Advancing Fungal Disease Epidemiology through Multilevel Modeling and Data Integration

This K01 award will support the career development of Dr. Brittany L Morgan Bustamante, an infectious disease epidemiologist at the UC Berkeley School of Public Health (BPH). Dr. Bustamante seeks to become an independent researcher leading studies on the upstream and contextual factors shaping infectious disease risk and outcomes. The proposed research will investigate three clinically important invasive fungal diseases—aspergillosis, candidiasis, and cryptococcosis. These infections are increasing in incidence and severity but remain underexamined in population-based studies. Although clinical risk factors are well documented, less is known about how broader contextual determinants such as healthcare infrastructure, characteristics of the physical and social environment, and access to services contribute to variation in disease incidence and severity. Fungal infections are especially difficult to diagnose and treat, and delayed detection may be influenced by barriers that occur outside the clinical encounter, including healthcare availability, neighborhood-level conditions, and system capacity. To address these gaps, this project will integrate electronic health record (EHR) and national inpatient data with contextual indicators to identify multilevel drivers (i.e., individual, place-based, policy) of fungal disease risk and severity. Aim 1 will apply a novel multilevel modeling approach to estimate how invasive fungal disease prevalence and in-hospital mortality vary across combinations of individual-level characteristics (e.g., age, sex, geography, insurance type). Aim 2 will use advanced spatial and multilevel methods to quantify the contribution of state-level measures of healthcare access (e.g., provider shortages, insurance coverage), environmental conditions (e.g., dust exposure), and neighborhood indicators (e.g., population density, housing vacancy) to examine geographic variation in infection risk. Aim 3 will estimate the causal effect of Medicaid expansion on fungal disease incidence and outcomes among high-risk individuals (i.e., those with diabetes or chronic obstructive pulmonary disease) using a difference-in-difference approach. The five-year training plan includes coursework, workshops, directed readings, and mentored research activities designed to: 1) Build expertise in developing constructs of the upstream and contextual factors influencing infectious disease risk; 2) Develop skills in the advanced epidemiological, computational, and statistical methods required to study multilevel determinants of disease using disparate data sources; and 3) Strengthen collaborative partnerships and develop leadership and professional skills to design and execute impactful, policy-relevant research projects. The environment fostered by BPH’s commitment to early career scientists, and its strengths in infectious disease epidemiology, biostatistics, and health-systems research provides an exceptional environment to support these goals.