Trends In Asthma Mortality Research Articles

Geographic variations in asthma mortality in Erie and Niagara counties, western New York, 1991-1996.

Asthma is one of the most common chronic respiratory diseases in the United States.1 More than 5000 persons died from asthma in 1995, and the trends in asthma mortality have been increasing in the United States over the past 2 decades.2 This investigation focused on Erie and Niagara counties in western New York. These counties have a combined population of 1.2 million and, together, are classified as a metropolitan area. Asthma mortality data for 1991 to 1996 were obtained from the New York State Bureau of Biometrics. Asthma mortality was determined from death certificate information. SPSS (SPSS, Inc, Chicago, Ill) was used in conducting statistical analyses. All population rates were calculated per 100 000 persons. Between 1991 and 1996, 158 asthma deaths were recorded in western New York. Eighty percent of these deaths occurred in Erie and Niagara counties. Average ageadjusted annual mortality rates were 1.61 for Erie County and 1.53 for Niagara County. In comparison, New York State had an average annual rate of 2.48 asthma deaths per 100 000 population. The majority of deaths (58%) during 1991 to 1996 occurred among individuals 65 years or older. The highest mortality rate for the period was 2.49 (95% confidence interval [CI] = 1.60, 3.38) in 1995; this rate decreased to 1.90 (95% CI = 1.12, 2.68) in 1996. Women had higher asthma mortality rates than men in Erie and Niagara counties (see Table 1 ▶). TABLE 1— Deaths From Asthma in Erie and Niagara Counties, by Age Group and Sex, 1991–1996 The city of Niagara Falls had an average annual asthma mortality rate of 2.96, almost 3 times that of the remainder of Niagara County (see Table 2 ▶). The city of Lockport had an annual mortality rate of 3.05, more than that of the rest of Erie County (1.09 per 100 000). Two zip codes in Buffalo's east side (14211 and 14215) accounted for 25% of the mortality from 1991 to 1996. TABLE 2— Deaths From Asthma, by Area: Western New York, 1991–1996 As a region, western New York had mortality rates lower than those in most of New York State. However, regional grouping masks areas of high risk for mortality due to asthma. Mortality was greatest in the 2 most populous counties (i.e., Erie and Niagara) and rare in rural counties of western New York. In Erie and Niagara counties, mortality was greater in urban areas than in suburban or rural areas. Buffalo, the most urbanized area in the 2 counties, had the highest annual mortality rate, comparable to that of New York City. Buffalo accounts for 20% of western New York's population but was responsible for 50% of asthma mortality in the region during the study period. The 2 zip codes with the highest asthma mortality rates in Buffalo comprise areas with large African American populations.3 Many US cities have large minority populations living in poverty, among whom the prevalence and severity of asthma are high.4–6 Given the reversibility of asthma and the availability of effective treatment strategies, deaths due to asthma are avoidable. The present report provides a basis for targeting interventions and evaluating their effectiveness.

Trends in asthma mortality in Italy and Spain, 1980-1996.

Asthma is a major public health problem, with variable trends in several countries. We analysed mortality trends from asthma in Italy and Spain between 1980 and 1996. Overall asthma-related mortality at all ages increased between 1980 and 1987 in both sexes in Italy, from 16.6 in 1980-1981 to 29.0 in 1986-1987 per million males, and from 8.0 in 1980-1981 to 13.8 in 1986-1987 per million females, but decreased thereafter to reach 14.6 per million in males and 8.7 in females in 1996. The downward trends after 1987 were consistent in middle age and elderly population, but asthma mortality tended to rise in children and young adults over the last few years. In Spain, overall age-standardized mortality rates from asthma declined in men from 37.8 in 1980-1981 to 10.1 in 1996, and from 19.5 in 1980-1981 to 13.2 per million females in 1996. In women, the fall in mortality rates was smaller, and overall mortality was higher than in males since early 1990s. Trends of asthma mortality in Italy and Spain were favourable over the last decade.

Decreases in asthma mortality in the United States

Rates of death from asthma in the United States increased from 1978 until 1988 and have tended to stabilize since then. To identify and evaluate recent trends in asthma mortality in the United States. Graphing and tabulation of data from the National Center for Health Statistics identifying asthma (ICD 493) as the underlying cause of death in the 50 United States and the District of Columbia with rates of death from asthma by age, race, and sex and age-adjusted rates of death by race. Rates of death from asthma in the United States increased from 0.8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989 and 2.1 in 1994 through 1996 but decreased to 2.0 in 1997. Rates decreased for black females and males and for white females in 1997. Age-adjusted rates of death from asthma decreased in 1997 for both blacks and whites. Deaths from asthma in children less than 15 years of age decreased from 191 in 1996 to 154 in 1997, the greatest decrease in any single year since 1971. Decreases in deaths from asthma in the United States in 1997 have followed stabilization of asthma mortality rates since 1988, although changes in a single year cannot establish a trend. Improved management is the most likely explanation of reversal of previous increases in asthma mortality.

Trends in asthma mortality in young people in southern Brazil.

Mortality from asthma increased and is now declining in some countries, but little is known about these trends in South America. We aimed to assess trends in mortality from asthma in southern Brazil in children and young adults. Death certificates of 425 people in the state of Rio Grande do Sul aged between 5 and 39 years in whom asthma was reported to be the underlying cause of death during the period 1970 to 1992 were reviewed. Population data were available in 10-year age groups. Testing for trends in mortality rates was conducted using linear and log-linear regression procedures. Asthma mortality rates in the age groups 5 to 19 and 20 to 39 years ranged between 0.04 and 0.39/100,000 and 0.28 to 0.75/100,000, respectively, and were nonuniformly distributed over the study period. The mean annual increase in rate in 5- to 19-year olds was +0.01 (95% CI 0.003 to 0.016), an average annual percentage increase of +6.8% (95% CI 3% to 11%), with a total increase of 352% between 1970 and 1992. This increase was not due to a shift in labeling from bronchitis to asthma. In the 20 to 39-year age group, asthma and bronchitis mortality rates showed no trend to increase or decrease. Asthma mortality in southern Brazil is low, but rose significantly between 1970 and 1992 in the 5 to 19-year age group. This trend differs from that found in other states of Brazil and several other Latin American countries. Reasons for this difference remain unclear.

Asthma in the elderly: underperceived, underdiagnosed and undertreated; a community survey

Bronchial asthma is now increasingly recognized in the elderly and is associated with significant morbidity and mortality. The aims of this study were two-fold: first, to assess the prevalence and, second, to evaluate diagnostic awareness, therapeutic management and patient perception of bronchial asthma among elderly patients in the community. From the age-sex register of an urban general practice in NE England, 2004 patients aged >65 years were eligible for inclusion. Response to an initial screening questionnaire on respiratory symptomatology was 68% ( n = 1362). Of these, 869 patients had respiratory symptoms: 390 voluntarily agreed to be evaluated further including assessment of airway physiology. In this group 369 390 had obstructive spirometry and, of these, 95 patients fulfilled clinical and physiological criteria of bronchial asthma. Prevalence of asthma within this age cohort was minimally and rather crudely assigned at 4.5% ( 95 2004 ). Among the 95 patients so-defined patients with asthma [age 70 ± 8 years (mean ± sd), FEV 1 = 0·96 ± 0.41, 33 male, 75 life-long non-smokers], subjective awareness, perception and attribution of pulmonary symptoms were poor. Further, despite tangible evidence of reversible and significant airflow limitation, only 21 were receiving inhaled glucocorticoid therapy (median daily dose 400 μg). Asthma in the elderly remains poorly perceived, poorly recognized and suboptimally treated. These findings are particularly apposite in the light of current epidemiological trends in asthma mortality and morbidity in elderly age cohorts.

Age specific trends in asthma mortality in England and Wales, 1983-95: results of an observational study

Objective: To determine trends in asthma mortality by age group in England and Wales during 1983-95.Design: Observational study.Setting: England and Wales.Subjects: All deaths classified as having an underlying cause of...

Stabilization of asthma mortality.

Rates of death from asthma in the United States have increased since 1978. To identify and evaluate recent trends in asthma mortality. Analysis of data from the National Center for Health Statistics identifying asthma (ICD 493) as the underlying cause of death in the 50 United States and the District of Columbia with rates of death from asthma by age, race, and sex and age-adjusted rates of death by race. The Bureau of the Census provided population data by age, race, and sex that permitted calculation of rates of death at 5 through 34 years of age. The Departments of Health of Australia, Canada, Great Britain, and New Zealand provided numbers of deaths from asthma and population data from which we have calculated rates of death. Rates of death from asthma in the United States increased from .8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989 and have been 1.9 or 2.0 since then until an increase to 2.1 in 1994. A significant difference in regression over groups indicates a difference in average rates between 1979 through 1987 compared with 1988 through 1994. Rates of death from asthma have been much higher for white females than white males with an increasing disparity. Rates of death from asthma at 5 through 34 years of age have been much greater in blacks than whites with no significant change in rates across time from 1980 through 1994. Age-adjusted rates for blacks over all ages increased from 1.5 in 1977 and 1978 to 3.5 in 1988 with rates no higher than that until an increase to 3.7 in 1994. Age-adjusted rates for whites increased from .5 in 1977 to 1.2 by 1989 with none higher than that since then through 1994. Comparison of slopes indicates a significantly greater increase for blacks than whites (F = 68.296, P < .0001). Equality of slopes tests indicate significantly greater age-adjusted rates of increase for each race separately for 1979 through 1987 compared with 1988 through 1994. Since 1988 rates of death from asthma in the United States for most ages have stabilized at rates more than 50% higher than those of 1979, but there has been only a suggestion of stabilization of rates at 5 through 34 years of age, ages at which certification of death as due to asthma is most accurate. Rates of death have been much higher for blacks than whites, and among whites rates have increased more for females than males. These differences might be due to difference in prevalence or severity of differences in accuracy of diagnosis. Improvements in management would reduce asthma mortality.

International trends in asthma mortality.

International trends in asthma mortality.

Rising asthma mortality in young males in Hong Kong, 1976–85

The trend in asthma mortality in Hong Kong was estimated from published statistics for the years 1976-85. To avoid coding errors in death certifications, only asthma deaths in the age group 5-34 years were analysed. Mortality rose annually by an average of 10.5% in male (P less than 0.02), but not female asthmatics. Such an increase was not due to a change in coding as a result of the revision of the International Classification of Diseases in 1979, or an exchange of diagnostic labelling from other respiratory diseases. The exact causes for the increase in asthma mortality have yet to be determined.

Trends in asthma mortality in Australia, 1911‐1986

Medical Journal of AustraliaVolume 153, Issue 6 p. 366-367 Letters to the Editor Trends in asthma mortality in Australia, 1911-1986 Adrian Bauman MB BS, MPH, Adrian Bauman MB BS, MPH Medical Student Department of Public HealthSearch for more papers by this authorSimon Lee, Simon Lee The University of Sydney, NSW, 2006Search for more papers by this author Adrian Bauman MB BS, MPH, Adrian Bauman MB BS, MPH Medical Student Department of Public HealthSearch for more papers by this authorSimon Lee, Simon Lee The University of Sydney, NSW, 2006Search for more papers by this author First published: 01 September 1990 https://doi.org/10.5694/j.1326-5377.1990.tb136973.xCitations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume153, Issue6September 1990Pages 366-367 RelatedInformation

Trends in asthma mortality in New Zealand, 1908–1986

Trends in mortality from asthma in non-Maori New Zealanders aged 5 to 34 years were examined for the period 1908-1986. Two previously documented epidemics of death from asthma occurred in the 1960s and the late 1970s. These epidemics are most likely to have been due to changes in the management of asthma: the introduction of isoprenaline forte by metered dose inhaler in the 1960s and inhaled fenoterol in the 1970s. A previously unreported rise in mortality, which was more gradual in onset and less severe, occurred in the 1940s and 1950s; a similar pattern occurred in England and Wales during the same period. It is unlikely that this increase in mortality was solely due to changes in diagnostic fashion or disease coding. Possible explanations include changes in the management or prevalence of asthma, or in environmental factors. It is notable that mortality was below 0.5 per 100,000 person-years prior to 1940, but has subsequently increased considerably. Thus, while modern methods for treating asthma have improved the quality of life of many asthmatics, mortality has increased during the period of their introduction and use.

Recent Trends in Asthma Mortality, Morbidity, and Management in New Zealand

Trends in mortality and hospital admission rates, prevalence, and drug sales, relating to asthma in New Zealand since 1960 were examined. Two epidemics of asthma death among people in the age range of 15-64 years occurred during this period with peak mortality rates more than four times pre-epidemic rates. Death from asthma was nevertheless rare compared with hospital admissions which have increased 20-fold in children and three- to fivefold in adults between 1960 and 1985. Asthma drug sales have also risen dramatically, particularly in the late 1970s when it is likely that a major change in the drug management of asthma occurred. Changes in asthma prevalence and severity may account in part for the increasing hospital admissions rates. However, the lack of any clear relationship between hospital admissions and death rates and the abrupt time course of the mortality epidemics suggest that changes in the management rather than in the disease itself may be responsible for the increased number of asthma deaths.

International Trends in Asthma Mortality: 1970 to 1985

Recent international trends in asthma mortality among people aged five to 34 years were examined as a follow-up to an epidemic of asthma deaths in the late 1970s which appeared to be confined to New Zealand. Mortality rates were compared in 14 countries with suitable statistics; Australia, Canada, England and Wales, Finland, France, Japan, Israel, the Netherlands, New Zealand, Singapore, Sweden, Switzerland, the United States, and West Germany, for the period 1970 to 1984/5. In New Zealand, asthma mortality in this age group more than trebled from 1.3 per 100,000 in 1974 to 4.2 per 100,000 in 1979 and since then has declined substantially to 1.85 per 100,000 in 1985. Asthma death rates vary more than six-fold among the other countries examined, and although the New Zealand experience has not been seen to the same degree elsewhere, a gradual increase in reported asthma mortality has occurred since the mid to late 1970s in the majority of countries studied. The increase and subsequent decline in asthma mortality in New Zealand could not be explained by changes in diagnostic fashions or in the International Classification of Disease coding rules. Similarly, the US data do not suggest there is diagnostic transfer among diseases of airway obstruction. However, part of the differences in asthma mortality among the countries examined and the recent increases in asthma death rates, could be due to changing diagnostic fashions rather than true differences in mortality. International studies on the validity of asthma death statistics and on asthma prevalence are required to clarify these issues.

Asthma deaths in the United Kingdom.

Mortality due to asthma was recognised by Thomas Willis in 1671 though it was not until the early 1960s that an epidemic of death raised major concern in the United Kingdom. Initially over-treatment with beta agonist aerosols was blamed as the cause both here and in Australia and New Zealand. Further studies in London, Cardiff and Birmingham suggested this was not the case, rather than under diagnosis, under appreciation and under treatment were a more common cause of asthma mortality. The British Thoracic Society's confidential survey in 1979 confirmed these findings and further suggested that wrong certification was a potential source of inaccuracy in older age groups. More recently the New Zealand Asthma Task Force have reported the results of a two year national survey of deaths, revealing similar results to the UK studies, also finding little evidence of beta agonist over usage, little effect of nebulized drug administration and no significant theophylline drug over usage. An examination of trends in Asthma Mortality in the United Kingdom by Stewart and Nunn shows that the changes in the World Health Organisation I.C.D. coding of 1967 and 1978 had little overall effect on asthma death certification in the 15-44 year old age group. When this is taken into account they found that asthma mortality has declined from 1958 to 1982 in females but that there has been no change in males despite therapeutic advances over the period. Asthma mortality date derived since; however, does suggest a small but significant annual incremental rise in the 15 to 44 year age group.(ABSTRACT TRUNCATED AT 250 WORDS)

ASTHMA MORTALITY IN ENGLAND AND WALES: EVIDENCE FOR A FURTHER INCREASE, 1974-84

The trend in asthma mortality has been estimated from published statistics for the years 1974-84, with account being taken of changes due to the revision of the International Classification of Diseases in 1979. Mortality rose annually by an average of 4.7% in the 5-34 year age-group (p <0.05), and the increased mortality since 1974 probably accounted for 408 excess deaths in the 5-64 year age-group between 1975 and 1984. No satisfactory explanation for this rise in mortality is likely until there is adequate monitoring of the prevalence and severity of asthma.