Epidemiology of Nontuberculous Mycobacterial Lung Disease and Tuberculosis, Hawaii, USA

Abstract

Previous studies found Hawaiians and Asian-Americans/Pacific Islanders to be independently at increased risk for nontuberculous mycobacterial pulmonary disease (NTMPD) and tuberculosis (TB). To better understand NTM infection and TB risk patterns in Hawaii, USA, we evaluated data on a cohort of patients in Hawaii for 2005-2013. Period prevalence of NTMPD was highest among Japanese, Chinese, and Vietnamese patients (>300/100,000 persons) and lowest among Native Hawaiians and Other Pacific Islanders (50/100,000). Japanese patients were twice as likely as all other racial/ethnic groups to have Mycobacterium abscessus isolated (adjusted odds ratio 2.0, 95% CI 1.2-3.2) but were not at increased risk for infection with other mycobacteria species. In contrast, incidence of TB was stable and was lowest among Japanese patients (no cases) and highest among Filipino, Korean, and Vietnamese patients (>50/100,000). Substantial differences exist in the epidemiology of NTMPD by race/ethnicity, suggesting behavioral and biologic factors that affect disease susceptibility.

Keywords: Hawaii; Hawai’i; TB; United States; bacterial infections; epidemiology; nontuberculous mycobacteria; pulmonary; tuberculosis and other mycobacteria.

Figure 1

Occurrence of nontuberculous mycobacteria species identified from pulmonary specimens obtained among a cohort of Kaiser Permanente Hawaii patients, Hawaii, 2005–2013. Other pathogenic nontuberculous mycobacteria species identified (n = 21) were Mycobacterium flavescens, M. immunogenum, M. mucogenicum, M. neoaurum, M. scrofulaceum, M. simiae, and undifferentiated M. chelonae/abscessus. NTM, nontuberculous mycobacteria.

Figure 2

Annual prevalence of pulmonary nontuberculous mycobacteria isolation, nontuberculous mycobacterial pulmonary disease, and tuberculosis (A) and annual prevalence of pulmonary nontuberculous mycobacteria isolation by species (B) among a cohort of Kaiser Permanente Hawaii patients, Hawaii, 2005–2013. MAC, Mycobacterium avium complex; NTM, nontuberculous mycobacteria; NTMPD, nontuberculous mycobacterial pulmonary disease; TB, tuberculosis.

Figure 3

Overall period prevalence of pulmonary nontuberculous mycobacteria isolation, nontuberculous mycobacterial pulmonary disease, and tuberculosis, by age group, among a cohort of Kaiser Permanente Hawaii patients, Hawaii, 2005–2013. NTM, nontuberculous mycobacteria; NTMPD, nontuberculous mycobacterial pulmonary disease; TB, tuberculosis.

Figure 4

Overall period prevalence of pulmonary nontuberculous mycobacteria isolation, nontuberculous mycobacterial pulmonary disease, and tuberculosis, by race/ethnicity, among a cohort of Kaiser Permanente Hawaii patients, Hawaii, 2005–2013. NHOPI, Native Hawaiians and Other Pacific Islanders; NTM, nontuberculous mycobacteria; NTMPD, nontuberculous mycobacterial pulmonary disease; TB, tuberculosis.

Figure 5

Overall period prevalence of pulmonary nontuberculous mycobacteria isolation, by race/ethnicity and age group, among a cohort of Kaiser Permanente Hawaii patients, Hawaii, 2005–2013. No cases of nontuberculous mycobacteria isolation were reported among Vietnamese patients >65 years of age. NHOPI, Native Hawaiians and Other Pacific Islanders.

Figure 6

Overall period prevalence of pulmonary nontuberculous mycobacteria isolation, by race/ethnicity and sex, among a cohort of Kaiser Permanente Hawaii patients, Hawaii, 2005–2013. Prevalence reflects number of unique patients with pulmonary nontuberculous mycobacteria detected during the 9-year period. *p<0.05 (significant difference).