LAUSR

BACKGROUND Nontuberculous mycobacterial pulmonary disease (NTM-PD) is an uncommon mycobacterial infection characterized by worsening lung function and increased healthcare resource utilization; however, overall risk for hospitalization among patients with NTM-PD remains unclear. STUDY DESIGN AND METHODS A retrospective, nested, case-control study was conducted using the Medicare claims database. Cases were defined as patients with ≥2 NTM-PD claims ≥30 days apart between 1/1/07 and 12/31/15. We included individuals aged ≥65 years with ≥12 months of continuous enrollment in both Parts A and B before the first NTM-PD diagnosis. Cases were matched 1:2 to Medicare beneficiaries without NTM-PD (controls) by age and sex. Hospitalizations following the first NTM-PD claim were compared between cases and controls using both univariate and multivariate analysis. RESULTS We identified 35,444 cases and 65,467 matched controls (mean age, 76.6 years; 70% female; ≥87% White). Baseline comorbidities, particularly pulmonary comorbidities, were more common in cases than controls (81.1% vs 17.7% for chronic obstructive pulmonary disease; 44.6% vs 0.6% for bronchiectasis). All-cause hospitalization was observed in 65.7% of cases and 44.9% of controls. Unadjusted annual hospitalization rates were significantly (P<0.05) greater among cases than controls. Cases also had a significantly shorter time to hospitalization than controls. The increased burden due to hospitalization was reflected in multivariate analysis adjusting for baseline comorbidities. All-cause hospitalization in patients with NTM-PD relative to controls was 1.2-times more likely (relative risk, 1.23; 95% CI, 1.21-1.25; P<0.0001) with a 46% greater hazard (hazard ratio, 1.46; 95% CI, 1.43-1.50; P<0.0001). INTERPRETATION Patients with NTM-PD were significantly more likely to be hospitalized, had greater annualized hospitalization rates, and had shorter time to hospitalization than age- and sex-matched controls without NTM-PD. These findings highlight the significantly increased burden of hospitalizations among patients with NTM-PD.