Population-based incidence and prevalence of nontuberculous mycobacterial lung disease in a large US managed care health plan, 2008 – 2015

Rationale:

Despite increasing recognition of the public health impact of nontuberculous mycobacterial lung disease (NTMLD), population-based reports on incidence and prevalence of NTMLD are only sparsely available in the United States. This study estimated the yearly NTMLD incidence and prevalence between 2008 and 2015 in a large US managed care claims database.

Methods:

A cohort of 16,872 insured members, diagnosed for NTMLD with an ICD9 031.0 or ICD10 A31.0, was identified from a US national health insurance plan. Each Individual who was diagnosed with NTMLD on at least two separate occasions ≥30 days apart was considered as a positive NTMLD identification, yielding 9,476 positively identified patients. For incidence, an NTMLD diagnosis in a calendar year was considered as a new case by ascertaining absence of the diagnosis during the prior year and 24-month continuous medical insurance coverage. For prevalence, all NTMLD diagnoses in a year were considered as prevalent cases and continuous medical insurance coverage of the year was required.

Results:

People ≥60 years of age at the first available NTMLD diagnosis comprised 69.4% of the patient cohort. The overall NTMLD incidence increased from 3.13 in 2008 to 4.73 in 2015 per 100,000 plan members (Table 1). People < 65 years had an incidence of 1.34 in 2008 and 1.82 in 2015 per 100,000 members. People ≥65 years had an incidence of 12.70 in 2008 and 18.37 in 2015 per 100,000 members. The increase in NTMLD incidence from 2008 to 2015 was 35.8% in people < 65 years compared to 44.6% in people ≥65 years. Incidence was 2.05 in 2008 vs. 2.71 in 2015 per 100,000 men, compared to 4.16 in 2008 vs. 6.69 in 2015 per 100,000 women. The overall prevalence increased from 6.64 in 2008 to 11.72 in 2015 per 100,000 plan members. The respective yearly prevalence rates were 2.87 in 2008 and 4.10 in 2015 per 100,000 people < 65 years vs. 30.27 and 47.48 per 100,000 people ≥65 years, and 3.79 in 2008 and 6.45 in 2015 per 100,000 men vs. 9.63 and 16.78 per 100,000 women.

Conclusions:

This study provides the most recent NTMLD epidemiological data from the claims database of a large US managed care health insurance plan. While NTMLD is rare in the US population, the public health impact of increasing NTMLD incidence and prevalence is important to consider in health policy and health care decision making.

 

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