Mortality and causes of death in non-tuberculous mycobacterial pulmonary disease

<sec><title>BACKGROUND</title>Mortality and causes of death in non-tuberculous mycobacterial pulmonary disease (NTM-PD) are not well-described over long follow-up periods, particularly in Europe. We investigated whether NTM-PD is associated with higher mortality rates and different causes of death than matched controls.</sec><sec><title>METHODS</title>Danish national registers were used to identify patients with NTM-PD from 2000–2017 and to match them 1:4 with controls based on age, sex, cohabitation status, and municipality.</sec><sec><title>RESULTS</title>We identified 661 patients with NTM-PD (50.4% male, median age 66 years, interquartile range [IQR] 48–84). The 5-year mortality rate for NTM-PD was 51% (95% CI 47–55) compared to 15% (95% CI 14–17) for controls. The hazard ratio (HR) of death for NTM-PD was 3.1 (95% CI 2.7–3.5; P < 0.001) compared to controls, persisting after adjusting for Charlson Comorbidity Index with an adjusted HR of 1.9 (95% CI 1.63–2.22; P < 0.001). Median age at death was 72 years (IQR 58–86) for NTM-PD patients and 81 years (IQR 69–93) for controls. Deaths due to respiratory diseases were more frequent in NTM-PD patients (45.2%) than in controls (11.6%). Mycobacterial infection directly caused death in 5.8% of NTM-PD patients.</sec><sec><title>CONCLUSION</title>NTM-PD is associated with significantly higher all-cause mortality than controls, particularly in the initial years following diagnosis. These findings highlight the need for increased attention to NTM-PD and related respiratory conditions.</sec>