Mortality association of nontuberculous mycobacterial infection requiring treatment in Taiwan: a population-based study

BACKGROUND: Infection due to nontuberculous mycobacteria (NTM) is an emerging issue worldwide, and we aimed to address the epidemiology and mortality association of NTM infection requiring treatment in Taiwan. METHODS: We used the 2003–2018 data of 2 million representative individuals in Taiwan’s National Health Insurance Research Database. We identified patients with newly diagnosed NTM infection and received treatment as NTM cases. Age- and sex-matched (1:40) as well as propensity score-matched (PSM) (1:2) non-NTM individuals were selected as non-NTM controls. We used a Cox proportional hazard model to determine hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: We identified 558 patients with NTM infection requiring treatment. The mean age was 62.5 ± 15.4 years, and 57.5% of them were male. The incidence increased from 0.54 per 100,000 person-year in 2003 to 3.35 per 100,000 person-year in 2018. The overall mortality was 35.2%, with a mean follow-up duration of 4.1 ± 3.6 years. We found that NTM infection was independently associated with a greater risk of mortality (HR: 1.71; 95% CI: 1.47–1.98) compared with age- and sex-matched controls, and the association remained consistent (HR: 1.44; 95% CI: 1.19–1.75) compared with propensity-matched controls. We also found that old age, male, high Charlson comorbidity index, and the use of steroids or anti-neoplastic agents/immunosuppressants were associated with mortality risk. CONCLUSION: In conclusion, we found a steady increase in patients with NTM infection requiring treatment in Taiwan and further demonstrated that NTM infection was associated with greater risk of mortality using two comparable non-NTM control subjects.