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Volume 23, Number 3—March 2017
Research

Pulmonary Nontuberculous Mycobacteria–Associated Deaths, Ontario, Canada, 2001–2013

Theodore K. MarrasComments to Author , Michael A. Campitelli, Hong Lu, Hannah Chung, Sarah K. Brode, Alex Marchand-Austin, Kevin L. Winthrop, Andrea S. Gershon, Jeffrey C. Kwong1, and Frances B. Jamieson1
Author affiliations: Mount Sinai Hospital, Toronto, Ontario, Canada (T.K. Marras, S.K. Brode); University of Toronto, Toronto (T.K. Marras, S.K. Brode, A.S. Gershon, J.C. Kwong, F.B. Jamieson); University Health Network, Toronto (T.K. Marras, S.K. Brode, J.C. Kwong); Institute for Clinical Evaluative Sciences, Toronto (M.A. Campitelli, H. Lu, H. Chung, A.S. Gershon, J.C. Kwong); West Park Healthcare Centre, Toronto (S.K. Brode); Public Health Ontario, Toronto (A. Marchand-Austin, J.C. Kwong, F.B. Jamieson); Oregon Health and Science University, Portland, Oregon, USA (K.L. Winthrop); Sunnybrook Health Sciences Centre, Toronto (A.S. Gershon)

Main Article

Table 5

Multivariable associations between baseline clinical variables and death among all patients with incident NTM pulmonary disease, Ontario, Canada, 2001–2013*

Variable Value, n = 9,681 Adjusted† HR (95% CI) p value
Male sex, no. (%) 49.1 1.47 (1.38–1.57) <0.0001
Median age, y (IQR)
 70 (58–78)
 1.05 (1.05–1.05)
 <0.0001
Income quintile,‡ %
1 (lowest; reference) 26.7 – –
2 21.7 0.93 (0.86–1.02) 0.1267
3 18.0 0.90 (0.82–0.99) 0.0332
4 16.3 0.86 (0.78–0.95) 0.0024
5
 17.1
 0.82 (0.74–0.90)
 <0.0001
Residential setting,§ %
Urban (reference) 89.5 – –
Suburban 7.8 0.98 (0.87–1.10) 0.7091
Rural
 2.7
 1.04 (0.87–1.25)
 0.6783
ACG number,¶ %
0–5 (reference) 11.9 – –
6–10 42.5 1.21 (1.05–1.39) 0.0084
>11
 45.6
 1.44 (1.25–1.66)
 <0.0001
Underlying condition, %
Asthma 35.1 0.88 (0.82–0.94) 0.0003
COPD 51.3 1.38 (1.29–1.48) <0.0001
Diabetes 19.9 1.05 (0.97–1.13) 0.2505
Rheumatoid arthritis 3.5 1.19 (1.01–1.39) 0.0339
Chronic kidney disease 8.1 1.40 (1.27–1.55) <0.0001
GERD 17.3 0.93 (0.86–1.01) 0.0832
Bronchiectasis 14.2 0.76 (0.69–0.84) <0.0001
Interstitial lung disease 8.1 1.51 (1.37–1.68) <0.0001
Lung cancer 8.0 3.03 (2.78–3.32) <0.0001
HIV infection 1.8 3.56 (2.81–4.49) <0.0001
Cystic fibrosis 1.0 1.95 (1.37–2.77) 0.0002
Solid organ transplant 1.4 1.06 (0.81–1.38) 0.6849
Bone marrow transplant 0.6 2.77 (1.93–3.97) <0.0001
Prior tuberculosis
 1.8
 0.66 (0.50–0.87)
 0.0037
Hospitalizations,# mean ± SD 0.41 ± 0.93 1.09 (1.05–1.14) <0.0001
Emergency department visits,# mean ± SD
 0.93 ± 1.24
 1.16 (1.13–1.20)
 <0.0001
NTM species, %
MAC (reference) 65.3 – –
M. xenopi 23.4 1.22 (1.13–1.31) <0.0001
M. fortuitum 2.7 1.02 (0.84–1.23) 0.8538
M. abscessus 2.5 0.98 (0.78–1.24) 0.8841
M. kansasii 1.6 1.25 (0.99–1.57) 0.0636
All other species 4.4 0.94 (0.80–1.10) 0.4306

*Multivariable Cox proportional hazards model including all 9,681 registered Ontario residents with incident NTM pulmonary disease (>1 positive sputum sample for the same species or 1 positive bronchoscopic or biopsy specimen). No matching required for this analysis, and so all covariates of interest were assessed. ACG, Adjusted Clinical Group; COPD, chronic obstructive pulmonary disease; GERD, gastresophageal reflux disease; IQR, interquartile range; MAC, mycobacterium avium complex; NTM, nontuberculous mycobacteria. Dashes indicate reference level for the variable (values not calculated).
†Adjusted for sex, age, income quintile, location, ACG case mix system, baseline underlying conditions (asthma, COPD, diabetes, HIV, rheumatoid arthritis, chronic kidney disease, GERD, bronchiectasis, interstitial lung disease, cystic fibrosis, prior tuberculosis, lung cancer, solid organ transplantation or bone marrow transplantation), health use (number of hospitalizations and emergency department visits in year before index date), and NTM disease diagnosis during follow-up as time-varying covariate (for NTM isolation group only).
‡Totals do not add to 100% because of missing income data in 0.4% of patients
§Residential setting characterized by Rural Index of Ontario (19).
¶Number of ACG diagnoses using the ACG case mix system (16).
#Number of events in the year before entry.

Main Article

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1These authors contributed equally to this article.

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Page updated: February 17, 2017
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