Updated NTM pulmonary disease estimates in U.S. Medicare beneficiaries revealed rising incidence, demographic disparities, and associated comorbidities.

Rates of nontuberculous mycobacteria pulmonary disease (NTM PD) have increased globally over the past two decades. However, national estimates of NTM PD incidences in the United States have not been assessed since 2015.

Using a population-based data set of Medicare beneficiaries at least 65 years of age, Samatha J. Bents and colleagues provided updated estimates of NTM PD trends in the United States and insight into demographic heterogeneity in disease burden in high-risk populations. They also evaluated the relative prevalence of various comorbid conditions previously found associated with NTM PD. They published their findings in BMC Infectious Diseases.

The researchers identified 59,724 cases of NTM PD from 2010 to 2019 from an annual mean population of 29,687,097 beneficiaries, with an average annual incidence of 20.1 per 100,000 population for the study period.

Overall, the NTM PD rate was highest in the South and among women, Asian people, and people aged 80 years and older. In the South, rates of NTM PD rose from 17.8 to 28.6 per 100,000 people from 2010 to 2019. Women had higher rates of disease than men, with an average annual 1.4- to 2.0-fold higher prevalence across age groups.

Among all racial and ethnic groups in 2019, NTM PD incidence among Asian people was 1.4-fold higher versus White people, 3.1-fold higher versus Hispanic people, and 4.3-fold higher versus Black people. In the same year, incidence among people aged at least 80 years was 3.3-fold higher compared with people aged 65-69 years and 1.3-fold higher compared with people aged 70-79 years.

Data showed that the annual percent change in NTM PD incidence was highest in the Northeast (6.5%) and Midwest (5.9%) but increased significantly across all regions. The relative prevalence (RP) of several comorbid conditions was strongly associated with concurrent NTM PD diagnosis, including allergic bronchopulmonary aspergillosis (RP=93.6), pulmonary tuberculosis (RP=87.8), bronchiectasis (RP=74.6), and cystic fibrosis (RP=34.2). The researchers also observed associations between NTM PD and other common conditions that increase the risk of NTM PD, including COPD (RP=5.6) and GERD (RP=2.4).

“Our study, taken together with several prior population-based studies similarly showing increased infection and disease trends, suggests a concurrent increased need for improved healthcare planning to handle an increased future caseload, as well as improved diagnostics and therapeutics to better detect and treat NTM PD,” the investigators concluded.

They underscored the importance of increased awareness of NTM PD diagnosis and treatment guidelines to help improve disease management.