Impact of Bronchiectasis on incident NTM pulmonary disease: A 10-Year national cohort study

Abstract

Background: Despite a well-established relationship between bronchiectasis and non-tuberculous mycobacterial pulmonary disease (NTM-PD), it is unclear whether the presence of bronchiectasis increases the risk of new NTM-PD. Methods: We performed a population-based, matched cohort study of adults aged 20 years with bronchiectasis using data obtained from the Korean National Health Insurance Service National Sample Cohort database between 2003 and 2013. We evaluated the incidence rate and risk of NTM-PD in the bronchiectasis cohort versus the matched cohort. We also assessed the risk factors of incident NTM-PD in bronchiectasis patients. Results: During the median follow-up duration of 6.1 years, the age- and sex-adjusted incidence of NTM-PD was 109.1/100,000 person-years in the bronchiectasis cohort and 5.6/100,000 person-years in the matched cohort (hazard ratio [HR] = 22.8, 95% confidence interval [CI] = 14.0-37.0, p <0.001). Multivariable analyses revealed that age (adjusted HR for patients aged 50-59 = 5.84, 95% CI = 2.05-16.6), female sex (adjusted HR = 1.64, 95% CI = 1.11-2.42), and previous pulmonary tuberculosis (adjusted HR = 4.89, 95% CI = 3.28-7.29) were associated with increased risk of incident NTM-PD in bronchiectasis patients. Conclusion: Risk of incident NTM-PD was approximately 23-fold greater in patients with bronchiectasis than in those without bronchiectasis. Age (the greatest risk was among patients aged 50-59), female sex, and previous pulmonary tuberculosis were risk factors for incident NTM-PD in bronchiectasis patients.