1 Center for Genes, Environment and Health and.
2 Computational Bioscience Program, School of Medicine, University of Colorado Denver, Aurora, Colorado.
Ann Am Thorac Soc. 2017 Oct;14(10):1523-1532. doi: 10.1513/AnnalsATS.201701-081OC.
Nontuberculous mycobacteria (NTM) are ubiquitous environmental microorganisms. Infection is thought to result primarily from exposure to soil and/or water sources. NTM disease prevalence varies greatly by geographic region, but the geospatial factors influencing this variation remain unclear.
To identify sociodemographic and environmental ecological risk factors associated with NTM infection and disease in Colorado.
We conducted an ecological study, combining data from patients with a diagnosis of NTM disease from National Jewish Health's electronic medical record database and ZIP code-level sociodemographic and environmental exposure data obtained from the U.S. Geological Survey, the U.S. Department of Agriculture, and the U.S. Census Bureau. We used spatial scan methods to identify high-risk clusters of NTM disease in Colorado. Ecological risk factors for disease were assessed using Bayesian generalized linear models assuming Poisson-distributed discrete responses (case counts by ZIP code) with the log link function.
We identified two statistically significant high-risk clusters of disease. The primary cluster included ZIP codes in urban regions of Denver and Aurora, as well as regions south of Denver, on the east side of the Continental Divide. The secondary cluster was located on the west side of the Continental Divide in rural and mountainous regions. After adjustment for sociodemographic, drive time, and soil variables, we identified three watershed areas with relative risks of 12.2, 4.6, and 4.2 for slowly growing NTM infections compared with the mean disease risk for all watersheds in Colorado. This study population carries with it inherent limitations that may introduce bias. The lack of complete capture of NTM cases in Colorado may be related to factors such as disease severity, education and income levels, and insurance status.
Our findings provide evidence that water derived from particular watersheds may be an important source of NTM exposure in Colorado. The watershed with the greatest risk of NTM disease contains the Dillon Reservoir. This reservoir is also the main water supply for major cities located in the two watersheds with the second and third highest disease risk in the state, suggesting an important possible source of infection.
非结核分枝杆菌（NTM）是普遍存在于环境中的微生物。人们认为，感染主要是由于暴露于土壤和/或水源而引起的。NTM 疾病的患病率因地理位置的不同而有很大差异，但影响这种差异的地理空间因素尚不清楚。
确定与科罗拉多州 NTM 感染和疾病相关的社会人口统计学和环境生态风险因素。
我们进行了一项生态研究，将来自国家犹太健康电子病历数据库的 NTM 疾病诊断患者的数据与美国地质调查局、美国农业部和美国人口普查局获得的邮政编码级别的社会人口统计学和环境暴露数据相结合。我们使用空间扫描方法来确定科罗拉多州 NTM 疾病的高风险集群。使用贝叶斯广义线性模型评估疾病的生态风险因素，该模型假设泊松分布的离散响应（按邮政编码计算的病例数），并使用对数链接函数。
我们确定了两个具有统计学意义的疾病高风险集群。主要集群包括丹佛和奥罗拉市的城市地区，以及丹佛以南、大陆分水岭东侧的地区。次要集群位于大陆分水岭以西的农村和山区。在调整了社会人口统计学、行车时间和土壤变量后，我们确定了三个流域区域，与科罗拉多州所有流域的平均疾病风险相比，其慢生长 NTM 感染的相对风险分别为 12.2、4.6 和 4.2。本研究人群存在固有局限性，可能会引入偏差。科罗拉多州可能存在不完全捕获 NTM 病例的情况，这可能与疾病严重程度、教育和收入水平以及保险状况等因素有关。
我们的研究结果提供了证据表明，来自特定流域的水可能是科罗拉多州 NTM 暴露的一个重要来源。风险最大的 NTM 疾病流域包含 Dillon 水库。该水库也是位于该州第二和第三大疾病风险流域内的两个主要城市的主要水源，这表明其可能是一个重要的感染源。
