Mortality and Prognostic Factors of Nontuberculous Mycobacterial Infection in Korea: A Population-based Comparative Study
- Authors
- Lee, Hyewon; Myung, Woojae; Lee, Eun-Mi; Kim, Hyekyeong; Jhun, Byung Woo
- Issue Date
- 15-May-2021
- Publisher
- University of Chicago Press
- Keywords
- nontuberculous mycobacteria; tuberculosis; mortality; comorbidity; macrolide
- Citation
- Clinical Infectious Diseases, v.72, no.10, pp E610 - E619
- Journal Title
- Clinical Infectious Diseases
- Volume
- 72
- Number
- 10
- Start Page
- E610
- End Page
- E619
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/18837
- DOI
- 10.1093/cid/ciaa1381
- ISSN
- 1058-4838
1537-6591
- Abstract
- Background. Population-based studies on the mortality burden of nontuberculous mycobacteria (NTM) infection are lacking. We compared the long-term mortality of NTM-infected patients with tuberculosis (TB)-patients and the general population, and investigated mortality-associated factors. Methods. We analyzed nationwide-data from the Korean National Health Insurance and Korea-Statistical Office between 2002 and 2017. NTM infection was identified using the International Classification of Disease, Tenth Revision code, with one-to-one matching to TB patients and general population controls. Results. A total of 530 401 individuals were analyzed, including 183 267 with NTM infections; 166 666 with TB; and 180 468 controls. The overall 6-, 10-, and 14-year cumulative survival probabilities in the NTM group were 86.3%, 80.8%, and 77.1%, respectively, which were significantly lower than those of the TB or control groups (log-rank P < .0001). In cases of NTM and TB coinfection, the overall 6-, 10-, and 14-year cumulative survival probabilities were 75.1%, 65.4%, and 57.0%, respectively. Multivariable analysis indicated that old age, male gender, province, and various respiratory or nonrespiratory comorbidities were significantly associated with mortality of NTM infection. The use of a macrolide (more than 1 year) negatively correlated with mortality of NTM infection (adjusted hazard ratio [aHR] 0.61, 95% confidence interval [CI] .53-.71), regardless of azithromycin (aHR 0.60, 95% CI .43-.85) or clarithromycin use (aHR 0.63, 95% CI .53-.75). Conclusions. NTM-infected patients had poor prognosis when compared to TB patients or the general population, especially for NTM and TB coinfection. NTM mortality was associated with certain demographic characteristics, but long-term use of macrolides may provide survival benefits.
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