Temporal Trends and Disparities in Nontuberculous Mycobacterial Mortality Among Older Adults in the United States: A CDC WONDER Analysis

Introduction Nontuberculous mycobacteria (NTM) are increasingly recognized as significant pathogens, particularly in older and immunocompromised individuals, yet national data on NTM-associated mortality trends are limited and rely on older cohorts. Materials and Methods This cross-sectional study used CDC WONDER data (1999–2023) to assess NTM-related (ICD-10: A31) mortality trends in U.S. adults aged ≥ 45. Trends were stratified by gender, age, race, urbanization status, region, state, and place of death. Age-adjusted and crude mortality rates (AAMRs, CMRs) were calculated per million population. Trends were analyzed using Joinpoint regression to estimate annual and average annual percent changes (APCs, AAPCs). Results NTM-related mortality increased significantly from 1999 to 2023, with AAMR rising from 5.1 to 7.0 per million (AAPC = 1.38%*, 95% CI: 0.77–1.99). Of the 15,626 deaths, females accounted for 51.7%. However, males had higher AAMRs throughout. CMRs greatly increased across age groups, with the ≥ 85 cohort demonstrating the highest burden and rise in mortality (AAPC = 2.66%*, 95% CI: 2.03–3.49). White and Hispanic groups both demonstrated significantly rising AAMRs over time, with Black adults being the only group demonstrating the reverse trend (AAPC = − 1.40%*, 95% CI: − 2.44 to − 0.14). All regions except the West showed rising AAMRs, led consistently by the South, which increased from 6.2 to 8.6 (AAPC = 1.32%*, 95% CI: 0.69–1.85). Hawaii (12.2), South Carolina (9.8), and Vermont (9.0) recorded the highest AAMRs. Urban areas consistently exhibited higher AAMRs than rural ones. Conclusion NTM mortality is rising, with marked disparities by age, gender, race, and geography, underscoring the need for targeted public health interventions.