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PLoS One. 2018 Jun 13;13(6):e0197976. doi: 10.1371/journal.pone.0197976. eCollection 2018.

Epidemiology of nontuberculous mycobacterial infections in the U.S. Veterans Health Administration.

Author information

1
VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America.
2
Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States of America.
3
Public Health and Preventive Medicine, Division of Infectious Diseases, Oregon Health and Sciences University, Portland, Oregon, United States of America.
4
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
5
National Center for Occupational Health and Infection Control, Patient Care Services (Public Health), Veterans Health Administration, Gainesville, Florida, United States of America.
6
Formerly with the National Center for Occupational Health and Infection Control, Patient Care Services (Public Health), Veterans Health Administration, Gainesville, Florida, United States of America.
7
Pulmonary Clinical Medicine Section, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America.

Abstract

OBJECTIVE:

We identified patients with non-tuberculous mycobacterial (NTM) disease in the US Veterans Health Administration (VHA), examined the distribution of diseases by NTM species, and explored the association between NTM disease and the frequency of clinic visits and mortality.

METHODS:

We combined mycobacterial isolate (from natural language processing) with ICD-9-CM diagnoses from VHA data between 2008 and 2012 and then applied modified ATS/IDSA guidelines for NTM diagnosis. We performed validation against a reference standard of chart review. Incidence rates were calculated. Two nested case-control studies (matched by age and location) were used to measure the association between NTM disease and each of 1) the frequency of outpatient clinic visits and 2) mortality, both adjusted by chronic obstructive pulmonary disease (COPD), other structural lung diseases, and immunomodulatory factors.

RESULTS:

NTM cases were identified with a sensitivity of 94%, a specificity of >99%. The incidence of NTM was 12.6/100k patient-years. COPD was present in 68% of pulmonary NTM. NTM incidence was highest in the southeastern US. Extra-pulmonary NTM rates increased during the study period. The incidence rate ratio of clinic visits in the first year after diagnosis was 1.3 [95%CI 1.34-1.35]. NTM patients had a hazard ratio of mortality of 1.4 [95%CI 1.1-1.9] in the 6 months after NTM identification compared to controls and 1.99 [95%CI 1.8-2.3] thereafter.

CONCLUSIONS:

In VHA, pulmonary NTM disease is commonly associated with COPD, with the highest rates in the southeastern US. After adjustment, NTM patients had more clinic visits and greater mortality compared to matched patients.

Conflict of interest statement

We have read the journal's policy and the authors of this manuscript have the following competing interests: some of the authors had operational roles in Veterans Affairs and were part of the funding agency. We confirm that this does not alter our adherence to PLOS ONE policies on sharing data and materials.

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