title: Impact of industrial structure and soil exposure on the regional variations in pulmonary nontuberculous mycobacterial disease prevalence.
abstract: The prevalence of pulmonary nontuberculous mycobacterial (pNTM) disease, including Mycobacterium avium complex (MAC), varies widely according to geographic region. However, the factors that influence regional variations in pNTM disease prevalence remain unknown. This study was undertaken to examine whether environmental or occupational factors or host traits could influence regional variations in pNTM disease prevalence.
  
  
  
  We collected laboratory data on pulmonary tuberculosis (pTB) and pNTM from two hospitals in the West Harima area of Japan and five hospitals in Kyoto City, Japan from 2012 to 2013. We estimated microbiological pNTM disease prevalence by multiplying all pTB cases in each area with the ratio of pNTM cases and pTB cases at the survey hospitals in each area. We administered a standardized questionnaire to 52 patients and 120 patients with pulmonary MAC (pMAC) disease at Ako City Hospital and Kyoto University Hospital, respectively.
  
  
  
  The estimated prevalence of microbiological pNTM disease in the West Harima area (85.4/100,000 population-years) was significantly higher than that observed in Kyoto City (23.6/100,000 population-years; p<.001). According to multiple logistic regression analysis, in Ako City Hospital, primary (activities directly related to natural resources) and secondary industries (construction, mining, and manufacturing primary industry produce; odds ratio [OR]=4.79; 95% confidence interval [CI]=1.49-14.0; p=.007) and soil exposure (OR=13.6; 95% CI=4.94-45.26; p<.001) were associated with pMAC disease.
  
  
  
  Environmental factors, both industrial structures associated with occupational dust and environmental soil exposure, could influence the regional variations in pNTM disease prevalence.
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hamada
authors.affiliation: Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University School of Medical Sciences, Nagoya, Japan. Electronic address: yutaka@med.nagoya-cu.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Toyohiro
authors.initials: T
authors.lastname: Hirai
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Murase
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuji
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Fujita
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Mio
authors.affiliation: Department of Respiratory Medicine, Takeda General Hospital, Kyoto, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Maekawa
authors.affiliation: Department of Cardiovascular Medicine, Ako City Hospital, Ako, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of Gastroenterology and Hepatology, Ako City Hospital, Ako, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ono
authors.affiliation: Department of Respiratory Medicine, Kyoto Katsura Hospital, Kyoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.affiliation: Department of Laboratory Medicine, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Clinical Laboratory, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Komori
authors.affiliation: Department of Infection Control and Clinical Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Fujita
authors.affiliation: Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University School of Medical Sciences, Nagoya, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Niimi
authors.affiliation: Clinical Laboratory of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ichiyama
authors.affiliation: Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chin
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
mesh_terms: D000368:Aged; D004777:Environment; D004781:Environmental Exposure / Q000032:analysis*; D005260:Female; D006801:Humans; D007221:Industry; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology* / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D015995:Prevalence; D012988:Soil Microbiology
keywords: Environmental factors; Host factors; Mycobacterium avium complex; Nontuberculous mycobacteria; Prevalence