Nontuberculous pulmonary mycobacteriosis in Denmark: incidence and prognostic factors.
BACKGROUND
Few population-based data are available regarding nontuberculous mycobacteria (NTM) pulmonary disease epidemiology and prognosis.


OBJECTIVE
To examine NTM pulmonary colonization incidence, disease incidence, and prognostic factors.


METHODS
All adults in Denmark with at least one NTM-positive pulmonary specimen during 1997 to 2008 were identified using national medical databases and were categorized as having possible or definite NTM disease or colonization.


RESULTS
We calculated annual age-standardized NTM incidence rates and adjusted hazard ratios (HR) of death associated with patient age, sex, comorbidity, NTM species, and NTM disease status. Of 1,282 adults with 2,666 NTM-positive pulmonary specimens, 335 (26%) had definite NTM disease, 238 (19%) possible disease, and 709 (55%) colonization only. NTM incidence rates decreased until 2002, followed by an increase from 2003 to 2008 (mean annual rate per 100,000 person-years: NTM colonization, 1.36; NTM disease, 1.08). Five-year mortality after definite NTM disease was 40.1%. After controlling for potential confounders, 5-year mortality for definite NTM disease was slightly higher than for NTM colonization (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.90-1.51). Mycobacterium xenopi was associated with worse prognosis (adjusted HR, 1.51; 95% CI, 0.99-2.33) than the reference Mycobacterium avium complex. High comorbidity level (HR, 2.97), age greater than or equal to 65 years (HR, 9.17), and male sex (female sex HR, 0.73) were predictors of death.


CONCLUSIONS
NTM disease incidence has remained unchanged in Denmark over the past 12 years. Patients with NTM colonization and disease have similarly poor prognosis. Negative prognostic factors include high levels of comorbidity, advanced age, male sex, and M. xenopi.
Andréjak
Claire
C
Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg and Aarhus, Denmark. claire_ski2002@yahoo.fr
Thomsen
Vibeke Ø
VØ
Johansen
Isik S
IS
Riis
Anders
A
Benfield
Thomas L
TL
Duhaut
Pierre
P
Sørensen
Henrik T
HT
Lescure
François-Xavier
FX
Thomsen
Reimar W
RW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000150:complications / Q000382:microbiology; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D009170:Nontuberculous Mycobacteria; D011379:Prognosis; D012737:Sex Factors; D016019:Survival Analysis; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D055815:Young Adult