Nontuberculous Mycobacterial Disease Mortality in the United States, 1999–2010: A Population-Based Comparative Study

Abstract

BackgroundEnvironmental nontuberculous mycobacteria (NTM) are ubiquitous organisms with which humans commonly interact. The epidemiologic characteristics of NTM diseases including mortality rate and its associated factors remain largely unknown. In this study, we explored the geographical area of exposure and mortality and comorbid conditions of affected persons to determine environment, host, and host-pathogen interactive factors.MethodsWe analyzed mortality related to nontuberculous mycobacterial infections from 1999 through 2010 by examining multiple-cause-of-death data from the National Center for Health Statistics. Among those who died with these diseases, we analyzed age-adjusted mortality rates, trends, associations with demographic variables, and comorbid conditions and correlated this information with similar data for tuberculosis-related mortality during the same time.Measurements and Mean ResultsFrom 1999 through 2010, nontuberculous mycobacterial disease was reported as an immediate cause of death in 2,990 people in the United States with a combined overall mean age-adjusted mortality rate of 0.1 per 100,000 person-years. A significant increase in the number of NTM related deaths was seen from 1999 through 2010 (R2 = 0.72, p<0.0001), but it was not significant after adjustment for age. Persons aged 55 years and older, women, those living in Hawaii and Louisiana, and those of non-Hispanic, white ethnicity had higher mortality rates. Compared to tuberculosis-related mortality, chronic obstructive pulmonary disease, bronchiectasis, HIV, interstitial lung diseases, and tobacco use were significantly more common in persons with nontuberculous mycobacteria-related deaths.ConclusionsNontuberculous mycobacteria-related death numbers are rising and are unevenly distributed. The strong association of nontuberculous mycobacterial disease with age suggests that its prevalence will increase as the United States population ages.

Health‐related quality of life, comorbidities and mortality in pulmonary nontuberculous mycobacterial infections: A systematic review

“…Studies examined the following outcomes: HRQOL alone (n = 2), 21,22 comorbidities alone (n = 1), 23 mortality alone (n = 11), 20,[24][25][26][27][28][29][30][31][32][33] and both comorbidities and mortality (n = 3). 9,34,35 The earliest study date was 1990 while the remaining spanned from 2003 to 2014. The majority originated from Western countries, namely, the USA (n = 4) and Canada (n = 2), but also the United Kingdom, Denmark and Finland.…”

“…Almost all studies were retrospective cohort studies except for two case-control studies 21,23 and two cross-sectional studies. 9,22 Mean patient age was predominately 65 years or older. Gender distribution and proportion with underlying diseases ranged widely.…”

“…All examined different conditions: Aspergillus-related lung disease, 23 respiratory diseases and non-respiratory diseases, 9,34 and pulmonary TB diagnosed during follow-up. 35 Among bronchiectasis patients in tertiary care in the UK, Kunst 23 (n = 91) found the odds of Aspergillusrelated lung disease were fivefold greater in those with pulmonary NTM disease after controlling for age and lung function (odds ratio (OR) (95% CI): 5.1 (1.5-17.0)).…”

“…5 From 1999-2010, NTM-related mortality rates increased from 0.069 to 0.077 per 100 000 person-years. 9 Improved diagnostic methods, increased clinician awareness and a broadened case definition in 2007 from the American Thoracic Society (ATS) may partially explain the trend. 6,10 However, absolute changes in pulmonary NTM infection frequency are likely occurring due, in part, to increased environmental exposure, changing susceptibility of an ageing population and reduced crossprotective immunity from decreased exposure to TB and Bacillus Calmette-Guérin vaccination.…”

Culture-Independent Detection of Nontuberculous Mycobacteria in Clinical Respiratory Samples

“…hile rates of infection caused by members of the Mycobacterium tuberculosis complex continue to fall in developed countries (1,2), disease caused by nontuberculous mycobacteria (NTM) is an area of growing concern (3)(4)(5)(6). Pulmonary infection represents more than 90% of NTM cases (7) and has been described in a range of clinical contexts (8)(9)(10)(11).…”