Predictors of Nontuberculous Mycobacterial Lung Disease in US Veterans

Abstract

SESSION TITLE: Lung Infections SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 02:45 PM - 04:15 PM PURPOSE: Nontuberculous mycobacteria lung disease (NTMLD) is an increasingly prevalent condition with significant challenges in clinical management. While it is known that patients who are immunocompromised or have underlying lung disorders are at risk of NTMLD, more research is needed to better understand determinants and associated factors. METHODS: We studied predictors of NTMLD diagnosis and all-cause mortality among U.S. Veterans receiving health care from the U.S. Department of Veterans Affairs (VA). National VA patient records from 2001-2012 were used to identify patients with NTMLD based on the presence of ≥1 NTMLD diagnostic code, ≥1 separate confirmatory code for nontuberculous mycobacterial infection, and ≥1 year of VA service before the first code. Ten comparison patients for each case were sampled at random from all VA patients in care in the month of the first NTMLD code, with no history of NTMLD, and with ≥1 year of prior VA service. A rich set of data on patient demographics, health care utilization, laboratory and physical test results, comorbidities, and prescriptions was linked and used in the analysis. Multivariable logistic regression was used to estimate independent associations of factors with NTM risk. Deaths were identified based on records from VA and Social Security files, and multivariable proportional hazards regression was used to estimate mortality risk associated with NTMLD after adjustment for other variables. RESULTS: The samples consisted of 2,747 patients with NTMLD and 27,470 controls. In the NTMLD group, 96.7% were men, 76.5% were white, and mean age was 66.6 years. NTMLD risk increased with age and was higher in men, African-Americans, and people living in the South. Strong direct associations were found with interstitial lung disease (odds ratio [OR]=11.1, 95% confidence interval [CI]=8.78-14.0), pneumonia (OR=7.83, 95% CI=6.33-9.69), and chronic obstructive pulmonary disease (OR=5.38, 95% CI=4.78-6.05), as well as HIV infection (OR=18.6, 95% CI=13.3-26.1), inflammatory bowel disease (OR=2.26, 95% CI=1.39-3.67), rheumatoid arthritis (OR=2.00, 95% CI=1.36-2.94), chronic hepatitis or cirrhosis (OR=1.79, 95% CI=1.20-2.67), and anemia (OR=1.59, 95%CI=1.35-1.87). NTMLD risk was inversely associated with dementia (OR=0.22, 95% CI=0.12-0.40) and obesity (OR=0.31, 95% CI=0.24-0.40). Medications associated with NTMLD risk included bronchodilators (OR=2.28, 95% CI=1.90-2.73), cytostatic medications (OR=1.95, 95% CI=1.29-2.95), smoking cessation drugs (OR=1.56, 95% CI=1.21-2.00), and oral anticoagulants (OR=1.54, 95% CI=1.28-1.86). Mortality was doubled in patients with NTMLD, but was reduced to a 14% increase (OR=1.14, 95% CI=1.07-1.22) after adjustment for comorbidities and other factors. CONCLUSIONS: NTMLD risk is associated with a number of predisposing pulmonary conditions as well as medical conditions and medications that may reduce immune function and host resistance. CLINICAL IMPLICATIONS: These results suggest the importance of both underlying host factors and environmental exposures in the etiology of NTMLD. Further work is needed to better understand determinants of this condition and optimal strategies for management. DISCLOSURE: Quanwu Zhang: Employee: Employee of insmed inc The following authors have nothing to disclose: Donald Miller, William Powell, Eric Garshick No Product/Research Disclosure Information