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

Makoto M. Jones, Kevin Winthrop, Scott D. Nelson, Scott L. Duvall, Olga V. Patterson, Kevin E. Nechodom, Kimberly E. Findley, Lewis J. Radonovich, Matthew H. Samore, Kevin P. Fennelly

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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.

Original languageEnglish (US)
Article number0197976
JournalPLoS One
Volume13
Issue number6
DOIs
StatePublished - Jun 1 2018

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veterans
Veterans Health
mycobacterial diseases
Epidemiology
United States Department of Veterans Affairs
Pulmonary diseases
epidemiology
Ambulatory Care
Health
respiratory tract diseases
Chronic Obstructive Pulmonary Disease
Infection
Mortality
Incidence
incidence
Lung
lungs
Natural Language Processing
International Classification of Diseases
Ambulatory Care Facilities

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Jones, M. M., Winthrop, K., Nelson, S. D., Duvall, S. L., Patterson, O. V., Nechodom, K. E., ... Fennelly, K. P. (2018). Epidemiology of nontuberculous mycobacterial infections in the U.S. Veterans Health Administration. PLoS One, 13(6), [0197976]. https://doi.org/10.1371/journal.pone.0197976

Epidemiology of nontuberculous mycobacterial infections in the U.S. Veterans Health Administration. / Jones, Makoto M.; Winthrop, Kevin; Nelson, Scott D.; Duvall, Scott L.; Patterson, Olga V.; Nechodom, Kevin E.; Findley, Kimberly E.; Radonovich, Lewis J.; Samore, Matthew H.; Fennelly, Kevin P.

In: PLoS One, Vol. 13, No. 6, 0197976, 01.06.2018.

Research output: Contribution to journalArticle

Jones, MM, Winthrop, K, Nelson, SD, Duvall, SL, Patterson, OV, Nechodom, KE, Findley, KE, Radonovich, LJ, Samore, MH & Fennelly, KP 2018, 'Epidemiology of nontuberculous mycobacterial infections in the U.S. Veterans Health Administration', PLoS One, vol. 13, no. 6, 0197976. https://doi.org/10.1371/journal.pone.0197976
Jones, Makoto M. ; Winthrop, Kevin ; Nelson, Scott D. ; Duvall, Scott L. ; Patterson, Olga V. ; Nechodom, Kevin E. ; Findley, Kimberly E. ; Radonovich, Lewis J. ; Samore, Matthew H. ; Fennelly, Kevin P. / Epidemiology of nontuberculous mycobacterial infections in the U.S. Veterans Health Administration. In: PLoS One. 2018 ; Vol. 13, No. 6.
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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.",
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AU - Patterson, Olga V.

AU - Nechodom, Kevin E.

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N2 - 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.

AB - 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.

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