Hospitalization burden high in adults with nontuberculous mycobacterial pulmonary disease

Older adults with nontuberculous mycobacterial pulmonary disease have significantly greater likelihood for hospitalization, higher hospitalization rates and shorter time to hospitalization than those without, researchers reported.

“The risk of hospitalization among persons with nontuberculous mycobacterial pulmonary disease demonstrates a very high burden of disease and associated morbidity,” D. Rebecca Prevots, PhD, MPH, chief of the Epidemiology and Population Studies Unit at the NIH, and colleagues wrote in Chest. “Hospitalizations are associated with an increased cost relative to outpatient care, and an improved understanding of the risk of hospitalization attributable to nontuberculous mycobacterial pulmonary disease will allow for a better estimation of the associated costs.”

The retrospective, nested, case-control study included 35,444 patients (mean age, 76.6 years; 69.8% women) aged 65 years and older with two or more nontuberculous mycobacterial pulmonary disease claims at least 30 days apart from 2007 to 2015 in the Medicare claims database. All individuals were continuously enrolled in Medicare Parts A and B at least 12 months before their first nontuberculous mycobacterial pulmonary disease diagnosis. These cases were compared with 65,467 age- and sex-matched controls (mean age, 76.6 years; 70.8% women).

Patients with nontuberculous mycobacterial pulmonary disease had more comorbidities at baseline compared with controls, including COPD (81.1% vs. 17.7%; P < .001) and bronchiectasis (44.6% vs. 0.6%; P < .001).

The rate of all-cause hospitalization was 65.7% for patients with nontuberculous mycobacterial pulmonary disease compared with 44.9% for controls.

Annual hospitalization rates were significantly greater among patients with nontuberculous mycobacterial pulmonary disease: all-cause hospitalization (incidence rate ratio [IRR] = 1.79; 95% CI, 1.77-1.81), COPD-related hospitalization (IRR = 5.83; 95% CI, 5.64-6.02), pneumonia-related hospitalization (IRR = 4.92; 95% CI, 4.75-5.1) and other pulmonary disease-related hospitalization (IRR = 4.16; 95% CI, 3.75-4.61).

Time to all-cause hospitalization was a median of 191 days for patients with nontuberculous mycobacterial pulmonary disease compared with 448 days among controls.

In addition, patients with nontuberculous mycobacterial pulmonary disease were one to two times more likely to be hospitalized (RR = 1.23; 95% CI, 1.21-1.25; P < .0001) and had a 46% higher risk for all-cause hospitalization compared with controls (HR = 1.46; 95% CI, 1.43-1.5; P < .0001).

“Patients with nontuberculous mycobacterial pulmonary disease aged > 65 years had statistically significantly more hospitalizations compared with age- and sex-matched control subjects without nontuberculous mycobacterial pulmonary disease, highlighting the need for careful medical management of these patients and the need for clinical management strategies that may reduce excess hospitalizations for these patients,” the researchers wrote.