Epidemiology Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Qrts 15 B-1, 8 West Drive, MSC 2665, Bethesda, MD 20892-2665, USA.
Am J Respir Crit Care Med. 2012 Sep 15;186(6):553-8. doi: 10.1164/rccm.201205-0913OC. Epub 2012 Jul 5.
Prevalence of pulmonary nontuberculous mycobacterial (PNTM) disease varies by geographic region, yet the factors driving these differences remain largely unknown.
To identify spatial clusters of PNTM disease at the county level and to describe environmental and sociodemographic factors predictive of disease.
PNTM cases identified from a nationally representative sample of Medicare Part B beneficiaries from 1997 to 2007 were geocoded by county and state of residence. County-level PNTM case counts and Medicare population data were then uploaded into SaTScan to identify significant spatial clusters and low-risk areas of disease. High-risk and low-risk counties were then compared to identify significant sociodemographic and environmental differences.
We identified seven significant (P < 0.05) clusters of PNTM cases. These high-risk areas encompassed 55 counties in 8 states, including parts of California, Florida, Hawaii, Louisiana, New York, Oklahoma, Pennsylvania, and Wisconsin. Five low-risk areas were also identified, which encompassed 746 counties in 23 states, mostly in the Midwest. Counties in high-risk areas were significantly larger, had greater population densities, and higher education and income levels than low-risk counties. High-risk counties also had higher mean daily potential evapotranspiration levels and percentages covered by surface water, and were more likely to have greater copper and sodium levels in the soil, although lower manganese levels.
Specific environmental factors related to soil and water exposure appear to increase the risk of PNTM infection. Still, given that environmental sources of NTM are ubiquitous and PNTM disease is rare, both host susceptibility and environmental factors must be considered in explaining disease development.
肺部非结核分枝杆菌（PNTM）疾病的流行因地理位置不同而有所差异，但导致这些差异的因素在很大程度上尚不清楚。
确定县级 PNTM 疾病的空间聚集，并描述预测疾病的环境和社会人口学因素。
从 1997 年至 2007 年医疗保险 B 部分受益人的全国代表性样本中确定 PNTM 病例，按县和居住地的州进行地理编码。然后将县级 PNTM 病例计数和医疗保险人口数据上传到 SaTScan 中，以确定显著的空间聚类和疾病的低风险区域。然后比较高风险和低风险县，以确定显著的社会人口学和环境差异。
我们确定了七个具有统计学意义（P < 0.05）的 PNTM 病例聚类。这些高风险区域包括 8 个州的 55 个县，其中包括加利福尼亚州、佛罗里达州、夏威夷州、路易斯安那州、纽约州、俄克拉荷马州、宾夕法尼亚州和威斯康星州的部分地区。还确定了五个低风险区域，这些区域包括 23 个州的 746 个县，主要在中西部地区。高风险县的面积明显更大，人口密度更高，教育和收入水平也更高，而低风险县则相反。高风险县的平均日潜在蒸散量水平和地表水覆盖率也更高，土壤中的铜和钠含量更高，而锰含量则更低。
与土壤和水暴露有关的特定环境因素似乎会增加 PNTM 感染的风险。尽管如此，鉴于 NTM 的环境来源无处不在，而 PNTM 疾病很少见，因此在解释疾病发展时，必须考虑宿主易感性和环境因素。
