Abstract Rationale Nontuberculous mycobacterial pulmonary disease (NTM-PD) has a rising incidence and prevalence globally. It is characterized by chronic productive cough, fatigue, and weight loss and disproportionately affects females and those over age 60 years. While it is known that sex plays a role in the clinical manifestations NTM-PD, it is unclear whether these sex differences extend to clinical outcomes. The impact of deployment-related airborne exposures and environments on NTM-PD has not been characterized. We compared NTM-PD prevalence and outcomes for Veterans across a national cohort. Methods We included Veterans engaged with primary care at any VA outpatient facility between fiscal years 16-23 who had ICD-10 codes for NTM (A31.0, A31.9). Demographics, smoking history, body mass index (BMI) at baseline, and medical comorbidities (2 years before initial diagnosis) were determined using established data sources. Self-identified race/ethnicity was categorized as white and non-white (combined black, Hispanic, Asian/Pacific Islander, Native American, mixed, unknown). Chronic severity of illness was measured using Charlson comorbidity Index (CCI) and categorized as 0-1, 2 or 3 or more. Our primary outcome was 1-year mortality by sex using logistic regression and adjusting for relevant confounders. Results Among n = 6456 (94% male) patients with NTM-PD diagnosis, men were older (mean age in years=70.5 (10.1) vs. 63.5 (12.2) than women. The majority of patients were white (70.1%), followed by Black (14.5%) and was overall similar by sex. Notably, comorbidities were more common among men (CCI 0-1 men=12.3% vs. women=22.7%; p 0.001); men were more likely to be comorbid with COPD (62% vs. 42%;p0.0001), alcohol use disorder (12% vs. 8%;p=0.03), cardiovascular disease (9% vs. 6%;p=0.04) and cancer (23% vs. 11%;p0.0001). Regarding clinical outcomes, men were significantly more likely to die at 1 year (17.3% vs 5.6%, p 0.001). In adjusted models stratified by sex, increasing comorbidity and age were associated with 1-year mortality in both group. Current smoking was only significant among men. (Table) In combined models, odds ration for 1-year mortality for women was 0.43 (95% CI 0.27-0.67). Conclusion Women were less likely to die within 1 year of diagnosis of pulmonary NTM disease after accounting for differences in age and comorbidity. This may be related to deployment-related differences in exposure. It is also like that residual confounding remains. We are also underpowered to address risk factors for mortality among women with NTM-PD. Further evaluation will be needed to evaluate factors that influence differences in timing of diagnosis between sexes. This abstract is funded by: N/A
Whitehead et al. (Fri,) studied this question.