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.