Epidemiology and Outcomes of Bronchiectasis in Alberta, Canada: A 15-Year Population-Based Study.

Rationale

Bronchiectasis is a chronic, progressive airway disease with rising global prevalence. However, no population-based epidemiologic study of adult bronchiectasis has been published from Canada, leaving the national burden, outcomes, and costs undefined.

Objectives

To determine the incidence, prevalence, mortality, health care utilization, and direct health care costs of bronchiectasis among adults in Alberta, overall and by airway disease phenotype.

Methods

We conducted a population-based retrospective cohort study (2010-2025) using linked Alberta provincial administrative health datasets. Adults (≥18 years) with bronchiectasis were identified using validated ICD-9/10 codes (ICD-10-CA J47; ICD-9 494), excluding cystic fibrosis. Patients were stratified by co-existing COPD or asthma. We estimated incidence, prevalence, health-care utilization, mortality, and direct health-care costs overall and by phenotype.

Results

We identified 12,169 adults with bronchiectasis (median age 65 years; 56% female). Prevalence increased to 311.6 per 100,000 adults in 2024, more than double that in 2010, while annual incidence remained stable at 25.1 (95% CI 24.4-25.7) per 100,000 adults. After age- and sex-standardization to the 2021 Canadian reference population, the standardized average annual incidence was 29.6 and the standardized 2024 prevalence was 433.2 (95% CI 426.3-440.2) per 100,000 adults. Bronchiectasis with comorbid COPD (27%) had the most severe outcomes, including high mortality (55% during follow-up; 17% within one year), the highest hospitalization rate (0.62 per person-year), and the greatest lifetime health-care costs (mean ∼$88,400 CAD). Bronchiectasis with comorbid asthma (13%) occurred in younger, predominantly female patients and was marked by frequent exacerbations (44%) but lower mortality (16%). Overall, patients experienced 0.42 hospital admissions per person-year and mean 5-year direct health-care costs exceeded $36,000 CAD per patient.

Conclusions

In this first Canadian population-based study of adult bronchiectasis, prevalence more than doubled over 15 years despite stable incidence, indicating a growing chronic respiratory disease burden. Bronchiectasis was associated with substantial mortality, acute care use and direct health-care costs, with especially poor outcomes among those with COPD overlap. These findings provide foundational Canadian data to inform disease recognition with phenotype-specific management and future health-system planning.