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Coccidioidomycosis is a disease acquired by inhaling spores of Coccidioides immitis, a fungus found in certain arid regions, including the San Joaquin Valley, California, USA, where 8 state prisons are located. During 2011, we reviewed coccidioidomycosis rates at 2 of the prisons that consistently report >80% of California’s cases among inmates and determined inmate risk factors for primary, severe, and disseminated coccidioidomycosis. Inmates of African American race/ethnicity who were >= 40 years of age were at significantly higher risk for primary coccidioidomycosis than their white counterparts (odds ratio 2.0, 95% CI 1.5-2.8). Diabetes was a risk factor for severe pulmonary coccidioidomycosis, and being African American was a risk factor for disseminated disease. These findings contributed to a court decision mandating exclusion of African American inmates and inmates with diabetes from the 2 California prisons with the highest rates of coccidioidomycosis.