Relationship Between Age, Sex, Geography and Incidence of Nontuberculous Mycobacteria in Denmark from 1991 to 2022

Overview

Journal ERJ Open Res

Specialty Pulmonary Medicine

Date 2025 Mar 5

PMID 40040897

Authors

Victor N Dahl

Andreas A Pedersen

Jakko van Ingen

Aase B Andersen

Troels Lillebaek

Christian M Wejse

Affiliations

Soon will be listed here.

Abstract

Objectives: We investigated age, sex and geographical differences in nontuberculous mycobacteria (NTM) incidence in Denmark.

Methods: A nationwide register-based study of all patients with NTM isolates in Denmark from 1991 to 2022 based on centralised microbiological data from the International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark. A Poisson regression model was used to calculate incidence rates (IRs) and rate ratios (IRRs).

Results: 4123 patients had NTM isolated for the first time. Their median age was 59 years (interquartile range 33-72), which increased over time. Males were younger than females. The proportion of females increased significantly over time. The type of NTM and patient age were closely associated. Pulmonary NTM isolation was increasingly common with higher age, while extrapulmonary NTM isolation was mainly seen in small children. Pulmonary NTM IRs were almost twice as high for females in 2008-2022 compared to 1991-2007 (IRR 1.9, 95% CI 1.7-2.1, p<0.001), with increases mainly seen in older age groups. The increase was less pronounced for males (IRR 1.3, 95% CI 1.1-1.4, p<0.001). There were considerable geographical differences, with age- and sex-adjusted NTM IRs being 10-40% higher in countryside, provincial and catchment municipalities than in the capital.

Conclusion: Age, sex and geography are essential determinants in NTM epidemiology. We found that rates of pulmonary NTM have been increasing, particularly in older females, while changes for males were less pronounced. Finally, we observed considerable geographical differences in NTM IRs in Denmark, with higher rates in less populated municipalities.

References

Loebinger M, Quint J, van der Laan R, Obradovic M, Chawla R, Kishore A . Risk Factors for Nontuberculous Mycobacterial Pulmonary Disease: A Systematic Literature Review and Meta-Analysis. Chest. 2023; 164(5):1115-1124. DOI: 10.1016/j.chest.2023.06.014. View

Donohue M . Epidemiological risk factors and the geographical distribution of eight Mycobacterium species. BMC Infect Dis. 2021; 21(1):258. PMC: 7953749. DOI: 10.1186/s12879-021-05925-y. View

Prevots D, Marshall J, Wagner D, Morimoto K . Global Epidemiology of Nontuberculous Mycobacterial Pulmonary Disease: A Review. Clin Chest Med. 2023; 44(4):675-721. PMC: 10625169. DOI: 10.1016/j.ccm.2023.08.012. View

Dahl V, Pedersen A, Norman A, Rasmussen E, van Ingen J, Andersen A . Clinical Significance, Species Distribution, and Temporal Trends of Nontuberculous Mycobacteria, Denmark, 1991-2022. Emerg Infect Dis. 2024; 30(9):1755-1762. PMC: 11346989. DOI: 10.3201/eid3009.240095. View

Prevots D, Shaw P, Strickland D, Jackson L, Raebel M, Blosky M . Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems. Am J Respir Crit Care Med. 2010; 182(7):970-6. PMC: 2970866. DOI: 10.1164/rccm.201002-0310OC. View

Mejia-Chew C, Chavez M, Lian M, McKee A, Garrett L, Bailey T . Spatial Epidemiologic Analysis and Risk Factors for Nontuberculous Mycobacteria Infections, Missouri, USA, 2008-2019. Emerg Infect Dis. 2023; 29(8):1540-1546. PMC: 10370856. DOI: 10.3201/eid2908.230378. View

Park S, Kang M, Han C, Lee S, Kim C, Lee J . Prevalence, incidence, and mortality of nontuberculous mycobacterial infection in Korea: a nationwide population-based study. BMC Pulm Med. 2019; 19(1):140. PMC: 6670190. DOI: 10.1186/s12890-019-0901-z. View

Thomson R, Furuya-Kanamori L, Coffey C, Bell S, Knibbs L, Lau C . Influence of climate variables on the rising incidence of nontuberculous mycobacterial (NTM) infections in Queensland, Australia 2001-2016. Sci Total Environ. 2020; 740:139796. DOI: 10.1016/j.scitotenv.2020.139796. View

Vonasek B, Gusland D, Hash K, Wiese A, Tans-Kersten J, Astor B . Nontuberculous Mycobacterial Infection in Wisconsin Adults and Its Relationship to Race and Social Disadvantage. Ann Am Thorac Soc. 2023; 20(8):1107-1115. PMC: 10405610. DOI: 10.1513/AnnalsATS.202205-425OC. View

10.

Spaulding A, Lai Y, Zelazny A, Olivier K, Kadri S, Prevots D . Geographic Distribution of Nontuberculous Mycobacterial Species Identified among Clinical Isolates in the United States, 2009-2013. Ann Am Thorac Soc. 2017; 14(11):1655-1661. PMC: 5711271. DOI: 10.1513/AnnalsATS.201611-860OC. View

11.

Hendrikx L, van Hees C, de Steenwinkel J, Bax H, Sprong T, Mulder B . Treatment and Outcome of Culture-Confirmed Disease. Open Forum Infect Dis. 2022; 9(4):ofac077. PMC: 8925999. DOI: 10.1093/ofid/ofac077. View

12.

Aiello A, Farzaneh F, Candore G, Caruso C, Davinelli S, Gambino C . Immunosenescence and Its Hallmarks: How to Oppose Aging Strategically? A Review of Potential Options for Therapeutic Intervention. Front Immunol. 2019; 10:2247. PMC: 6773825. DOI: 10.3389/fimmu.2019.02247. View

13.

Dahl V, Molhave M, Floe A, van Ingen J, Schon T, Lillebaek T . Global trends of pulmonary infections with nontuberculous mycobacteria: a systematic review. Int J Infect Dis. 2022; 125:120-131. DOI: 10.1016/j.ijid.2022.10.013. View

14.

Tremblay V, Ayad T, Lapointe A, Giguare C, Quintal M, Arcand P . Nontuberculous mycobacterial cervicofacial adenitis in children: epidemiologic study. J Otolaryngol Head Neck Surg. 2009; 37(5):616-22. View

15.

Hoefsloot W, van Ingen J, Andrejak C, Angeby K, Bauriaud R, Bemer P . The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study. Eur Respir J. 2013; 42(6):1604-13. DOI: 10.1183/09031936.00149212. View

16.

Andrejak C, Nielsen R, Thomsen V, Duhaut P, Sorensen H, Thomsen R . Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis. Thorax. 2012; 68(3):256-62. DOI: 10.1136/thoraxjnl-2012-201772. View

17.

Chan E, Iseman M . Slender, older women appear to be more susceptible to nontuberculous mycobacterial lung disease. Gend Med. 2010; 7(1):5-18. DOI: 10.1016/j.genm.2010.01.005. View

18.

Dahl V, Laursen L, He Y, Zhang Y, Wang M . Species distribution among patients with nontuberculous mycobacteria pulmonary disease in Europe. J Infect. 2023; 87(5):469-472. DOI: 10.1016/j.jinf.2023.03.010. View

19.

Cowman S, van Ingen J, Griffith D, Loebinger M . Non-tuberculous mycobacterial pulmonary disease. Eur Respir J. 2019; 54(1). DOI: 10.1183/13993003.00250-2019. View

20.

Freeman J, Morris A, Blackmore T, Hammer D, Munroe S, McKnight L . Incidence of nontuberculous mycobacterial disease in New Zealand, 2004. N Z Med J. 2007; 120(1256):U2580. View