Deaths Related to Nontuberculous Mycobacterial Infections in the United States, 1999-2014

Abstract

Rationale: Unlike tuberculosis, nontuberculous mycobacterial disease is not reportable to public health authorities in the United States, and the total burden of disease is uncertain.

Objectives: To estimate the mortality of nontuberculous mycobacterial disease in the United States over a 15-year period and to identify temporal trends.

Methods: The U.S. Multiple Cause of Death Files from 1999 through 2014 were searched for a listing of nontuberculous mycobacterial disease by International Classification of Diseases, Tenth Revision code as either the underlying or a contributing cause of death. Characteristics of individuals with nontuberculous mycobacteria-related deaths in the United States were summarized according to demographic characteristics. Age-adjusted mortality rates and rate ratios were calculated using bridged-race population estimates of U.S. census population data. Time trends were evaluated with negative binomial regression.

Measurements and main results: There was a significant increase in nontuberculous mycobacteria-related deaths among individuals without a diagnosis of HIV infection (P = 0.004). Mortality rates increased with advancing age. Age-adjusted mortality rate ratios were lower for men (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.80-0.87) compared with women, and were lower for Hispanic individuals (RR, 0.53; 95% CI, 0.49-0.56) and black, non-Hispanic persons (RR, 0.83; 95% CI, 0.77-0.88) compared with white, non-Hispanic individuals.

Conclusions: The mortality rate of nontuberculous mycobacterial disease among HIV-uninfected individuals has increased in the United States between 1999 and 2014. These deaths occurred disproportionately in older white women. Considering the concurrent decline in tuberculosis-related deaths, these findings demonstrate a shift in the epidemiology of fatal mycobacterial infections in the United States.

Keywords: epidemiology; mortality; nontuberculous mycobacteria.

Figure 1.

Comparison of the annual frequency and rate of deaths related to NTM and TB in the United States, 1999–2014. TB = tuberculosis; NTM = nontuberculous mycobacterial disease.

Figure 2.

Deaths related to NTM in the United States, 1999–2014, according to the presence or absence of HIV infection on the death certificate. NTM = nontuberculous mycobacterial disease.