Incidence of Nontuberculous Mycobacterial Pulmonary Infection, by Ethnic Group, Hawaii, USA, 2005-2019

Abstract

To further clarify differences in the risk for nontuberculous mycobacterial pulmonary infection (NTM-PI) among ethnic populations in Hawaii, USA, we conducted a retrospective cohort study among beneficiaries of Kaiser Permanente Hawaii (KPH). We abstracted demographic, socioeconomic, clinical, and microbiological data from KPH electronic health records for 2005-2019. An NTM-PI case-patient was defined as a person from whom >1 NTM pulmonary isolate was obtained. We performed Cox proportional hazards regression to estimate incidence of NTM-PI while controlling for confounders. Across ethnic groups, risk for NTM-PI was higher among persons who were underweight (body mass index [BMI] <18.5 kg/m²). Among beneficiaries who self-identified as any Asian ethnicity, risk for incident NTM-PI was increased by 30%. Low BMI may increase susceptibility to NTM-PI, and risk may be higher for persons who self-identify as Asian, independent of BMI.

Keywords: Hawaii; Mycobacterium avium complex; Mycobacterium infections; NTM; Nontuberculous mycobacteria; United States; bacteria; ethnic group; nontuberculous; respiratory infections; tuberculosis and other mycobacteria.

Figure

Nontuberculous mycobacterial pulmonary infection incidence among Kaiser Permanente Hawaii beneficiaries, by ethnicity and body mass index category, Hawaii, USA, 2005–2019. Numbers above bars indicate incidence (cases/100,000 person-years) by BMI category. Underweight, <18.5 kg/m²; normal weight, 18.5 to <25 kg/m²; overweight/obese, >25 kg/m². NHOPI, Native Hawaiian and Other Pacific Islander.