Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Clinical Research Center, National Hospital Organization Tokyo Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan.
Department of Real-world Evidence, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Respir Investig. 2024 Nov;62(6):1102-1108. doi: 10.1016/j.resinv.2024.09.015. Epub 2024 Oct 1.
Chronic pulmonary aspergillosis (CPA) has recently gained attention owing to its substantial health burden. However, the precise epidemiology and prognosis of the disease are still unclear due to the lack of a nationwide descriptive analysis. This study aimed to elucidate the epidemiology of patients with CPA and to investigate their prognosis.
Using a national administrative database covering >99% of the population in Japan, we calculated the nationwide incidence and prevalence of CPA from 2016 to 2022. Additionally, we clarified the survival rate of patients diagnosed with CPA and identified independent prognostic factors using multivariate Cox proportional hazard analysis.
During the study period, while the prevalence of CPA remained stable at 9.0-9.5 per 100,000 persons, its incidence declined to 2.1 from 3.5 per 100,000 person-years. The 1-, 3-, and 5-year survival rates were 65%, 48%, and 41%, respectively. During the year of CPA onset, approximately 50% of patients received oral corticosteroids (OCS) at least once, while about 30% underwent frequent OCS treatment (≥4 times per year) within the same timeframe. Increased mortality was independently associated with older age (>65 years) (hazard ratio [HR], 2.65; 95% confidence interval (CI), 2.54-2.77), males (1.24; 1.20-1.29), a history of chronic obstructive pulmonary disease (1.05; 1.02-1.09), lung cancer (1.12; 1.06-1.18); and ILD (1.19; 1.14-1.24); and frequent OCS use (1.13; 1.09-1.17). Conversely, decreased mortality was associated with a history of tuberculosis (HR, 0.81; 95% CI, 0.76-0.86), non-tuberculous mycobacteria (0.91; 0.86-0.96), and other chronic pulmonary diseases (0.89; 0.85-0.92).
The incidence of CPA decreased over the past decade, although the prevalence was stable and much higher than that in European countries. Moreover, the patients' prognosis was poor. Physicians should be vigilant about CPA onset in patients with specific high-risk underlying pulmonary conditions.
慢性肺曲霉病（CPA）因其对健康的巨大负担而受到关注。然而，由于缺乏全国性的描述性分析，该病的精确流行病学和预后仍不清楚。本研究旨在阐明 CPA 患者的流行病学，并研究其预后。
我们利用覆盖日本 99%以上人口的国家行政数据库，计算了 2016 年至 2022 年期间的全国 CPA 发病率和患病率。此外，我们还通过多变量 Cox 比例风险分析明确了诊断为 CPA 的患者的生存率，并确定了独立的预后因素。
在研究期间，虽然 CPA 的患病率保持在每 100,000 人 9.0-9.5 不变，但发病率从每 100,000 人年 3.5 降至 2.1。1、3 和 5 年生存率分别为 65%、48%和 41%。在 CPA 发病的当年，约有 50%的患者至少接受过一次口服皮质类固醇（OCS）治疗，而约 30%的患者在同一时间段内接受过频繁的 OCS 治疗（≥4 次/年）。较高的死亡率与年龄较大（>65 岁）（风险比 [HR]，2.65；95%置信区间 [CI]，2.54-2.77）、男性（1.24；1.20-1.29）、慢性阻塞性肺疾病史（1.05；1.02-1.09）、肺癌（1.12；1.06-1.18）和间质性肺病（ILD）（1.19；1.14-1.24）；和频繁使用 OCS（1.13；1.09-1.17）相关。相反，结核病（HR，0.81；95%CI，0.76-0.86）、非结核分枝杆菌（0.91；0.86-0.96）和其他慢性肺部疾病（0.89；0.85-0.92）史与死亡率降低相关。
过去十年 CPA 的发病率有所下降，尽管患病率保持稳定且远高于欧洲国家。此外，患者的预后较差。医生应警惕特定高危潜在肺部疾病患者 CPA 的发病。
