Nontuberculous Mycobacteria Pulmonary Disease Prevalence, New York City, 2012 to 2020

Nontuberculous mycobacteria pulmonary disease (NTM PD) has been increasing in the United States, and New York City is an important hotspot, with a high burden of disease.

We assessed how neighborhood-level risk factors influenced NTM PD prevalence in New York City.

We used outpatient claims data from hospitals participating in the Patient-Centered Outcomes Research Institute network, compiled by the INSIGHT Clinical Research Network at Weill Cornell Medicine. NTM PD period prevalence (referred to here as 'prevalence') was estimated by New York City neighborhood for the study period 2012 through 2022. A case was defined as someone with at least one claim for NTM PD. De-identified NTM PD case data and demographic data were analyzed by neighborhood of residence at diagnosis. Using prevalence estimates, we detected high- and low-prevalence regions within New York City and associated these estimates with demographic, clinical, socioeconomic, and environmental neighborhood-level factors using Poisson regression and backward elimination of covariates.

Overall, 6,169 NTM PD cases were identified among persons receiving care across 17 private New York City hospitals. The mean age was 67.5 years, 68.7% were female, and 57.3% were White. Over the study period, NTM PD prevalence increased throughout New York City, and median year built of housing units, median income, and median age of residents were significant neighborhood-level risk factors. The highest prevalence neighborhoods were in Manhattan, while the lowest prevalence neighborhoods were in Brooklyn and Staten Island.

Our findings indicate that neighborhood-level access to care may explain the heterogeneity in NTM PD prevalence among New York City neighborhoods, as higher income, newer neighborhoods exhibited the highest NTM PD prevalences. Future studies should examine the extent of undetected NTM PD in New York City, particularly in low-income areas.