Background: We identified patients with non-tuberculous mycobacterial (NTM) disease in the US Veterans Health Administration (VHA), examined the distribution of diseases by NTM species, and explored the association between NTM disease and the frequency of clinic visits and mortality.
Methods: We used natural language processing to identify mycobacterial isolates from VHA data between 2008 and 2012 and used algorithms to apply modified ATS/IDSA guidelines for NTM diagnosis. We performed validation against a reference standard of chart review. Incidence rates were calculated. Two nested case-control studies (matched by age and location) were used to measure the association between NTM disease and each of 1) the frequency of outpatient clinic visits and 2) mortality, adjusted by chronic obstructive pulmonary disease (COPD), other structural lung diseases, and immunomodulatory factors.
Results: NTM cases were identified with a sensitivity of 94%, a specificity of >99%. The incidence of NTM was 12.6/100k patient-years (Figure 1 breaks incidence down by region and group; Figure 3 by first 3 digits of zipcode and also shows spatial autocorrelation). COPD was present in 68% of pulmonary NTM. NTM incidence was highest in the southeastern US. Extra-pulmonary NTM rates increased during the study period (Figure 2 shows incidence over time). The incidence rate ratio of clinic visits in the first year after diagnosis was 1.3 [95%CI 1.34-1.35]. NTM patients had a hazard ratio of mortality of 1.4 [95%CI 1.1-1.9] in the 6 months after NTM identification compared to controls and 1.99 [95%CI 1.8-2.3] thereafter.
Conclusion: In VHA, pulmonary NTM disease is commonly associated with COPD, with the highest rates in the southeastern US. After adjustment, NTM patients had more clinic visits and greater mortality compared to matched patients.
Bristol Myers Squibb: Grant Investigator , Research grant
Pfizer: Consultant , Consulting fee
Bristol Myers Squibb: Consultant , Consulting fee
Lilly: Consultant , Consulting fee
Amgen: Consultant , Consulting fee
Abbvie: Consultant , Consulting fee
UCB: Consultant , Consulting fee
S. D. Nelson, None
S. Duvall, None
O. Patterson, None
K. Nechodom, None
K. Findley, None
L. Radonovich, None
M. Samore, None
K. Fennelly, None
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