Nontuberculous mycobacterial pulmonary disease risk in tuberculosis survivors: A nationwide Korean cohort study

OBJECTIVES: To evaluate the risk of incident non-tuberculous mycobacterial pulmonary disease (NTM-PD) following pulmonary tuberculosis (TB) in a nationwide longitudinal Korean cohort. METHODS: Using data from the Korean National Health Insurance Service and the Korean Disease Control and Prevention Agency (2013-2017), we identified 13,547 individuals with drug-susceptible pulmonary TB and 40,641 age- and sex-matched controls. Multivariable Cox models were used to evaluate the risk of NTM-PD. RESULTS: Over a median follow-up of 5.4 years (292,138 person-years), the incidence rate was 1.19 per 1000 person-years (PY) in the post-TB cohort and 0.10 per 1000 PY in controls (P < 0.01). Prior pulmonary TB was associated with a significantly higher risk of NTM-PD (adjusted hazard ratio [HR] 7.67; 95% CI, 4.60-12.76). Within the post-TB cohort, bronchiectasis increased the risk of NTM-PD (adjusted HR 3.66; 95% CI, 2.09-6.40), whereas female sex (adjusted HR 0.41; 95% CI, 0.18-0.91), overweight status (adjusted HR 0.27; 95% CI, 0.11-0.67), and light smoking (<20 pack-years; adjusted HR 0.11; 95% CI, 0.03-0.49) were negatively associated with NTM-PD risk. CONCLUSION: Individuals with prior pulmonary TB have a markedly elevated risk of NTM-PD. Targeted surveillance and early diagnostic strategies for NTM-PD in TB survivors may improve outcomes.