Volume 97, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Few data are available on the burden of malaria hospitalization in the United States. Study of malaria using hospital-based data can better define the impact of malaria and help inform prevention efforts. U.S. malaria cases identified from hospitalization discharge records in the 2000–2014 Nationwide Inpatient Sample were examined. Frequencies and population rates were reported by demographics, infecting species, clinical, financial, institutional, geographic, and seasonal characteristics, and disparities were identified. Time trends in malaria cases were assessed using negative binomial regression. From 2000 to 2014, there were an estimated 22,029 malaria-related hospitalizations (4.88 per 1 million population) in the United States, including 182 in-hospital deaths and 4,823 severe malaria cases. The rate of malaria-related hospitalizations did not change significantly over the study period. The largest number of malaria-related hospitalizations occurred in August. Malaria-related hospitalizations occurred disproportionately among patients who were male, black, or 25–44 years of age. accounted for the majority of malaria-related hospitalizations. On average, malaria patients were hospitalized for 4.36 days with charges of $25,789. Patients with a malaria diagnosis were more often hospitalized in the Middle Atlantic and South Atlantic census divisions, urban teaching, private not-for-profit, and large-bed-size hospitals. Malaria imposes a substantial disease burden in the United States. Enhanced primary and secondary prevention measures, including strategies to increase the use of pretravel consultations and prompt diagnosis and treatment are needed.


Article metrics loading...

Loading full text...

Full text loading...



  1. World Health Organization, 2016. World Malaria Report 2016. Geneva, Switzerland: World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/252038/1/9789241511711-eng.pdf?ua=1.
  2. Centers for Disease Control and Prevention, 2016. Malaria. Available at: http://www.cdc.gov/malaria/. Accessed April 15, 2015.
  3. Guyatt HL, Snow RW, , 2004. Impact of malaria during pregnancy on low birth weight in sub-Saharan Africa. Clin Microbiol Rev 17: 760769.[Crossref]
  4. Steketee RW, Campbell CC, , 2010. Impact of national malaria control scale-up programmes in Africa: magnitude and attribution of effects. Malar J 9: 299.[Crossref]
  5. Cullen KA, Mace KE, Arguin PM, , 2016. Malaria surveillance: United States, 2013. MMWR Surveill Summ 65: 122.[Crossref]
  6. Checkley AM, Smith A, Smith V, Blaze M, Bradley D, Chiodini PL, Whitty CJM, , 2012. Risk factors for mortality from imported falciparum malaria in the United Kingdom over 20 years: an observational study. BMJ 344: e2116.[Crossref]
  7. Hagmann SHF, Van PV, Stauffer WM, Miller AO, Connor BA, Hale DC, Coyle CM, Cahill JD, Marano C, Esposito DH, Kozarsky PE, , 2014. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel. Fam Pract 31: 678687.[Crossref]
  8. Sinka ME, Bangs MJ, Manguin S, Rubio-Palis Y, Chareonviriyaphap T, Coetzee M, Mbogo CM, Hemingway J, Patil AP, Temperley WH, Gething PW, Kabaria CW, Burkot TR, Harbach RE, Hay SI, , 2012. A global map of dominant malaria vectors. Parasit Vectors 5: 69.[Crossref]
  9. Zucker JR, , 1996. Changing patterns of autochthonous malaria transmission in the United States: a review of recent outbreaks. Emerg Infect Dis 2: 3743.[Crossref]
  10. Abanyie FA, Arguin PM, Gutman J, , 2011. State of malaria diagnostic testing at clinical laboratories in the United States, 2010: a nationwide survey. Malar J 10: 340.[Crossref]
  11. Doyle TJ, Glynn MK, Groseclose SL, , 2002. Completeness of notifiable infectious disease reporting in the United States: an analytical literature review. Am J Epidemiol 155: 866874.[Crossref]
  12. Healthcare Cost and Utilization Project (HCUP), 2013. Introduction to the HCUP Nationwide Inpatient Sample (NIS) 2011. Rockville, MD: Agency for Healthcare Research and Quality. Available at: http://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2011.jsp. Accessed March 26, 2016.
  13. Healthcare Cost and Utilization Project (HCUP), 2014. Introduction to the HCUP Nationwide Inpatient Sample (NIS) 2012. Rockville, MD: Agency for Healthcare Research and Quality. Available at: http://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2012.jsp. Accessed March 26, 2016.
  14. Centers for Disease Control and Prevention, 2015. Classification of Diseases, Functioning, and Disability. Conversion Table. Available at: http://www.cdc.gov/nchs/icd/icd9cm.htm. Accessed September 12, 2014.
  15. Healthcare Cost and Utilization Project (HCUP), 2015. Clinical Classifications Software (CCS) for ICD-9-CM and Chronic Condition Indicator. HCUP Tools and Software. Rockville, MD: Agency for Healthcare Research and Quality. Available at: https://www.hcup-us.ahrq.gov/tools_software.jsp. Accessed June 26, 2016.
  16. U.S. Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), 2016. Bridged-Race Population Estimates, United States July 1st Resident Population by State, County, Age, Sex, Bridged-Race, and Hispanic Origin. Available at: http://wonder.cdc.gov/bridged-race-v2014.html. Accessed April 15, 2016.
  17. Cullen KA, Arguin PM, , 2013. Malaria surveillance: United States, 2011. MMWR Surveill Summ 62: 117.
  18. Cullen KA, Arguin PM, Centers for Disease Control an Prevention (CDC), 2014. Malaria surveillance: United States, 2012. MMWR Surveill Summ 63: 122.
  19. Centers for Disease Control and Prevention, National Center for Health Statistics, 2016. Multiple Cause of Death 1999–2014. Available at: http://wonder.cdc.gov/mcd-icd10.html. Accessed on June 11, 2016.
  20. Causer LM, Newman RD, Barber AM, Roberts JM, Stennies G, Bloland PB, Parise ME, Steketee RW, , 2002. Malaria surveillance: United States, 2000. MMWR Surveill Summ 51: 921.
  21. Filler S, Causer LM, Newman RD, Barber AM, Roberts JM, MacArthur J, Parise ME, Steketee RW, , 2003. Malaria surveillance: United States, 2001. MMWR Surveill Summ 52: 114.
  22. Shah S, Filler S, Causer LM, Rowe AK, Bloland PB, Barber AM, Roberts JM, Desai MR, Parise ME, Steketee RW, , 2004. Malaria surveillance: United States, 2002. MMWR Surveill Summ 53: 2134.
  23. Eliades MJ, Shah S, Ngyuen-Dinh P, Newman RD, Barber AM, Roberts JM, Mail S, Parise ME, Steketee RW, , 2005. Malaria surveillance: United States, 2003. MMWR Surveill Summ 54: 2539.
  24. Skarbinski J, James EM, Causer LM, Barber AM, Mali S, Nguyen-Dinh P, Roberts JM, Parise ME, Slutsker L, Newman RD, , 2006. Malaria surveillance: United States, 2004. MMWR Surveill Summ 55: 2337.
  25. Thwing J, Skarbinski J, Newman RD, Barber AM, Mali S, Roberts JM, Slutsker L, Arguin PM, , 2007. Malaria surveillance: United States, 2005. MMWR Surveill Summ 56: 2338.
  26. Mali S, Steele S, Slutsker L, Arguin PM, , 2008. Malaria surveillance: United States, 2006. MMWR Surveill Summ 57: 2439.
  27. Mali S, Steele S, Slutsker L, Arguin PM, , 2009. Malaria surveillance: United States, 2007. MMWR Surveill Summ 58: 116.
  28. Mali S, Steele S, Slutsker L, Arguin PM, , 2010. Malaria surveillance: United States, 2008. MMWR Surveill Summ 59: 115.
  29. Mail S, Tan KR, Arguin PM, , 2011. Malaria surveillance: United States, 2009. MMWR Surveill Summ 60: 115.
  30. Mali S, Kachur SP, Arguin PM, , 2012. Malaria surveillance: United States, 2009. MMWR Surveill Summ 61: 117.
  31. World Tourism Organization, 2014. UNWTO Tourism Highlights, 2014 edition. Madrid, Spain: World Tourism Organization. Available at: http://mkt.unwto.org/publication/unwto-tourism-highlights-2014-edition. Accessed March 25, 2015.
  32. Schlagenhauf P, Weld L, Goorhuis A, Gautret P, Weber R, von Sonnenburg F, Lopez-Velez R, Jensenius M, Cramer JP, Field VK, Odolini S, Gkrania-Klotsas E, Chappuis F, Malvy D, van Genderen PJJ, Mockenhaupt F, Jaureguiberry S, Smith C, Beeching NJ, Ursing J, Rapp C, Parola P, Grobusch MP, , 2015. Travel-associated infection presenting in Europe (2008–2012): an analysis of EuroTravNet longitudinal, surveillance data, and evaluation of the effect of the pre-travel consultation. Lancet 15: 5564.[Crossref]
  33. Schlagenhauf P, Chen LH, Wilson ME, Freedman DO, Tcheng D, Schwartz E, Pandey P, Weber R, Nadal D, Berger C, von Sonnenburg F, Keystone J, Leder K, , 2010. Sex and gender differences in travel-associated disease. Clin Infect Dis 50: 826832.[Crossref]
  34. Leder K, Torresi J, Libman MD, Cramer JP, Castelli F, Schlagenhauf P, Wilder-Smith A, Wilson ME, Keystone JS, Schwartz E, Barnett ED, von Sonnenburg F, Brownstein JS, Cheng AC, Sotir MJ, Esposito DH, Freedman DO, , 2013. GeoSentinel surveillance of illness in returned travelers, 2007–2011. Ann Intern Med 158: 456468.[Crossref]
  35. Kerlin DH, Gatton ML, , 2013. Preferential invasion by Plasmodium merozoites and the self-regulation of parasite burden. PLoS One 8: e57434.[Crossref]
  36. White NJ, Pukrittayakamee S, Hien TT, Faiz MA, Mokuolu OA, Dondorp AM, , 2014. Malaria. Lancet 383: 723735.[Crossref]
  37. Hwang J, Cullen KA, Kachur SP, Arguin PM, Baird JK, , 2014. Severe morbidity and mortality risk from malaria in the United States, 1985–2011. Open Forum Infect Dis 1: 18.[Crossref]
  38. Mendis K, Sina BJ, Marchesini P, Carter R, , 2001. The neglected burden of Plasmodium vivax malaria. Am J Trop Med Hyg 64 (Suppl): 97106.[Crossref]
  39. Centers for Disease Control and Prevention, 2013. Treatment of Malaria. Available at: http://www.cdc.gov/malaria/resources/pdf/clinicalguidance.pdf. Accessed March 26, 2016.
  40. International Trade Administration, 2013. National Travel and Tourism Office. US Department of Commerce. US Travel and Tourism Statistics (Inbound). Region of origin profiles, p. 6. Africa (Lond) 6. Available at: http://tinet.ita.doc.gov/outreachpages/download_data_table/2012_Africa_Market_Profile.pdf. Accessed June 28, 2016.
  41. International Trade Administration, 2013. National Travel and Tourism Office. US Department of Commerce. US Travel and Tourism Statistics (US Resident Outbound). US to overseas for leisure/visit friends and relatives (VFR). Page 7. Available at: http://tinet.ita.doc.gov/outreachpages/download_data_table/2012-US-Leisure-VFR.pdf. Accessed June 28, 2016.
  42. Hamer DH, Connor BA, , 2004. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med 11: 2326.[Crossref]
  43. LaRocque RC, Rao SR, Tsibris A, Lawton T, Barry MA, Marano N, Brunette G, Yanni E, Ryan ET, , 2010. Pre-travel health advice-seeking behavior among US international travelers departing from Boston Logan International Airport. J Travel Med 17: 387391.[Crossref]
  44. Centers for Disease Control and Prevention, 2015. Malaria. Yellow Book 2015. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/malaria. Accessed April 15, 2016.
  45. International Trade Administration, 2016. National Travel and Tourism Office. US Department of Commerce. Monthly arrivals to the United States, 1996–2015. Available at: http://travel.trade.gov/research/monthly/arrivals/. Accessed June 28, 2016.
  46. Ash LR, Orihel TC, , 2007. Atlas of Human Parasitology, 5th edition. Chicago, IL: ASCP Press.

Data & Media loading...

  • Received : 10 Feb 2017
  • Accepted : 17 Mar 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error