Temporal trends and recent disparities in nontuberculous mycobacterial mortality among older adults in the United States: A CDC WONDER analysis.

INTRODUCTION

Even though nontuberculous mycobacteria (NTM) are increasingly recognized as significant pathogens, particularly in older and immunocompromised individuals, nationwide data on NTM-associated mortality trends are limited.

MATERIALS AND

METHODS

The present cross-sectional study used CDC WONDER data (1999-2023) to assess NTM-related (ICD-10: A31) mortality trends adults in the U.S. aged ≥ 45. Trends were stratified by gender, age, race, urbanization status, region, state, and place of death. Age-adjusted and crude mortality rates (AAMRs, CMRs) were calculated per million population. Trends were analyzed using Joinpoint regression to estimate annual and average annual percentage changes (APCs, AAPCs).

RESULTS

NTM-related mortality increased significantly from 1999 to 2023, with AAMR rising from 5.1 to 7.0 per million (AAPC = 1.38%*, 95% CI: 0.77-1.99). Among the reported 15,626 deaths, females accounted for 51.7%. However, males had higher AAMRs throughout. CMRs markedly increased across age groups, with the ≥ 85 cohort displaying the highest burden and most pronounced rise in mortality (AAPC = 2.66%*, 95% CI: 2.03-3.49). White and Hispanic groups displayed significantly rising AAMRs over time, with Black adults being the only group evidencing the reverse trend (AAPC = -1.40%*, 95% CI: -2.44 to -0.14). All regions except for the West reported rising AAMRs, led consistently by the South, which increased from 6.2 to 8.6 (AAPC = 1.32%*, 95% CI: 0.69-1.85). Hawaii (12.2), South Carolina (9.8), and Vermont (9.0) recorded the highest AAMRs. Urban areas consistently exhibited higher AAMRs than rural areas.

CONCLUSION

NTM mortality is rising, with considerable demographic and geographic disparities, underscoring a need for targeted public health interventions.