{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T09:19:14Z","timestamp":1783156754351,"version":"3.54.6"},"posted":{"date-parts":[[2026,7,1]]},"group-title":"Epidemiology","reference-count":42,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"crossref","award":["2027707"],"award-info":[{"award-number":["2027707"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Civilian Research and Development Foundation Global","award":["G-202401-71690"],"award-info":[{"award-number":["G-202401-71690"]}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"crossref","award":["JP23jm0210111"],"award-info":[{"award-number":["JP23jm0210111"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Science, Research and Innovation Fund via the Program Management Unit for Human Resources & Institutional Development, Research and Innovation","award":["B50G670096"],"award-info":[{"award-number":["B50G670096"]}]},{"name":"Intramural Research Program of the National Institutes of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>BACKGROUND<\/jats:title>\n                  <jats:p>Nontuberculous mycobacteria (NTM) are environmental organisms increasingly causing chronic respiratory infection. Although NTM pulmonary infection is rising globally, most studies are single-country. This study evaluated temporal trends in pulmonary NTM incidence across Queensland (Australia), Phnom Penh (Cambodia), Japan, Thailand, and the United States (US), and described regional species distribution.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Laboratory and insurance claims data were used. Incident infections were defined using region-specific criteria. For Queensland, Japan, and Thailand, data and denominators covered entire regions. US estimates included Medicare beneficiaries aged \u226565 years, and Cambodian incidence was estimated from Phnom Penh data and standardised nationally. Incidence rates per 100,000 population and incidence rate ratios (IRRs) were calculated overall and by sex. Age-stratified analyses and species distributions were summarised where data were available.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>\n                    Pulmonary NTM incidence increased in all regions and was highest in Japan (47.20\u201357.40 per 100,000) and lowest in Phnom Penh (0.23\u20130.38). Queensland showed the largest increase over 24 years (IRR 7.06, p&lt;0.0001). Female predominance occurred in high-income regions, whereas Thailand showed ~1.5-fold male predominance and Phnom Penh showed no sex predominance. Incidence was higher among individuals aged \u226560 years.\n                    <jats:italic>Mycobacterium avium<\/jats:italic>\n                    complex predominated in Japan and Queensland, and\n                    <jats:italic>M. abscessus<\/jats:italic>\n                    in Thailand and Phnom Penh.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Pulmonary NTM incidence increased in all regions, varying by demographic patterns and species distribution. Differences largely reflect under-ascertainment related to diagnostic capacity and tuberculosis-focused health systems rather than true infection burden. Strengthened surveillance and diagnostic capacity are needed to define the global burden of NTM pulmonary infection.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>KEY MESSAGES<\/jats:title>\n                  <jats:list list-type=\"bullet\">\n                    <jats:list-item>\n                      <jats:p>Pulmonary NTM incidence increased across all five study regions, however varied substantially by region, age, sex, and species.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>This study provides the first NTM incidence estimates from Thailand and Cambodia, where limited diagnostic capacity and tuberculosis-focused health systems influence observed incidence.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Combining laboratory and claims data across high- and middle-income regions provides robust, comparable estimates to inform NTM surveillance and public health planning.<\/jats:p>\n                    <\/jats:list-item>\n                  <\/jats:list>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.27.26356627","type":"posted-content","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T19:35:21Z","timestamp":1782934521000},"source":"Crossref","is-referenced-by-count":0,"title":["Incidence trends of nontuberculous mycobacterial pulmonary infections in Australia, Cambodia, Japan, Thailand, and the United States"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3694-7728","authenticated-orcid":false,"given":"Atha R.","family":"Pradana","sequence":"first","affiliation":[{"name":"Gallipoli Medical Research, Greenslopes Private Hospital, and Greenslopes Clinical Unit, The University of Queensland, Queensland, 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Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Maryland, United States"},{"name":"International Center for Excellence in Research Cambodia, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Matsumoto-Takahashi","sequence":"additional","affiliation":[{"name":"Graduate School of Public Health, St. Luke\u2019s International University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Goh","sequence":"additional","affiliation":[{"name":"Gallipoli Medical Research, Greenslopes Private Hospital, and Greenslopes Clinical Unit, The University of Queensland, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kan","family":"Khemnak","sequence":"additional","affiliation":[{"name":"Information and Communication 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