Incremental Mortality Associated with Nontuberculous Mycobacterial Lung Disease Among US Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2023 Nov 2

PMID 37914999

Authors

Ping Wang

Theodore K Marras

Mariam Hassan

Anjan Chatterjee

Affiliations

Soon will be listed here.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with nontuberculous mycobacterial lung disease (NTMLD). Both conditions are associated with increased morbidity and mortality, but data are lacking on the additional burden associated with NTMLD among patients with COPD. Thus, the goal of this study was to assess the incremental mortality risk associated with NTMLD among older adults with COPD.

Methods: A retrospective cohort study was conducted using the US Medicare claims database (2010-2017). Patients with preexisting COPD and NTMLD (cases) were matched 1:3 by age and sex with patients with COPD without NTMLD (control patients). Patients were followed up until death or data cutoff (December 31, 2017). Incremental risk of mortality was evaluated by comparing the proportions of death, annualized mortality rate, and mortality hazard rate between cases and control patients using both univariate and multivariate analyses adjusting for age, sex, comorbidities, and COPD severity.

Results: A total of 4,926 cases were matched with 14,778 control patients. In univariate analyses, a higher proportion of cases (vs. control patients) died (41.5% vs. 26.7%; P < 0.0001), unadjusted annual mortality rates were higher among cases (158.5 vs. 86.0 deaths/1000 person-years; P < 0.0001), and time to death was shorter for cases. This increased mortality risk was also reflected in subsequent multivariate analyses. Patients with COPD and NTMLD were more likely to die (odds ratio [95% CI], 1.39 [1.27-1.51]), had higher mortality rates (rate ratio [95% CI], 1.36 [1.28-1.45]), and had higher hazard of death (hazard ratio [95% CI], 1.37 [1.28-1.46]) than control patients.

Conclusions: The substantial incremental mortality burden associated with NTMLD in patients with COPD highlights the importance of developing interventions targeting this high-risk group and may indicate an unmet need for timely and appropriate management of NTMLD.

Citing Articles

Nontuberculous mycobacterial pulmonary disease added burden to COPD and bronchiectasis in Japan.

Wang P, Morimoto K, Hasegawa N, Hassan M, Chatterjee A ERJ Open Res. 2024; 10(4).

PMID: 38978557 PMC: 11228608. DOI: 10.1183/23120541.00911-2023.

Identifying potentially undiagnosed nontuberculous mycobacterial lung disease among patients with chronic obstructive pulmonary disease: Development of a predictive algorithm using claims data.

Wang P, Marras T, Allison P, Hassan M, Chatterjee A J Manag Care Spec Pharm. 2023; 29(8):927-937.

PMID: 37243674 PMC: 10397327. DOI: 10.18553/jmcp.2023.22417.

References

Gothe H, Rajsic S, Vukicevic D, Schoenfelder T, Jahn B, Geiger-Gritsch S . Algorithms to identify COPD in health systems with and without access to ICD coding: a systematic review. BMC Health Serv Res. 2019; 19(1):737. PMC: 6805625. DOI: 10.1186/s12913-019-4574-3. View

Vestbo J, Hurd S, Agusti A, Jones P, Vogelmeier C, Anzueto A . Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2012; 187(4):347-65. DOI: 10.1164/rccm.201204-0596PP. View

Griffith D, Aksamit T, Brown-Elliott B, Catanzaro A, Daley C, Gordin F . An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175(4):367-416. DOI: 10.1164/rccm.200604-571ST. View

Ryu Y, Koh W, Daley C . Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease: Clinicians' Perspectives. Tuberc Respir Dis (Seoul). 2016; 79(2):74-84. PMC: 4823187. DOI: 10.4046/trd.2016.79.2.74. View

Mapel D, Dutro M, Marton J, Woodruff K, Make B . Identifying and characterizing COPD patients in US managed care. A retrospective, cross-sectional analysis of administrative claims data. BMC Health Serv Res. 2011; 11:43. PMC: 3050697. DOI: 10.1186/1472-6963-11-43. View

Prevots D, Marras T . Epidemiology of human pulmonary infection with nontuberculous mycobacteria: a review. Clin Chest Med. 2015; 36(1):13-34. PMC: 4332564. DOI: 10.1016/j.ccm.2014.10.002. View

Menzin J, Boulanger L, Marton J, Guadagno L, Dastani H, Dirani R . The economic burden of chronic obstructive pulmonary disease (COPD) in a U.S. Medicare population. Respir Med. 2008; 102(9):1248-56. DOI: 10.1016/j.rmed.2008.04.009. View

Park H, Jeong B, Chon H, Jeon K, Daley C, Koh W . Lung Function Decline According to Clinical Course in Nontuberculous Mycobacterial Lung Disease. Chest. 2016; 150(6):1222-1232. DOI: 10.1016/j.chest.2016.06.005. View

Andrejak C, Thomsen V, Johansen I, Riis A, Benfield T, Duhaut P . Nontuberculous pulmonary mycobacteriosis in Denmark: incidence and prognostic factors. Am J Respir Crit Care Med. 2009; 181(5):514-21. DOI: 10.1164/rccm.200905-0778OC. View

10.

Winthrop K, Marras T, Adjemian J, Zhang H, Wang P, Zhang Q . Incidence and Prevalence of Nontuberculous Mycobacterial Lung Disease in a Large U.S. Managed Care Health Plan, 2008-2015. Ann Am Thorac Soc. 2019; 17(2):178-185. PMC: 6993793. DOI: 10.1513/AnnalsATS.201804-236OC. View

11.

Marras T, Vinnard C, Zhang Q, Hamilton K, Adjemian J, Eagle G . Relative risk of all-cause mortality in patients with nontuberculous mycobacterial lung disease in a US managed care population. Respir Med. 2018; 145:80-88. PMC: 6283283. DOI: 10.1016/j.rmed.2018.10.022. View

12.

Larsson L, Polverino E, Hoefsloot W, Codecasa L, Diel R, Jenkins S . Pulmonary disease by non-tuberculous mycobacteria - clinical management, unmet needs and future perspectives. Expert Rev Respir Med. 2017; 11(12):977-989. DOI: 10.1080/17476348.2017.1386563. View

13.

McShane P, Naureckas E, Tino G, Strek M . Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2013; 188(6):647-56. DOI: 10.1164/rccm.201303-0411CI. View

14.

Adjemian J, Prevots D, Gallagher J, Heap K, Gupta R, Griffith D . Lack of adherence to evidence-based treatment guidelines for nontuberculous mycobacterial lung disease. Ann Am Thorac Soc. 2013; 11(1):9-16. PMC: 3972983. DOI: 10.1513/AnnalsATS.201304-085OC. View

15.

Pravosud V, Mannino D, Prieto D, Zhang Q, Choate R, Malanga E . Symptom Burden and Medication Use Among Patients with Nontuberculous Mycobacterial Lung Disease. Chronic Obstr Pulm Dis. 2021; 8(2):243-254. PMC: 8237979. DOI: 10.15326/jcopdf.2020.0184. View

16.

Maiga M, Siddiqui S, Diallo S, Diarra B, Traore B, Shea Y . Failure to recognize nontuberculous mycobacteria leads to misdiagnosis of chronic pulmonary tuberculosis. PLoS One. 2012; 7(5):e36902. PMC: 3353983. DOI: 10.1371/journal.pone.0036902. View

17.

Yeh J, Wang Y, Lin C, Chou C, Yeh T, Wu B . Nontuberculous mycobacterial infection is associated with increased respiratory failure: a nationwide cohort study. PLoS One. 2014; 9(6):e99260. PMC: 4053398. DOI: 10.1371/journal.pone.0099260. View

18.

OConnell M, Birkenkamp K, Kleiner D, Folio L, Holland S, Olivier K . Lung manifestations in an autopsy-based series of pulmonary or disseminated nontuberculous mycobacterial disease. Chest. 2011; 141(5):1203-1209. PMC: 3342780. DOI: 10.1378/chest.11-0425. View

19.

Daley C, Iseman M . Mycobacterium avium complex and lung cancer: chicken or egg? Both?. J Thorac Oncol. 2012; 7(9):1329-30. DOI: 10.1097/JTO.0b013e318265a7ef. View

20.

Diel R, Lipman M, Hoefsloot W . High mortality in patients with Mycobacterium avium complex lung disease: a systematic review. BMC Infect Dis. 2018; 18(1):206. PMC: 5934808. DOI: 10.1186/s12879-018-3113-x. View