Abstract
Survival implications of nontuberculous mycobacterial pulmonary disease (NTM-PD) and NTM pulmonary isolation without disease (NTM-PI) are unclear. To study deaths associated with NTM-PD and NTM-PI and differences in survival between them, we conducted a population-based cohort study of persons with microbiologically defined NTM-PD or NTM-PI diagnosed during 2001–2013 in Ontario, Canada. We used propensity score matching and Cox proportional hazards models to compare survival. Among 9,681 NTM-PD patients and 10,936 NTM-PI patients, 87% and 91%, respectively, were successfully matched with unexposed controls. Both NTM-PD and NTM-PI were associated with higher rates of death for all species combined and for most individual species. Compared with NTM-PI, NTM-PD was associated with higher death rates for all species combined, Mycobacterium avium complex, and M. xenopi. NTM-PD and NTM-PI were significantly associated with death, NTM-PD more so than NTM-PI.
Highlights
Survival implications of nontuberculous mycobacterial pulmonary disease (NTM-PD) and NTM pulmonary isolation without disease (NTM-PI) are unclear
Patients who could not be matched to unexposed controls were older (NTM-PI, median 74 vs. 64 years, p
Patients had a high prevalence of underlying conditions by adjusted clinical group numbers (7.3–10.1), including asthma (25%–36%), chronic obstructive pulmonary disease (COPD; 25%–52%), diabetes (12%–24%), chronic kidney disease (3%–8%), and gastresophageal reflux disease (11%–20%), ranging by species–condition groups
Summary
Survival implications of nontuberculous mycobacterial pulmonary disease (NTM-PD) and NTM pulmonary isolation without disease (NTM-PI) are unclear. Among 9,681 NTMPD patients and 10,936 NTM-PI patients, 87% and 91%, respectively, were successfully matched with unexposed controls. Both NTM-PD and NTM-PI were associated with higher rates of death for all species combined and for most individual species. One population-based study of survival in NTM-PD patients has been reported, but it did not include controls without NTM, so NTMattributable death could not be determined [11]. In studying all residents of Ontario, Canada, who had NTM-PD, we sought to describe their clinical characteristics, estimate their survival, and determine whether patients with NTM-PD have higher rates of death than population age-, sex-, and propensity-matched unexposed controls. We sought to compare survival of patients with NTM pulmonary isolation but not disease (NTM-PI) with patients who had NTM-PD, as well as survival for patients with different NTM species
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