Deaths Related to Nontuberculous Mycobacterial Infections in the United States, 1999-2014.
Unlike tuberculosis, nontuberculous mycobacterial disease is not reportable to public health authorities in the United States, and the total burden of disease is uncertain.



To estimate the mortality of nontuberculous mycobacterial disease in the United States over a 15-year period and to identify temporal trends.



The U.S. Multiple Cause of Death Files from 1999 through 2014 were searched for a listing of nontuberculous mycobacterial disease by International Classification of Diseases, Tenth Revision code as either the underlying or a contributing cause of death. Characteristics of individuals with nontuberculous mycobacteria-related deaths in the United States were summarized according to demographic characteristics. Age-adjusted mortality rates and rate ratios were calculated using bridged-race population estimates of U.S. census population data. Time trends were evaluated with negative binomial regression.



There was a significant increase in nontuberculous mycobacteria-related deaths among individuals without a diagnosis of HIV infection (P = 0.004). Mortality rates increased with advancing age. Age-adjusted mortality rate ratios were lower for men (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.80-0.87) compared with women, and were lower for Hispanic individuals (RR, 0.53; 95% CI, 0.49-0.56) and black, non-Hispanic persons (RR, 0.83; 95% CI, 0.77-0.88) compared with white, non-Hispanic individuals.



The mortality rate of nontuberculous mycobacterial disease among HIV-uninfected individuals has increased in the United States between 1999 and 2014. These deaths occurred disproportionately in older white women. Considering the concurrent decline in tuberculosis-related deaths, these findings demonstrate a shift in the epidemiology of fatal mycobacterial infections in the United States.
1 Public Health Research Institute and.
Christopher
C
Vinnard
2 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
Sarah
S
Longworth
3 Drexel University College of Medicine, Philadelphia, Pennsylvania.
Alyssa
A
Mezochow
4 Division of Pulmonary Medicine, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey.
Amee
A
Patrawalla
1 Public Health Research Institute and.
Barry N
BN
Kreiswirth
2 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
Keith
K
Hamilton
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000401:mortality*; D012044:Regression Analysis; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D055815:Young Adult
epidemiology; mortality; nontuberculous mycobacteria