title: Nontuberculous mycobacterial disease mortality in the United States, 1999-2010: a population-based comparative study.
abstract: BACKGROUND
  Environmental nontuberculous mycobacteria (NTM) are ubiquitous organisms with which humans commonly interact. The epidemiologic characteristics of NTM diseases including mortality rate and its associated factors remain largely unknown. In this study, we explored the geographical area of exposure and mortality and comorbid conditions of affected persons to determine environment, host, and host-pathogen interactive factors.
  
  
  METHODS
  We analyzed mortality related to nontuberculous mycobacterial infections from 1999 through 2010 by examining multiple-cause-of-death data from the National Center for Health Statistics. Among those who died with these diseases, we analyzed age-adjusted mortality rates, trends, associations with demographic variables, and comorbid conditions and correlated this information with similar data for tuberculosis-related mortality during the same time.
  From 1999 through 2010, nontuberculous mycobacterial disease was reported as an immediate cause of death in 2,990 people in the United States with a combined overall mean age-adjusted mortality rate of 0.1 per 100,000 person-years. A significant increase in the number of NTM related deaths was seen from 1999 through 2010 (R(2) = 0.72, p<0.0001), but it was not significant after adjustment for age. Persons aged 55 years and older, women, those living in Hawaii and Louisiana, and those of non-Hispanic, white ethnicity had higher mortality rates. Compared to tuberculosis-related mortality, chronic obstructive pulmonary disease, bronchiectasis, HIV, interstitial lung diseases, and tobacco use were significantly more common in persons with nontuberculous mycobacteria-related deaths.
  
  
  CONCLUSIONS
  Nontuberculous mycobacteria-related death numbers are rising and are unevenly distributed. The strong association of nontuberculous mycobacterial disease with age suggests that its prevalence will increase as the United States population ages.
authors.affiliation: Division of Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, Illinois, United States of America.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mirsaeidi
authors.affiliation: Division of Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, Illinois, United States of America.
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Machado
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona, United States of America.
authors.forename: Joe G N
authors.initials: JG
authors.lastname: Garcia
authors.affiliation: Division of Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, Illinois, United States of America.
authors.forename: Dean E
authors.initials: DE
authors.lastname: Schraufnagel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D054884:Host-Pathogen Interactions; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology / Q000208:ethnology / Q000382:microbiology / Q000401:mortality*; D009170:Nontuberculous Mycobacteria / Q000502:physiology; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D014507:Urbanization; D055815:Young Adult