Nontuberculous Mycobacteria–Associated Lung Disease, United States in Hospitalized Persons, 1998–2005

Megan E. Billinger; Kenneth N. Olivier; Cecile Viboud; Ruben Montes de Oca; Claudia Steiner; Steven M. Holland; D. Rebecca Prevots

Disclosures

Emerging Infectious Diseases. 2009;15(10) 

In This Article

Results

From 1998 through 2005, a total of 23,216 pulmonary NTM–associated hospitalizations were identified, of which 16,475 (71%) were non-AIDS related. Of these, 9,439 (57%) were women and 8,997 (55%) were among persons >70 years of age. The proportion of pulmonary NTM hospitalizations among persons >70 years of age varied by sex: 45% of men and 62% of women were >70 years of age. For both sexes, the average annual prevalence of non-AIDS pulmonary NTM-associated hospitalizations increased with age, but among persons >70 years of age, the relative prevalence was higher for women than for men. The relative prevalence for persons 70–79 years of age compared with those 40–49 years of age was 15-fold higher for women (9.4/100,000 vs. 0.6/100,000), and 9-fold higher for men (7.6/100,000 vs. 0.8/100,000); similar relative differences were seen in the ≥80–95-year age group (Figure 1).

Figure 1.

Average annual prevalence of non-AIDS pulmonary nontuberculous mycobacteria–associated hospitalizations by age group and sex, Healthcare Cost and Utilization Project state inpatient databases, USA, 1998–2005.

To study trends within the older age groups over time, we restricted our analysis to the >50-year age group and examined trends during the period 1998–2005 for men and women separately. Among men, the prevalence decreased significantly among the 50–59-year age group (2.7% per year; p = 0.011 by χ2 test), and increased significantly among men 70–79 years of age (5.3% per year; p = 0.0001 by χ2 test); no significant changes were evident in the other age groups ( Table 1 ; Figure 2). Among women, the prevalence increased significantly for women 60–79 years of age with an average annual increase of 4.6% (p = 0.0069 by χ2 test) among women 60–69 years of age and 5.5% (p<0.0001) among women 70–79 years of age ( Table 1 ; Figure 3).

Figure 2.

Prevalence of non-AIDS pulmonary nontuberculous mycobacteria–associated hospitalizations among men by age group and year, Healthcare Cost and Utilization Project (HCUP) state inpatient databases, USA, 1998–2005.

Figure 3.

Prevalence of non-AIDS pulmonary nontuberculous mycobacteria–associated hospitalizations among women by age group and year, Healthcare Cost and Utilization Project (HCUP) state inpatient databases, USA, 1998–2005.

We studied trends by geographic area and chose the 3 states with the greatest numbers of annual observations during the study period to ensure robust trend analysis. California, Florida, and New York represent unique regions in the United States and overall comprised 62% of NTM hospitalizations in the 11 states included in the analysis. To compare prevalence across these states, we calculated age-adjusted prevalence for men and women. Among both sexes, prevalence was highest in Florida; a significant annual increase was seen from 1998 through 2005. Among men, the average annual age-adjusted prevalence in Florida was 2.1/100,000 population, with a significant increase from 2.1 to 2.4 (3.2% increase/year); the average annual prevalence in California was 1.3 and for New York 1.4, with no significant change during the study period ( Table 1 , Figure 4). Among women, the average annual age-adjusted prevalence in Florida was 2.4/100,000; an increase of 1.8 in 1998 to 2.8 in 2005 (average 6.5%/year) was identified. For women in New York, annual prevalence increased significantly from 1.4/100,000 to 1.9/100,000 (4.6%/year); no significant change was detected in California ( Table 1 ; Figure 5).

Figure 4.

Age-adjusted prevalence of non-AIDS pulmonary nontuberculous mycobacteria–associated hospitalizations among men, California (CA), Florida (FL), and New York (NY), USA, Healthcare Cost and Utilization Project state inpatient databases, 1998–2005.

Figure 5.

Age-adjusted prevalence of non-AIDS pulmonary nontuberculous mycobacteria–associated hospitalizations among women, California (CA), Florida (FL), and New York (NY), USA, Healthcare Cost and Utilization Project state inpatient databases, 1998–2005.

Among the 16,475 non-AIDS pulmonary NTM–associated hospitalizations during 1998–2005, a total of 5,148 (31%) hospitalizations had pulmonary NTM as a primary diagnosis. The other leading primary diagnoses were pneumonia (7%), obstructive chronic bronchitis with acute exacerbation (5%), acute respiratory failure (2%), congestive heart failure (1.4%), and bronchiectasis (1.3%). No other single primary diagnosis comprised >1% of the primary diagnosis ( Table 2 ). We analyzed secondary diagnoses to identify associated underlying illnesses for hospitalizations where pulmonary NTM was the primary diagnosis. Hospitalizations could be associated with combinations of up to 29 secondary diagnoses, such that the sum of the underlying illnesses identified in any of those fields could add up to >100%. Of these, preexisting cardiovascular conditions, such as hypertension and atrial fibrillation, were most common (47%). Structural lung diseases, such as COPD (34%) and bronchiectasis (15%), were also common ( Table 3 ).

To identify distinct patterns of underlying illnesses by sex, we analyzed the age and sex distribution for selected underlying illnesses among hospitalizations where non-AIDS pulmonary NTM was the primary diagnosis. For hospitalizations with secondary diagnoses related to COPD, the prevalence of hospitalization was higher for men than for women in all age groups, ranging from 2-fold in the 50–59-year age group to 1.3× greater in the ≥70-year age group (Figure 6). Among persons hospitalized with bronchiectasis as a secondary diagnosis, the prevalence was consistently higher in women than in men in all age groups, ranging from 3-fold higher in the 50–59-year age group to 4-fold in the 70–79-year age group (Figure 7).

Figure 6.

Prevalence of chronic obstructive pulmonary disease as a secondary diagnosis by age group and sex when non-AIDS pulmonary nontuberculous mycobacteria is the primary diagnosis, Healthcare Cost and Utilization Project state inpatient databases, USA, 1998–2005.

Figure 7.

Prevalence of bronchiectasis as a secondary diagnosis by age group and sex when non-AIDS pulmonary nontuberculous mycobacteria is the primary diagnosis, Healthcare Cost and Utilization Project state inpatient databases, USA, 1998–2005.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....