaigns can educate people from certain communities or occupational groups on how to reduce their exposure to fungal pathogens or when they should seek healthcare for possible fungal diseases. These fungal disease–specific strategies can add to broader measures designed to address inequities in the social determinants of health.

  1. Gold JAW, Ahmad FB, Cisewski JA, Rossen LM, Montero AJ, Benedict K, et al. Increased deaths from fungal infections during the COVID-19 pandemic—National Vital Statistics System, United States, January 2020–December 2021. Clin Infect Dis. 2022.
  2. Das R, McNary J, Fitzsimmons K, Dobraca D, Cummings K, Mohle-et al. Occupational coccidioidomycosis in California: outbreak investigation, respirator recommendations, and surveillance findings. J Occup Environ Med. 2012; 54(5): 564-7.
  3. Rayens E, Rayens M, Norris KA. Demographic and Socioeconomic Factors Associated with Fungal Infections Risk, United States 2019. Emerg Infect Dis. 2022;28(10):1955-1969.
  4. de Perio MA, Benedict K, Williams SL, Niemeier-Walsh C, Green BJ, Coffey C, et al. Occupational histoplasmosis: epidemiology and prevention measures. J Fungi (Basel, Switzerland). 2021; 7(7).
  5. Choptiany M, Wiebe L, Limerick B, Sarasfield P, Cheang M, Light B, et al. Risk factors for acquisition of endemic blastomycosis. Can J Infect Dis Med Microbiol. 2009; 20(4): 117-2.
  6. Wheeler C, Lucas KD, Mohle-Boetani JC. Rates and risk factors for Coccidioidomycosis among prison inmates, California, USA, 2011. Emerg Infect Dis. 2015 Jan;21(1):70-5.