Bronchiectasis Prevalence Rises in All Payers as Incidence Stays Flat

Annual prevalence of non–cystic fibrosis (CF) bronchiectasis among insured patients—commercial, Medicare, or Medicaid—rose from 2016 to 2024 while incidence remained relatively stable, leading researchers to suggest it may reflect case accumulation over time and survival among continuously enrolled beneficiaries.¹

Current population-representative data on non-CF bronchiectasis in the US remain limited, creating a need to measure prevalence, incidence, and exacerbation rates among insured individuals.¹ Between 2009 and 2013, US claims data showed an annual prevalence of 139 per 100,000 persons, with an incidence of 29 per 100,000. Bronchiectasis contributed to an annual health care burden of $14.68 billion in 2022, driven largely by hospitalizations among those with frequent respiratory exacerbations.¹ Prior research assessing health care use and spending among Medicare beneficiaries with non-CF bronchiectasis also found inpatient hospitalization to be the largest contributor to fee-for-service spending, followed by carrier/physician services and Part D outpatient pharmacy.²

Bronchiectasis Prevalence Rises Across Commercial, Medicare, and Medicaid Plans

Using data from the Merative MarketScan Research Databases—spanning January 1, 2015, to December 31, 2024—researchers assessed commercial insurance, Medicare supplemental, and Medicaid program beneficiary claims. Included patients were 18 years or older with 2 or more bronchiectasis claims, identified by ICD codes, more than 30 days apart.¹

Respiratory exacerbations, captured up to 12 months before the second qualifying claim and during follow-up, were defined as either outpatient initiation of a new qualifying systemic antibiotic regimen or an inpatient claim of pneumonia, lower respiratory infection, or bronchiectasis exacerbation.

Of approximately 122 million people in MarketScan's databases, 225,337 had 1 or more bronchiectasis claims, and 39.8% of those had 2 or more claims more than 30 days apart. After exclusions, 80,749 cases remained. Among these cases, more than 75% had a second claim within 1 year and more than 88% within 2 years. The cohort was 64.6% female with a mean (SD) age of 65.9 (14.6) years.

A pulmonologist-assigned bronchiectasis diagnosis was present in 56.8% of commercial and 55.9% of Medicare cases, yet only 11.6% of Medicaid cases. Between 2016 and 2024, average prevalence was highest among Medicare supplemental enrollees (685.6 per 100,000), followed by Medicaid (66.1) and commercial insurance (39.3); the combined commercial-Medicare estimate was 105.3 per 100,000. Although prevalence increased significantly over time across all 3 insurance types, the smallest gain was among commercial insurance and the largest in Medicaid. All payers showed a higher prevalence among women and a consistent increase with age.

In contrast, incidence remained relatively stable, averaging 12.6 per 100,000 in commercial, 196.5 in Medicare, and 19.0 in Medicaid; the combined commercial-Medicare estimate was 32.1 per 100,000. Annual percent changes (APCs) were small but significant (−0.7%, +1.5%, and +1.2%, respectively). However, all insurance groups experienced a temporary decline in incidence around 2020, followed by a rebound between 2021 and 2023, which was more pronounced in the Medicare group.

"The widening gap between prevalence and incidence suggests case accumulation over time and survival in this chronic, typically nonfatal condition. Heightened clinician awareness and incorporation of bronchiectasis into chronic airway management guidelines likely boost diagnosis," the study authors wrote. "Nonetheless, structural barriers within Medicaid, including lower specialist access and imaging utilization, may contribute to case underascertainment and lower apparent burden despite high risk-factor frequency."

Exacerbation Rates Decline, but Cohort Changes Explain Part of the Drop

Baseline-period frequent-exacerbator proportions were fairly similar between commercial and Medicare, at 26.5% and 25.1%, respectively, and 19.4% in Medicaid. The overall cohort rate during follow-up was 0.88 events per person-year (APC, −5.2%), with higher rates in the commercial and Medicare groups than in Medicaid. The authors said the decline partly reflects changes in cohort composition, as case ascertainment increasingly captured milder disease, along with pandemic-era reductions in respiratory infections. Among incident cases only, exacerbation rates fell 18.3% in commercial and 29.6% in Medicare but were essentially unchanged in Medicaid (+1.0%), and calendar trends were attenuated by 12.3% after standardizing for follow-up time. Any contribution from improved clinical management, they added, cannot be separated from this cohort shift.

Outpatient events accounted for approximately 87% of exacerbations overall (>84% in commercial and Medicare, ~65% in Medicaid) and mirrored overall temporal patterns. Severe exacerbations, defined as those managed with an inpatient admission or outpatient intravenous antibiotics, occurred at about twice the rate in Medicaid as in commercial and Medicare, whereas outpatient exacerbation rates were higher in commercial and Medicare. In the Medicaid group, severe exacerbations also declined faster than outpatient events (−9.0% vs −5.4% annually).

Chronic obstructive pulmonary disease (COPD) prevalence ranged from 21.4% in commercial insurance to 58.5% in Medicaid, with smoking history following a similar pattern. Interstitial lung disease (ILD) was most frequent among Medicare supplemental enrollees (6.2%).

Several baseline factors were associated with more frequent flares after diagnosis. In multivariable analyses, having 2 or more exacerbations at baseline was the factor most strongly associated with higher subsequent exacerbation rates (adjusted rate ratio [aRR], 1.96), followed by chronic Pseudomonas aeruginosa infection (aRR, 1.22), primary ciliary dyskinesia (aRR, 1.19), and primary immunodeficiency (aRR, 1.18). Three or more baseline pulmonologist visits were associated with lower rates (aRR, 0.79), although the authors cautioned that this association may be influenced by residual confounding.

Because the study relied on diagnosis codes, it captured only clinically recognized disease and likely underestimated bronchiectasis, particularly among those with limited health care access. Claims data may also miss exacerbations managed outside formal care, and commercial and Medicare supplemental estimates were weighted to reflect the US employer-sponsored insured population, whereas the Medicaid sample may not reflect the national Medicaid population.

These "findings underscore the need for integrated prevention, early intervention, and risk-stratified follow-up to improve outcomes in this heterogeneous population," the study authors concluded. "Expanded and equitable access to specialty care and guideline-supported therapies may represent opportunities to further reduce exacerbation burden."

References

1. Cristancho-Rojas CN, Henkle E, Fu R, Polgreen PM, Curtis JR, Winthrop KL. Bronchiectasis prevalence, incidence, and exacerbation rates among insured adults in the US: a descriptive analysis. Ann Am Thorac Soc. Published online October 5, 2026. doi:10.1093/annalsats/aaoag310

2. McCrear S. Non-CF bronchiectasis linked to high Medicare use and spending. AJMC. October 14, 2026. Accessed November 12, 2026. https://www.ajmc.com/view/non-cf-bronchiectasis-linked-to-high-medicare-use-and-spending