Mortality from asthma, 1979–1984

doi:10.1016/0091-6749(88)90069-3

Journal of Allergy and Clinical Immunology

Volume 82, Issue 5, Part 1, November 1988, Pages 705-717

https://doi.org/10.1016/0091-6749(88)90069-3 Get rights and content

Abstract

Review of data from the National Center for Health Statistics to characterize deaths from asthma disclosed increases in rates of death from 1.2 per 100,000 in 1979 to 1.5 in 1983 and 1984. For black subjects, rates of death from asthma increased from 1.8 in 1979 to 2.5 in 1984; for white subjects, from 1.1 in 1979 to 1.4 in 1984. Age-adjusted rates of death from asthma increased from 1.9 in 1979 to 2.8 in 1983 and 2.6 in 1984 for black subjects, and from 0.8 to 1979 to 1.0 in 1984 for white subjects. Rates for other minority groups have been lower than rates for white subjects. A modest increase in prevalence of asthma among black subjects is insufficient to account for their much higher rate of death from asthma. Increases in rates of death have occurred in both metropolitan and nonmetropolitan areas in all regions of the country and in all but a few states. At least half the deaths from asthma have occurred at hospitals: this proportion did not change from 1979 to 1984. Increases in deaths from asthma have occurred in several other countries as well. Other reviews of deaths from asthma have implicated undertreatment and delays in treatment with bronchodilators and adrenal corticosteroids as factors contributing to death. High rates of death among black subjects suggest underutilization or lack of accessibility of health care. The large proportion of deaths that have occurred at hospitals suggests delays or other inadequacies of treatment at hospitals.

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In the middle to late twentieth century, asthma therapy was not providing satisfactory control of the disease. Physician visits, self-reported reactive airway disease prevalence, and deaths due to asthma increased between 1960 and 1990.1–4 Even more troubling was that a percentage of the deaths were attributed to the bronchodilator therapy, specifically exacerbations of disease related to long-acting beta2-agonist (LABA) use.
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This 25-year prospective study of a large cohort of adults with well-characterized asthma showed an excess mortality compared with matched control subjects, to a large extent explained by death from obstructive lung disease.
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Asthma mortality has stabilized since 1988 and decreased since 1998. Improved management and recent decreases in prevalence are the most likely explanations for these recent trends.
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Hubo 716 fallecimientos por asma (tasa global de 3,82/100.000 habitantes; 3,3 en los varones y 4,33 en las mujeres). Casi dos tercios de los fallecimientos se produjeron en personas mayores de 65 años. La mortalidad se ha mantenido estable en todo el período, excepto en el grupo mayor de 65 años, en el que se detecta una tendencia a su disminución (β = −0,63; p = 0,037). Para el grupo de 5-34 años la tasa oscila entre 0,1 y 0,6/100.000 habitantes. El número de fallecimientos fue mayor en invierno en los mayores de 65 años (31,7%; intervalo de confianza del 95%, 27,8-35,7). El 56,2% de los fallecimientos suceden en el domicilio; las muertes en el hospital son más frecuentes entre mujeres (p<0,001) y en menores de 65 años, y su tendencia es creciente (p = 0,004)
La mortalidad por asma en la ciudad de Barcelona es estable en el período de estudio y presenta una tasa para el grupo de 5-34 años más alta que en España y ligeramente mayores que las de los países de nuestro entorno
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Asthma mortality in the city of Barcelona was stable during the period studied. Its rate for the 5-34 year-old age group was higher than for Spain and slightly greater than in similar nearby countries
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Objective.—To examine racial and income disparities in asthma prevalence in US children, and disparities in morbidity and ambulatory health care use among children with asthma.
Methods.—Using 1993–1996 National Health Interview Survey data, we measured asthma prevalence and morbidity in children aged 3 to 17 years (N = 14 211) stratifying by race and poverty status. Measures of morbidity included asthma-related activity limitation and number of bed days. We used the ratio of asthma-related doctor contacts to number of bed days in the past 2 weeks to measure health care use adjusted for severity of illness.
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Original articleMortality from asthma, 1979–1984

Abstract

Br J Dis Chest

J Allergy Clin Immunol

Chest

Vital Statistics of the United States

Estimates of selected comparability ratios based on dual coding of 1976 death certificates by the eighth and ninth revisions of the International Classification of Diseases

Increases in deaths from asthma

Ann Allergy

Effects of treatment on mortality from asthma

Ann Allergy