Division of General Internal Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City.
Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung City.
Ther Adv Respir Dis. 2022 Jan-Dec;16:17534666221103213. doi: 10.1177/17534666221103213.
Infection due to nontuberculous mycobacteria (NTM) is an emerging issue worldwide, and we aimed to address the epidemiology and mortality association of NTM infection requiring treatment in Taiwan.
We used the 2003-2018 data of 2 million representative individuals in Taiwan's National Health Insurance Research Database. We identified patients with newly diagnosed NTM infection and received treatment as NTM cases. Age- and sex-matched (1:40) as well as propensity score-matched (PSM) (1:2) non-NTM individuals were selected as non-NTM controls. We used a Cox proportional hazard model to determine hazard ratios (HRs) with 95% confidence intervals (CIs).
We identified 558 patients with NTM infection requiring treatment. The mean age was 62.5 ± 15.4 years, and 57.5% of them were male. The incidence increased from 0.54 per 100,000 person-year in 2003 to 3.35 per 100,000 person-year in 2018. The overall mortality was 35.2%, with a mean follow-up duration of 4.1 ± 3.6 years. We found that NTM infection was independently associated with a greater risk of mortality (HR: 1.71; 95% CI: 1.47-1.98) compared with age- and sex-matched controls, and the association remained consistent (HR: 1.44; 95% CI: 1.19-1.75) compared with propensity-matched controls. We also found that old age, male, high Charlson comorbidity index, and the use of steroids or anti-neoplastic agents/immunosuppressants were associated with mortality risk.
In conclusion, we found a steady increase in patients with NTM infection requiring treatment in Taiwan and further demonstrated that NTM infection was associated with greater risk of mortality using two comparable non-NTM control subjects.
非结核分枝杆菌（NTM）感染是全球范围内的一个新出现的问题，我们旨在解决台湾需要治疗的 NTM 感染的流行病学和死亡率相关性。
我们使用了台湾全民健康保险研究数据库中 2003-2018 年 200 万代表性个体的数据。我们确定了新诊断为 NTM 感染并接受治疗的患者为 NTM 病例。选择年龄和性别匹配（1:40）以及倾向评分匹配（PSM）（1:2）的非 NTM 个体作为非 NTM 对照。我们使用 Cox 比例风险模型确定危险比（HR）及其 95%置信区间（CI）。
我们共鉴定了 558 例需要治疗的 NTM 感染患者。患者的平均年龄为 62.5±15.4 岁，其中 57.5%为男性。发病率从 2003 年的每 100,000 人年 0.54 上升到 2018 年的每 100,000 人年 3.35。总体死亡率为 35.2%，平均随访时间为 4.1±3.6 年。我们发现与年龄和性别匹配的对照组相比，NTM 感染与更高的死亡率风险独立相关（HR：1.71；95%CI：1.47-1.98），与倾向评分匹配的对照组相比，这种相关性仍然一致（HR：1.44；95%CI：1.19-1.75）。我们还发现，高龄、男性、高 Charlson 合并症指数以及使用类固醇或抗肿瘤药物/免疫抑制剂与死亡率风险相关。
总之，我们发现台湾需要治疗的 NTM 感染患者数量稳步增加，并进一步证明使用两种可比的非 NTM 对照，NTM 感染与更高的死亡率风险相关。
