Incidence of Nontuberculous Mycobacterial Pulmonary Infection, by Ethnic Group, Hawaii, USA, 2005–2019

I n the United States, studies have indicated that risk for nontuberculous mycobacterial pulmonary disease (NTM-PD) differs by geographic location and ethnic group (1). Nontuberculous mycobacteria are environmental bacteria that are widespread in soil and water and can be acquired through the natural or built environment (2). Nationally, disease prevalence is highest in the southeastern United States and Hawaii (1,3), and disease is associated with selected environmental conditions (2), as well as with higher mycobacterial abundance in household plumbing (4). However, independent of geographic region, estimated prevalence is 2-fold higher among persons who self-identify as Asian/ Pacific Islander than among those who self-identify as White (1). The incidence and prevalence of NTM infection and disease are increasing in the United States (5), and testing and positivity rates are highest among persons who self-identify as Asian (6); prevalence is also increasing in Hawaii (