Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems

Abstract

Rationale: Single-site clinic-based studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease, but systematic data are lacking.

Objectives: To describe prevalence and trends for NTM lung disease at four geographically diverse integrated heath care delivery systems in the United States.

Methods: We abstracted mycobacterial culture results from electronic laboratory databases and linked to other datasets containing clinical and demographic information. Possible cases were defined as a single positive NTM pulmonary isolate, and definite cases were defined as two positive sputum cultures, or one positive culture from a bronchoalveolar lavage or lung biopsy. Annual prevalence was calculated using United States census data; average annual prevalence is presented for 2004-2006. Poisson regression models were used to estimate the annual percent change in prevalence.

Measurements and main results: A total of 28,697 samples from 7,940 patients were included in the analysis. Of these, 3,988 (50%) were defined as possible cases, and 1,865 (47%) of these were defined as definite cases. Average annual (2004-2006) site-specific prevalence ranged from 1.4 to 6.6 per 100,000. Prevalence was 1.l- to 1.6-fold higher among women relative to men across sites. The prevalence of NTM lung disease was increasing significantly at the two sites where trends were studied, by 2.6% per year among women and 2.9% per year among men. Among persons aged greater than or equal to 60 years, annual prevalence increased from 19.6 per 100,000 during 1994-1996 to 26.7 per 100,000 during 2004-2006.

Conclusions: The epidemiology of nontuberculous mycobacterial lung disease is changing, with a predominance of women and increasing prevalence at the sites studied.

Figure 1.

Study population, four integrated health care delivery systems. BAL = bronchoalveolar lavage; MTB = Mycobacterium tuberculosis.

Figure 2.

Observed annual prevalence with fitted trend from Poisson regression model among (A) women, (B) men, (C) women <60 years, and (D) men <60 years. Group Health and Kaiser Permanente Southern California combined, 1994–2006.

Figure 3.

(A) Average annual prevalence by age and sex. Group Health and Kaiser Permanente Southern California combined, 2004–2006. (B) Cumulative incidence by age and sex. Group Health and Kaiser Permanente Southern California combined, 2004–2006.

Figure 4.

Radiographic findings among possible and definite cases with at least one chest CT (n = 257). Kaiser Permanente Southern California, 2006. BE = bronchiectasis; CAV = cavities; NOD = nodules.