Background: There are little data available regarding nontuberculous mycobacterial (NTM) disease in the United States. Our objective was to estimate the mortality burden of NTM disease in the United States over a 15-year period, and to identify temporal trends.
Methods: We obtained data from the National Center for Health Statistics, which receives information from death certificates from all 50 states, including demographic information and cause of death. The U.S. Multiple Cause of Death Files were searched from 1994 through 2014 for a listing of NTM disease (ICD10 codes A31.0, A31.1, A31.8, A31.9) as either the underlying or contributing cause of death. Characteristics of individuals with NTM-related deaths in the U.S. were summarized according to demographic characteristics. Age-adjusted mortality rates and rate ratios (RRs) were calculated with 95% confidence intervals (CIs) using bridged-race population estimates of U.S. census population data.
Results: The annual number of NTM-related deaths, according to the presence or absence of HIV co-infection at the time of death, is shown in the Figure. In a negative binomial regression model, there was a significant increase in NTM-related death among individuals without a co-morbid HIV diagnosis (p=0.004). Among NTM-related deaths without HIV co-infection, age-specific mortality rate ratios increased with increasing age categories. Age-adjusted mortality rate ratios were lower in men (RR 0.84, 95% CI 0.80, 0.87) compared with women, and lower in Hispanic individuals (RR 0.53, 95% CI 0.49, 0.56) and black, non-Hispanic individuals (RR 0.83, 95% CI 0.77, 0.88) compared with white, non-Hispanic individuals.
Conclusion: The age-adjusted mortality rate of NTM disease among individuals without HIV disease has increased during the previous 15 years in the U.S., and these deaths were disproportionately observed in older white women. Considering the decline in tuberculosis-related deaths in the U.S. during the same period, these findings demonstrate a profound shift in the epidemiology of fatal mycobacterial infections in the U.S.
Figure: Nontuberculous mycobacteria related deaths in the United States, 1999 to 2014, according to the presence of absence of HIV diagnosis at time of death
S. Longworth, None
A. Patrawalla, None
B. N. Kreiswirth, None
C. Vinnard, None
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