The prevalence of non-cystic fibrosis bronchiectasis in the US

Objectives:

Non-cystic fibrosis bronchiectasis (NCFBE) is a rare, chronic lung disease characterized by bronchial inflammation and permanent airway dilation. Chronic infections with Pseudomonas aeruginosa (PA) have been linked to higher morbidity and mortality in NCFBE patients. Prevalence of PA among NCFBE have been reported in epidemiologic studies to be as high as 30%, however there has not been a large nationwide assessment of diagnostic patterns in the US. This study assessed the prevalence of PA diagnosis among US commercially insured NCFBE patients.

Methods:

Using data from the 2007 – 2013 PharMetrics Plus administrative claims database, we identified bronchiectasis (ICD-9-CM: 494.xx) patients, then excluded those with cystic fibrosis (277.XX). Patients were stratified by evidence of PA (482.1 or 041.7). We compared patient demographics and comorbidities between NCFBE patients with and without PA infection. Frequencies and percentages were compared using bivariate statistics (e.g., chi-square test).

Results:

Among a base population of 101,321,694, we identified 23,740 patients with NCFBE of which 2.5% (595) had evidence of PA. Patients were mostly over 50 years of age (82.7%) and female (61.7%). Patients with PA had higher comorbidity rates in numerous disease areas including cardiac arrhythmias (44.2% vs. 24.1%, p < 0.0001), CHF (28.0% vs. 12.3%, p < 0.0001), COPD (83.7% vs. 60.9%, p < 0.0001), coagulopathy (12.2% vs. 5.5%, p < 0.0001) and fluid and electrolyte disorders (34.7% vs. 17.7%, p < 0.0001).

Conclusions:

The prevalence of PA appears to be vastly under-reported in diagnostic healthcare data compared to epidemiologic studies, which may suggest a lack of diagnosis in routine healthcare practice. We also found PA patients to have much higher comorbidity rates. Greater emphasis on identifying NCFBE patients with PA is needed.

Funding Source:

Grifols, RTP, NC