Nontuberculous mycobacterial pulmonary disease (NTM PD) incidence trends in the United States, 2010-2019

Abstract

Background: Nontuberculous mycobacteria (NTM) are ubiquitous environmental bacteria that cause chronic lung disease. Rates of NTM pulmonary disease (NTM PD) have increased over the last several decades, yet national estimates in the United States (US) have not been assessed since 2015.

Methods: We used a nationally representative population of Medicare beneficiaries aged ≥ 65 years to assess rates of NTM PD in a high-risk population from 2010 to 2019. Poisson generalized linear models were used to assess the annual percent change in incidence in the overall population and among key demographic groups such as sex, geography, and race/ethnicity. We evaluated the relative prevalence of various comorbid conditions previously found to be associated with NTM PD.

Results: We identified 59,724 cases of incident NTM PD from 2010 to 2019 from an annual mean population of 29,687,097 beneficiaries, with an average annual incidence of 20.1 per 100,000 population. NTM PD incidence was overall highest in the South and among women, Asian individuals, and persons aged ≥ 80 years relative to other studied demographic groups. The annual percent change in NTM PD incidence was highest in the Northeast, at 6.5%, and Midwest, at 5.9%, and among women, at 6.5%. Several comorbid conditions were highly associated with concurrent NTM diagnosis, including allergic bronchopulmonary aspergillosis, bronchiectasis, and cystic fibrosis.

Conclusions: Here we provide current estimates of NTM PD incidence and prevalence and describe increasing trends in the US from 2010 to 2019. Our study suggests a need for improved healthcare planning to handle an increased future caseload, as well as improved diagnostics and therapeutics to better detect and treat NTM PD in populations aged ≥ 65 years.

Keywords: Environmental bacteria; Nontuberculous mycobacteria; Pulmonary disease.

Fig. 1

NTM PD incidence trends from 2010–2019. (a) Annual incidence time series per 100k Medicare beneficiaries colored by US region (Midwest, Northeast, South, and West) compared to national. Annual national incidence by (b) age groups, 65–69-years, 70–79-years, and 80 + years, (c) sex, women and men, and (d) race, Asian, Black, Hispanic, and White

Fig. 2

Prevalence of selected comorbid conditions among persons with incident NTM PD in 2019. (a) Percent of persons with NTM PD incident cases in 2019 with comorbid conditions compared to the general Medicare population. (b) Relative prevalence of comorbid conditions among persons with NTM PD