VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America.
Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States of America.
PLoS One. 2018 Jun 13;13(6):e0197976. doi: 10.1371/journal.pone.0197976. eCollection 2018.
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.
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.
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.
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.
我们在美国退伍军人健康管理局（VHA）中鉴定了患有非结核分枝杆菌（NTM）病的患者，按 NTM 种属检查疾病分布，并探讨了 NTM 病与就诊频率和死亡率之间的关联。
我们将分枝杆菌分离株（从自然语言处理中获取）与 2008 年至 2012 年期间 VHA 数据中的 ICD-9-CM 诊断相结合，然后应用改良的 ATS/IDSA NTM 诊断指南。我们通过图表审查的参考标准进行了验证。计算了发病率。两项嵌套病例对照研究（按年龄和地点匹配）用于测量 NTM 病与以下两者之间的关联：1）门诊就诊频率，2）死亡率，两者均通过慢性阻塞性肺疾病（COPD）、其他结构性肺病和免疫调节因素进行调整。
我们以 94%的灵敏度和>99%的特异性识别出 NTM 病例。NTM 的发病率为 12.6/100k 患者年。68%的肺部 NTM 患者存在 COPD。美国东南部的 NTM 发病率最高。研究期间，肺外 NTM 发病率增加。诊断后第一年就诊的发病率比值比为 1.3[95%CI 1.34-1.35]。与对照组相比，NTM 患者在 NTM 确诊后 6 个月的死亡率危险比为 1.4[95%CI 1.1-1.9]，此后为 1.99[95%CI 1.8-2.3]。
在美国退伍军人健康管理局，肺部 NTM 病通常与 COPD 相关，东南部的发病率最高。调整后，与匹配患者相比，NTM 患者就诊次数更多，死亡率更高。
