PSY40 - ALL-CAUSE MORTALITY INCREASED WITH NONTUBERCULOUS MYCOBACTERIAL LUNG DISEASE IN US MEDICARE

Abstract

Nontuberculous Mycobacterial Lung Disease (NTMLD) is a chronic, debilitating, and progressive disease. This study evaluates all-cause mortality in patients with NTMLD in the US Medicare. Patients (n=43,394) were identified from the Medicare database (excluding Part C) based on physician claims for NTMLD on ≥2 separate occasions ≥30 days apart between 2007 and 2015. About 12% patients were <65 years and qualified for Medicare due to disability. A control cohort (n=84,814) was randomly selected and matched to the NTMLD sample by age and sex. Cox regression was used to derive adjusted risk of mortality accounting for baseline comorbidities of pulmonary, immune, cardiovascular, cancer and other disorders. Mean age was 74 (standard deviation: ±10) years and 68% were female. Mean Charlson comorbidity index (CCI) was 2.9 (±2.6) in NTMLD vs 1.3 (±1.9) in control cohort. Mean CCI was 2.8 (±2.5) in NTMLD vs 1.4 (±2.0) in controls for Medicare members ≥65 years, and 3.8 (±3.3) in NTMLD vs 1.1 (±1.9) in controls for those <65 years. Observed yearly mortality in NTMLD vs controls was 9.7% vs 5.0% respectively among people ≥65 years old (RR = 2.0; 1.9-2.0), and 10.4% vs 2.5% respectively among people <65 years old (RR = 4.1; 3.8-4.5). Adjusted mortality increased with NTMLD by 35% overall (HR = 1.35; 1.3-1.4), by 23% in age group ≥65 (HR = 1.23, 1.19-1.27) and almost doubled in age group <65 (HR = 1.97, 1.80-2.15). NTMLD was associated with a 35% increased risk of all-cause mortality in the overall US Medicare population. Mortality risk almost doubled with NTMLD in the younger member population with disability (<65 years), and increased with NTMLD by 23% in the majority of Medicare population (≥65 years), compared to that in the controls.