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. 2018 Sep;37(9):1795-1803.
doi: 10.1007/s10096-018-3315-6. Epub 2018 Jun 27.

Nontuberculous mycobacterial disease managed within UK primary care, 2006-2016

Eleanor L Axson  1 , Chloe I Bloom  2 , Jennifer K Quint  2
Affiliations

Nontuberculous mycobacterial disease managed within UK primary care, 2006-2016

Eleanor L Axson et al. Eur J Clin Microbiol Infect Dis. 2018 Sep.

Abstract

Previous UK studies investigating nontuberculous mycobacteria have been limited to reporting isolation from culture, not burden of disease. We assessed the burden of nontuberculous mycobacterial disease (NTMD) in UK primary care from 2006 to 2016. Using electronic healthcare records, we identified patients with NTMD using a strict definition including patients with guideline-directed treatment/monitoring. We described treatment regimens and incidence/prevalence in the general population and in patients with underlying chronic respiratory diseases. Incidence of primary care-managed NTMD in the general population decreased (2006 to 2016 rates per 100,000 person-years, 3.85 to 1.28). Average annual prevalence of NTMD in the general population was 6.38 per 100,000. Around 85% were taking antimycobacterial therapy; 53.2% were taking a guideline-recommended regimen. Incidence of NTMD in patients with respiratory disease decreased (2006 to 2016 rates per 100,000 person-years, 12.5 to 7.40). Average annual prevalence of NTMD in patients with respiratory disease was 27.7 per 100,000. This is the first UK study using nationally representative data to investigate the burden of NTMD managed within primary care. Incidence and prevalence of managed NTMD within primary care is gradually declining. Increasing complexity in the management of NTMD may be driving a shift in care to secondary settings.

Keywords: Bronchiectasis; COPD; Epidemiology; NTM; Primary care.

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Conflict of interest statement

Conflict of interest

Miss Axson has nothing to disclose. Dr. Bloom has nothing to disclose. Dr. Quint reports grants and personal fees from Insmed, during the conduct of the study; grants from MRC, grants from Wellcome Trust, grants from British Lung Foundation, grants and personal fees from GSK, grants and personal fees from Boehringer Ingelheim, grants from Royal College of Physicians, personal fees from Chiesi, personal fees from Teva, outside the submitted work.

Ethical approval

The protocol for this research was approved by the Independent Scientific Advisory Committee (ISAC) for MHRA Database Research (protocol number 17_113R) and the approved protocol was made available to the journal and reviewers during peer review. Following initial approval, an amendment was also submitted to ISAC and approved (protocol 17_113RA), expanding the analysis to more respiratory diseases. Generic ethical approval for observational research using the CPRD with approval from ISAC has been granted by a Health Research Authority (HRA) Research Ethics Committee (East Midlands – Derby, REC reference number 05/MRE04/87).

Informed consent

No patients were involved in the design or analyses for this study.

Figures

Fig. 1
Fig. 1
Mapping of patient inclusion. a Patients identified with NTMD medcodes. b Patients identified with prodcodes of drugs used in the treatment of NTMD. *Patients identified in the prodcode search who also had a medcode were mapped in the medcode scheme
Fig. 2
Fig. 2
Annual incidence per 100,000 person-years of NTMD in UK primary care, 2006–2016. Presented overall for a strict cohort and b expanded cohort, and by age group for c strict cohort and d expanded cohort. NTMD, nontuberculous mycobacterial disease; pyrs, person-years
Fig. 3
Fig. 3
Annual prevalence per 100,000 population of NTMD in UK primary care, 2006–2016. Presented for our strict definition a overall and b by age-group for our strict NTMD definition. NTMD, nontuberculous mycobacterial disease; pop, population
Fig. 4
Fig. 4
Annual incidence per 100,000 person-years of NTMD in patients with underlying respiratory disease in UK primary care, 2006–2016. Presented overall for a strict cohort and b expanded cohort. CRD, chronic respiratory disease; NTMD, nontuberculous mycobacterial disease; pyrs, person-years
Fig. 5
Fig. 5
Annual prevalence per 100,000 population of NTMD in patients with underlying respiratory disease in UK primary care, 2006–2016. Presented for our strict NTMD definition in patients with underlying respiratory disease. NTMD, nontuberculous mycobacterial disease; pop, population
See this image and copyright information in PMC

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