Chest
Original Research: Chest InfectionsRisk of Mycobacterial Infections Associated With Rheumatoid Arthritis in Ontario, Canada
Section snippets
Study Population and Setting
We conducted a population-based cohort study using linked health administrative data and Public Health Ontario Laboratory data from Ontario. We included all people in Ontario's Registered Persons Database aged ≥ 15 years on January 1, 2001, and followed them until the earliest of emigration, death, or December 31, 2010. Ontario residents have universal public health insurance under the Ontario Health Insurance Plan (OHIP), the single payer for medically necessary services. We excluded people
Results
We identified 59,017 individuals with RA as of January 1, 2001, and 54,541 individuals who developed RA during the study period, for a total 113,558 individuals with RA. There were 9,760,075 individuals who never developed RA. Ontarians with RA were more frequently female, older, more likely to have comorbidities (except HIV), and more likely to die during the study period than those in the non-RA group (Table 1).
In the RA group, we identified 64 cases of TB and 298 cases of NTM disease. In the
Discussion
In this population-based study of almost 10 million people, including > 113,000 with RA, we found that the presence of RA was associated with an approximately twofold higher adjusted incidence of TB and NTM. Importantly, among people with RA, the incidence of NTM disease was approximately fivefold higher than that of TB. Also, NTM disease was associated with an increased risk of death in people with RA.
The association between RA and TB has been described previously. Most prior studies
Acknowledgments
Author contributions: T. K. M. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. S. K. B. served as principal author. S. K. B. and T. K. M. contributed to the concept and design of the study, drafting and revision of the manuscript, and approval of the final version of the manuscript; F. B. J., J. C. K., J. M. P., and C. B. contributed to the concept and design of the study, revision of the manuscript,
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2022, ChestCitation Excerpt :In vitro data have demonstrated that MABC remain viable in mildly acidic and neutral pH environments, permitting their survival in the stomach after ingestion of contaminated water before microaspiration into the lungs.52 A higher rate of NTM disease exists among patients with rheumatoid arthritis (RA) compared with patients without RA (adjusted hazard ratio, 2.07; 95% CI, 1.84-2.32), and a 1.81 times greater risk of death exists among patients with RA in whom NTM disease develops compared with patients with RA who do not have the infection.53 Immunosuppression for Sjögren’s syndrome during the first year of diagnosis has been associated with an increased risk of NTM infection.54
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Part of this article was presented in abstract form (Brode SK, Jamieson FB, Ng R, et al.Am J Respir Crit Care Med. 2013;187:A3793).
FUNDING/SUPPORT: The Grant-in-Aid Program of the Ontario Thoracic Society and Ontario Lung Association funded this research. This research was also supported by the Institute for Clinical Evaluative Sciences, a nonprofit research institute funded by the Ontario Ministry of Health and Long-Term Care.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.