Epidemiology and Disease Burden

  • There is considerable geographic diversity in the epidemiology of nontuberculous mycobacteria (NTM) pulmonary disease1,2
  • Although M. avium and M. abscessus are the two most common causes of NTM pulmonary disease, the prevalence of NTM species varies by geographic region1,3
  • The prevalence of NTM pulmonary disease is highest and increasing the most in older adults in the US and parts of Asia, particularly in those with preexisting lung disease2,4
Epidemiology
Epidemiology of NTM Pulmonary Disease
Rising Prevalence of NTM Pulmonary Disease
Prevalence within the US

Epidemiology of NTM Pulmonary Disease

The epidemiology of NTM pulmonary disease is poorly understood and there is considerable geographic diversity in both disease prevalence and distribution of species causing infection.2 


NTM pulmonary disease is not a reportable condition in most regions and relatively few studies have been conducted to estimate disease prevalence in the US and abroad.2 The studies conducted to date have found that prevalence is highest in East Asia followed by North America, with Europe having slightly lower rates.4-8 A total of approximately 86,000 NTM pulmonary disease cases were estimated in the US for 2010, with the number of cases expected to increase over time.9

 

Global Prevalence of NTM Pulmonary Disease

 

Country or RegionAnnual Prevalence

North America 

USA (2015)4  

Canada (Ontario, 2020)10  

 

11.7/100,000

19.0 /100,000

Europe

EU5 (UK-FR-DE-IT-ES, 2016)6 

Netherlands (2017)7 

 

6.2/100,000

6.2/100,000

Asia

Japan (2016)6 

South Korea (2016)8  

 

24.9/100,000

39.6/100,000

Epidemiological studies consistently show that NTM pulmonary disease disproportionately affects older individuals with chronic underlying lung disease. 


In a US National Managed Care Claims Database (Optum), of those meeting the case definition for NTM pulmonary disease (n=6,280), 89.1% were over the age of 50. Furthermore, 80.2% of patients had preexisting underlying lung disease, including 52.6% with chronic obstructive pulmonary disease and 37.0% with bronchiectasis.4


Studies from the US and Japan have also reported a higher prevalence of NTM pulmonary disease in females.2,4 Roughly two-thirds of patients with NTM pulmonary disease in the US managed care claims database were women.4

Rising Prevalence of NTM Pulmonary Disease

Population-based studies demonstrate that the prevalence of NTM pulmonary disease is increasing in the US and abroad. Despite these increases at the most recent estimated prevalence, NTM pulmonary disease remains a rare disease affecting less than 200,000 people in the US.9 

Average Yearly Rise in Prevalence of NTM Pulmonary Disease from 2008 to 20154

 

According to the National Managed Care Claims Database (Optum), the annual prevalence of NTM pulmonary disease in the US has increased between 2008 and 2015 (from 6.8 to 11.7/100,000) at an average annual increase of +7.5%.4


Prevalence of NTM pulmonary disease is highest and increasing the most in older individuals and women.4

 

  • Age differences: In people <65 years of age, prevalence of NTM increased from 2.9 to 4.1/100,000 compared with an increase in people ≥65 years from 30.3 to 47.5/100,000 between 2008 and 20154
  • Biological sex: Prevalence of NTM increased from 3.8 to 6.5/100,000 in men compared to an increase in women from 9.6 to 16.8/100,000 between 2008 and 20154
Yearly change

Geographic Prevalence of NTM Pulmonary Disease Within the United States

The prevalence of NTM pulmonary disease within the US varies widely by state or region with studies identifying several high-risk areas.9,11 Studies suggest that disease prevalence is rising in most states.4 


States with the highest prevalence and case numbers of NTM pulmonary disease are generally located in southeastern and coastal regions of the US. These are areas with climatic conditions associated with increased NTM risk (e.g., high mean daily potential evapotranspiration levels and percentages covered by surface water).9,11 The prevalence of NTM pulmonary disease increased by at least 10% in 39 states from 2008 to 2015.4

NTM Prevalence Varies by Region9

NTM Epidemiology Map

Reprinted with permission of the American Thoracic Society. Copyright © 2024 American Thoracic Society. All rights reserved. Strollo SE, et al. The Burden of Pulmonary Nontuberculous Mycobacterial Disease in the United States. Ann Am Thorac Soc. 2015;12(10):1458–64. Annals of the American Thoracic Society is an official journal of the American Thoracic Society.9

References

  1. Spaulding AB, Lai YL, Zelazny AM, et al. Geographic Distribution of Nontuberculous Mycobacterial Species Identified among Clinical Isolates in the United States, 2009-2013. Ann Am Thorac Soc. 2017;14(11):1655–1661. doi:10.1513/AnnalsATS.201611-860OC
  2. Prevots DR, Marras TK. Epidemiology of human pulmonary infection with nontuberculous mycobacteria: a review. Clin Chest Med. 2015;36(1):13–34. doi:10.1016/j.ccm.2014.10.002
  3. Prevots DR, Shaw PA, Strickland D, et al. Nontuberculous mycobacterial lung disease prevalence at four integrated health care delivery systems. Am J Respir Crit Care Med. 2010;182(7):970-6. doi:10.1164/rccm.201002-0310OC
  4. Winthrop KL, Marras TK, Adjemian J, Zhang H, Wang P, Zhang Q. Incidence and Prevalence of Nontuberculous Mycobacterial Lung Disease in a Large U.S. Managed Care Health Plan, 2008-2015. Ann Am Thorac Soc. 2020;17(2):178–185. doi:10.1513/AnnalsATS.201804-236OC
  5. Marras TK, Mendelson D, Marchand-Austin A, May K, Jamieson FB. Pulmonary nontuberculous mycobacterial disease, Ontario, Canada, 1998-2010. Emerg Infect Dis. 2013;19(11):1889–91. doi:10.3201/eid1911.130737
  6. Schildkraut JA, Gallagher J, Morimoto K, et al. Epidemiology of nontuberculous mycobacterial pulmonary disease in Europe and Japan by Delphi estimation. Respir Med. 2020;173:106164. doi:10.1016/j.rmed.2020.106164
  7. Schildkraut JA, Zweijpfenning SMH, Nap M, et al. The epidemiology of nontuberculous mycobacterial pulmonary disease in the Netherlands. ERJ Open Res. 2021;7(3)doi:10.1183/23120541.00207-2021
  8.  Lee H, Myung W, Koh WJ, Moon SM, Jhun BW. Epidemiology of Nontuberculous Mycobacterial Infection, South Korea, 2007-2016. Emerg Infect Dis. 2019;25(3):569–572. doi:10.3201/eid2503.181597
  9. Strollo SE, Adjemian J, Adjemian MK, Prevots DR. The Burden of Pulmonary Nontuberculous Mycobacterial Disease in the United States. Ann Am Thorac Soc. 2015;12(10):1458–64. doi:10.1513/AnnalsATS.201503-173OC
  10. Marras T, Nelson P, Peci A, et al. Pulmonary Nontuberculous Mycobacteria, Ontario, Canada, 2020. Emerging Infectious Disease journal. 2023;29(7):1415. doi:10.3201/eid2907.230216
  11. Adjemian J, Olivier KN, Seitz AE, Falkinham JO, 3rd, Holland SM, Prevots DR. Spatial clusters of nontuberculous mycobacterial lung disease in the United States. Am J Respir Crit Care Med. 2012;186(6):553–8. doi:10.1164/rccm.201205-0913OC
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