Published ahead of print on May 16, 2007, doi:10.1164/rccm.200702-201OC Am. J. Respir. Crit. Care Med., Volume 176, Number 3, August 2007, 306-313 A more recent version of this article appeared on August 1, 2007
Submitted on February 6, 2007 Nontuberculous Mycobacterial Sensitization in the United States: National Trends Over Three DecadesKamran Khan1,1 Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Infectious Diseases, University of Toronto, St. Michael's Hospital, Centre for Research on Inner City Health, the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada, 2 Department of Medicine, Division of Infectious Diseases, University of Toronto, St. Michael's Hospital, Centre for Research on Inner City Health, the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada, 3 Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, University Health Network and Mount Sinai Hospital, Joint Division of Respirology, Toronto, ON, Canada * To whom correspondence should be addressed. E-mail: ted.marras{at}utoronto.ca.
Rationale: The prevalence of pulmonary nontuberculous mycobacteria (NTM) infections in the United States appears to be rising, but it is unclear if this is due to enhanced detection or actual increases in the burden of infection. Temporal changes in the epidemiology of Mycobacterium intracellulare sensitization may help explain recently observed trends in pulmonary NTM infections. Objectives: Describe the epidemiology of Mycobacterium intracellulare sensitization in the United States in 1971-1972 and 1999-2000. Methods: We studied nationally representative cohorts of the United States non-institutionalized civilian population participating in the 1971-1972 and 1999-2000 National Health and Nutrition Examination Surveys (NHANES). Participants were skin tested with Mycobacterium intracellulare antigen and sensitization prevalence was compared across NHANES surveys and between participant subgroups. Logistic regression was used to identify associations between participant characteristics, environmental factors, and NTM sensitization. Measurements and Main Results: The 1971-1972 and 1999-2000 NHANES cohorts included 1,490 and 7,384 individuals respectively. Between 1971-1972 and 1999-2000, the prevalence of Mycobacterium intracellulare sensitization increased from 11.2% (95% CI: 9.2-13.5%) to 16.6% (95% CI: 13.2-20.6%). On multivariate analysis of the 1999-2000 cohort, age, gender, race, birthplace, education, and occupation were strongly associated with Mycobacterium intracellulare sensitization. Conclusions: In 1999-2000, an estimated one in six persons in the United States demonstrated Mycobacterium intracellulare sensitization, up from one in nine persons in 1971-1972. The observed rising prevalence of sensitization is consistent with observed increases in the rates of pulmonary NTM infections in the United States. Key words: Mycobacterium infections, atypical, Skin testing, Epidemiology, Trends, Risk factors
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