Trends In Asthma Mortality Research Articles

Asthma Mortality Trends Across EU15+ Countries with a Focus on Age Disparities

There have been significant advancements in the management of asthma over the past decades. We assessed trends in asthma mortality between EU15+ countries and characterized differences in mortality by age strata.

Trends in Asthma Mortality in the United States: 1999 to 2015.

Trends in Asthma Mortality in the United States: 1999 to 2015.

Trends in Asthma Mortality in the United States: A Population-Based Study

Trends in Asthma Mortality in the United States: A Population-Based Study

Trends in international asthma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993–2012)

International time trends in asthma mortality have been strongly affected by changes in management and in particular drug treatments. However, little is known about how asthma mortality has changed over the past decade. In this study, we assessed these international trends. We collated age-standardised country-specific asthma mortality rates in the 5-34 year age group from the online WHO Mortality Database for 46 countries. To be included in the analysis, we specified that a country must have 10 years of complete data in the WHO Mortality Database between 1993 and 2012. In the absence of consistent and accurate asthma prevalence and prescribing data, we chose to use a locally weighted scatter plot smoother (LOESS) curve, weighted by the individual country population in the 5-34-year age group to show the global trends in asthma mortality rates with time. Of the 46 countries included in the analysis of asthma mortality, 36 were high-income countries, and 10 were middle-income countries. The LOESS estimate of the global asthma mortality rate was 0·44 deaths per 100 000 people (90% CI 0·39-0·48) in 1993 and 0·19 deaths per 100 000 people (0·18-0·21) in 2006. Despite apparent further reductions in some countries and regions of the world, there was no appreciable change in global asthma mortality rates from 2006 through to 2012, when the LOESS estimate was also 0·19 deaths per 100 000 people (0·16-0·21). The trend for reduction in global asthma mortality observed since the late 1980s might have stalled, with no appreciable difference in a smoothed LOESS curve of asthma mortality from 2006 to 2012. Although better implementation of established management strategies that have been shown to reduce mortality risk is needed, to achieve a further substantive reduction in global asthma mortality novel strategies will also be required. The Medical Research Institute of New Zealand, which is supported by Health Research Council of New Zealand Independent Research Organisation.

Trends in asthma mortality in the 0- to 4-year and 5- to 34-year age groups in Brazil.

ABSTRACTObjective: To provide an update on trends in asthma mortality in Brazil for two age groups: 0-4 years and 5-34 years.Methods: Data on mortality from asthma, as defined in the International Classification of Diseases, were obtained for the 1980-2014 period from the Mortality Database maintained by the Information Technology Department of the Brazilian Unified Health Care System. To analyze time trends in standardized asthma mortality rates, we conducted an ecological time-series study, using regression models for the 0- to 4-year and 5- to 34-year age groups.Results:There was a linear trend toward a decrease in asthma mortality in both age groups, whereas there was a third-order polynomial fit in the general population.Conclusions: Although asthma mortality showed a consistent, linear decrease in individuals ≤ 34 years of age, the rate of decline was greater in the 0- to 4-year age group. The 5- to 34-year group also showed a linear decline in mortality, and the rate of that decline increased after the year 2004, when treatment with inhaled corticosteroids became more widely available. The linear decrease in asthma mortality found in both age groups contrasts with the nonlinear trend observed in the general population of Brazil. The introduction of inhaled corticosteroid use through public policies to control asthma coincided with a significant decrease in asthma mortality rates in both subsets of individuals over 5 years of age. The causes of this decline in asthma-related mortality in younger age groups continue to constitute a matter of debate.

Population-based weight loss and gain do not explain trends in asthma mortality in Cuba: A prospective study from 1964 to 2014

BackgroundThe increase in prevalence of obesity is a possible risk factor for asthma in developed countries. As the people of Cuba experienced an acute population-based decrease in weight in the 1990s, we tested the hypothesis that national weight loss and subsequent weight gain was associated a reciprocal changes in asthma mortality. MethodsData were obtained on mortality rates from asthma and COPD in Cuba from 1964 to 2014, along with data on prevalence of obesity for this period. Joinpoint analysis was used to identify inflexion points in the data. ResultsAlthough the prevalence of obesity from 1990 to 1995 decreased from 14% to 7%, over the same time period the rate of asthma mortality increased from 4.5 deaths per 100,000 population to 5.4 deaths per 100,000 population. In 2010, the obesity prevalence subsequently increased to 15% in 2010, while the asthma mortality rate dropped to 2.3 deaths per 100,000 population. The optimal model for fit of asthma mortality over time gave an increasing linear association from 1964 to 1995 (95% confidence interval for inflexion point: 1993 to 1997), followed by a decrease in asthma mortality rates from 1995 to 1999 (95% confidence interval for inflexion point: 1997 to 2002). ConclusionsThese national data do not support the hypothesis that population-based changes in weight are associated with asthma mortality. Other possible explanations for the large decreases in asthma mortality rates include changes in pollution or better delivery of medical care over the same time period.

Trends in asthma mortality in Brazil in the 0-4 and 5-34-year age groups

Methods Data on asthma mortality were obtained from the Mortality Information System SIM/DATASUS (Departamento de Informatica do SUS – Brazilian Health System Database), using the International Classification of Diseases codes J45 and J46 for the period from 1980 to 2010. An ecological time-series study was conducted to analyze time trends in standardized mortality rates of asthma, using regression models for the 0-4 and 5-34year age groups.

Trends of Asthma Mortality in Galicia from 1993 to 2007

Introduction. In the past few years, deaths due to asthma appear to decrease at least in Western countries; but there are significant variations between populations. The aim of this study is to describe the trends in deaths due to asthma between 1993 and 2007 in our community and to analyze any factors associated with this. Methods. All cases, which had asthma as a cause of death, were included in the study. The mortality data were obtained from the official death certificate from the Deaths Register. Mortality relative risk, based on the calendar year, sociodemographic variables (age and gender), seasons, and days of the week, were estimated using a Poisson generalized linear model with a log-link. Results. In the 15 years of the study period, a total of 1180 people had died due to asthma, mainly in winter (34.5%), women (64.5%), and advanced age (65 years or above; 84.6%). A tendency of decreased mortality in all age groups was observed during the period of the study, which was significant in both the sexes in the 35- to 64-year-old age group, and in males above 65 years. Conclusion. Death due to asthma is changing favorably in our community, with a tendency to decrease in the past few years. Advanced age, being female, and the winter period are associated with a higher mortality rate due to asthma.

Temporal Trends of Asthma Mortality Rates in Brazil from 1980 to 2010

Objective. Mortality from asthma has varied among countries during the last several decades. This study aimed to identify temporal trends of asthma mortality in Brazil from 1980 to 2010. Method. We analyzed 6840 deaths of patients aged 5–34 years that occurred in Brazil with the underlying cause of asthma. We applied a log-linear model using Poisson regression to verify peaks and trends. We also calculated the point estimation and 95% confidence interval (CI 95%) of the annual percent change (APC) of the mortality rates, and the average annual percent change (AAPC) for 2001–2010. Results. A decline was observed from 1980 to 1992 [APC = −3.4 (−5.0 to −1.8)], followed by a nonsignificant rise until 1996 [APC = 6.8 (−1.4 to 15.6)], and a new downward trend from 1997 to 2010 [APC = −2.7 (−3.9 to −1.6)]. The APCs varied according to age strata: 5–14 years from 1980 to 2010 [−0.3 (−1.1 to 0.5)]; 15–24 years from 1980 to 1991 [−2.1 (−5.0 to 0.9)], from 1992 to 1996 [6.8 (−6.7 to 22.2)], and from 1997 to 2010 [−3.9 (−5.7 to −2.0)]; 24–25 years from 1980 to 1992 [−2.5 (−4.6 to −0.3)], from 1993 to 1995 [12.0 (−21.1 to 59.1)], and from 1996–2010 [−1.7 (−3.0 to −0.4)]. AAPC from 2001 to 2010 was −1.7 (−3.0 to −0.4); the decline for this period was significant for patients over 15 years old, women, and those living in the Southeast region. Conclusion. Asthma mortality rates in Brazil have been declining since the late 1990s.

Death rates for asthma in English populations 1979–2007: Comparison of underlying cause and all certified causes

To report on trends in mortality for asthma using all certified causes of death mentioned on death certificates (conventionally termed 'mentions'), not just the underlying cause. Retrospective analysis using death certificate information and population data. Analysis of mortality records in the Oxford region (mentions available from 1979 to 2007) and English national data (mentions available from 1995 to 2007). The data were considered in periods defined by different national rules for selecting underlying cause of death (1979-1983, 1984-1992, 1993-2000, 2001-2007), and were also analysed as single calendar years. In Oxford, underlying cause mortality rates per million population in the four periods were 25, 32, 22 and 15, respectively. Rates for mentions were 44, 47, 41 and 29, respectively. Rule changes exaggerated the increase in underlying cause mortality in 1984-1992 (when 67% of asthma deaths were coded as underlying cause). Conversely, the decrease in underlying cause mortality for asthma by 2001-2007 is less than it seems (because just under 50% of asthma deaths in 2001-2007 were coded as underlying cause). Comparisons of trends in asthma and chronic obstructive airways disease (COPD) for individuals aged ≥ 55 years showed a decrease for both asthma and COPD in men; in women, a decrease in asthma and an increase in COPD was seen from the early 1990s. Approximately half of all deaths certified for asthma are missed when asthma mortality is analysed using underlying cause alone. The long-term decreasing trend in asthma mortality is real, and is not attributable to a trend in transferring certification from underlying to contributing cause. Nonetheless, caution is needed when comparing asthma deaths using underlying cause alone across periods that include changes to rules for the selection of underlying cause.

Recent Trends in Asthma Mortality in Ohio and Cuyahoga County: African Americans and Residents of Poverty Areas Remain Disproportionately Burdened

Recent Trends in Asthma Mortality in Ohio and Cuyahoga County: African Americans and Residents of Poverty Areas Remain Disproportionately Burdened

International Trends in Asthma Mortality Rates in the 5- to 34-Year Age Group: A Call for Closer Surveillance

International time trends in asthma mortality have played an important sentinel role in the identification of two epidemics of asthma mortality in some countries in the 1960s and the 1970s and 1980s. Since then, little attention has been paid to the ongoing international time trends.Country-specific data on asthma mortality rates since 1960 in the 5- to 34-year-old age group were collated. To be included in the analysis, countries were required to have data available prior to 1980. A scatter plot smoothing technique was used to model the change in asthma mortality rates with time.Asthma mortality rates from 20 countries were included in the analysis. An increase in asthma mortality rates was found in the 1960s, with a mean increase of 53% from 0.55 per 100,000 in 1960 and 1961 to a peak of 0.84 in 1966 and 1967. This trend was followed by a progressive decline to a nadir of 0.45 per 100,000 in 1974 and 1975. A gradual increase was then found in asthma mortality rates to a peak of 0.62 per 100,000 in 1985 and 1986, with a mean increase of 38% during this period. Since the late 1980s, there has been a widespread and progressive reduction in mortality rates to a level of 0.23 per 100,000 in 2004 and 2005, with a mean reduction of 63% during this period.The widespread increase in asthma mortality in the 1980s and the subsequent, even greater reduction has largely gone unrecognized. We propose that awareness of such trends and their causes is important and that they are investigated contemporaneously.

Trends in Asthma Mortality in Spain from 1960 to 2005

Background and objective No data have been published on trends in asthma mortality in Spain between 1960 and 2005. The aim of this study was to trace these trends for both the general population and the 5- to 34-year age group in Spain. Material and methods The data on asthma mortality for the general population and by age and sex were obtained from the Spanish National Institute of Statistics and used to calculate the asthma mortality rates per 100 000 inhabitants. Results The overall asthma mortality rate per 100 000 inhabitants was 9.36 in 1960 and 2.22 in 2005, showing a reduction from 12.26 to 0.96 in males and from 6.58 to 3.44 in females. In the 5- to 34-year age group, the mortality rate for both sexes ranged from 0.4 to 0.1, showing great variability over time. Conclusions Asthma mortality decreased in the period analyzed, but less in women than in men. The trend and rates in Spain are similar to those of most countries for which data are available.

Evolución de la mortalidad por asma en España, 1960–2005

Background and ObjectiveNo data have been published on trends in asthma mortality in Spain between 1960 and 2005. The aim of this study was to trace these trends for both the general population and the 5- to 34-year age group in Spain. Material and MethodsThe data on asthma mortality for the general population and by age and sex were obtained from the Spanish National Institute of Statistics and used to calculate the asthma mortality rates per 100 000 inhabitants. ResultsThe overall asthma mortality rate per 100 000 inhabitants was 9.36 in 1960 and 2.22 in 2005, showing a reduction from 12.26 to 0.96 in males and from 6.58 to 3.44 in females. In the 5- to 34-year age group, the mortality rate for both sexes ranged from 0.4 to 0.1, showing great variability over time. ConclusionsAsthma mortality decreased in the period analyzed, but less in women than in men. The trend and rates in Spain are similar to those of most countries for which data are available.

Temporal Trends in Asthma Mortality over 30 Years

Background. Bronchial asthma is an important cause of morbidity and mortality worldwide. There is limited availability of updated information on asthma mortality trends. In this context, further investigation of asthma mortality trends is necessary. Objective. We aimed to assess trends in asthma mortality trends in the Autonomous Community of Andalusia (over 7 million inhabitants), Spain, during the period 1975–2005. Method. Official population estimates and data on asthma deaths were obtained from official authorities. Crude and age-adjusted death rates for different age and gender groups were calculated. Joinpoint regression analysis was used for trend analysis. Results. Age-adjusted death rates for asthma have fallen 2.9% for females and 7.7% for males from 1975 to 2005. This trend has not been constant but has varied during the study period. After a non-significant increase from 1975 to 1981 (4.5% for females and 3.8% for males), adjusted asthma mortality rates have been declining 3.7% for females and 9.6% for males (both p values < 0.05) since 1981. Age-group analysis revealed that the downturn in asthma mortality rates occurred in all age groups above 45 years for males and 35 years for females. Conclusions. During the last decades, significant variation in asthma mortality was found in Andalusia. This variation has not been constant during the study period. Currently, the decreasing trend initiated in 1981 continues.

International trends in asthma mortality.

Throughout the 20th century many different patterns of asthma mortality have been observed. Following relatively stable asthma mortality rates during the first half of this century, there has been a gradual increase in asthma mortality in many countries over the last 50 years. Although a number of possible explanations have been proposed to explain this trend-including increases in asthma prevalence, increases in exposure to factors that trigger asthma attacks and changes in asthma management-their relative contribution in different countries is uncertain. Another pattern is that of sudden marked increases in asthma mortality occurring in at least seven countries in the 1960s and in New Zealand in the 1970s. Available evidence indicates that the cause of these 'epidemics' was the use of high dose preparations of two specific beta-agonist drugs, namely isoprenaline forte and fenoterol. The most recent trend observed in a number of western countries during the last decade has been a gradual reduction in asthma mortality; this may relate to improvements in the management of asthma.

Asthma Mortality in Southern Brazil: Is There a Changing Trend?

Background. Mortality from asthma increased during the last decades but is now declining in some countries. Little is known about this trend in Brazil. Objective. The objective of the study was to determine the trends in asthma mortality in Southern Brazil. Methods. We reviewed death certificates of 566 people in the state of Rio Grande do Sul, Brazil, between 5 and 39 years of age in whom asthma was reported to be the underlying cause of death during the period of 1981-2003. Population data were available in 5-year age groups. Mortality rates were submitted to linear and quadratic regression procedures. Results. Among children and teenagers (5–19 years), there were 170 asthma deaths, ranging from 4 to 13 deaths each year with rates of 0.154/100,000 to 0.481/100,000. In young adults (20–39 years), 396 asthma deaths occurred, ranging from 9 to 32 each year, with rates from 0.276/100,000 to 1.034/100,000. There was an initial increase in rates, with later stabilization, and then the start of a decline beginning in the late 1990s and the early part of this decade. This trend occurred in both age subgroups examined but was more evident in males. Conclusions. Asthma mortality in southern Brazil remains low and appears to be decreasing after reaching a peak in the mid-1990s. The reason for these trends remains unknown.

Continuing decreases in asthma mortality in the United States

Rates of death from asthma in the United States increased after 1978 until 1988 and then tended to stabilize through 1997. To identify and evaluate subsequent trends in asthma mortality in the United States. Tabulation and graphing of data from the National Center for Health Statistics identifying asthma (International Classification of Diseases [ICD], Ninth Revision, code, 493; ICD-10 code, J45-J46) 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 have decreased to 1.6 in 2000, a decrease accounted for only partly by implementation in 1999 of the ICD-10. Rates have been higher for women than men but have decreased for both. Age-adjusted rates of death for asthma have been much higher for blacks than whites. 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.

Mortality from asthma in children and young adults in Louisiana

Asthma mortality rates have been increasing despite our improved understanding of the pathophysiology of asthma and advanced methods of treatment. Although there are many national studies of asthma mortality rates, few studies have concentrated on subnational regions such as individual states. We sought to determine the trends in asthma mortality in children and young adults during the last 15 years in Louisiana. Asthma mortality data were acquired from the Louisiana State Center for Health Statistics for the years 1983 through 1997. All asthma deaths coded International Classification of Disease, Ninth Revision 493 were included in the data set along with year, sex, and rate characteristics. State population estimates obtained from the United States Bureau of Census for three 5-year periods (1983 to 1987, 1988 to 1992, and 1993 to 1997) were used to calculate crude and adjusted mortality rates. These time periods were compared with one another and with the period 1983 to 1987, which was used as a baseline. For all residents, the mortality rate increased from 0.41 deaths per 100,000 persons during the 1983 to 1987 time period to 0.49 and 0.63 deaths per 100,000 persons during 1988 to 1992 and 1993 to 1997 time periods, respectively. Mortality rates have increased in both the white and non-white populations over the 15-year study period, with the most pronounced increases among the non-white population. Asthma mortality rates in Louisiana have increased, particularly among the non-white population, over the last 15 years, although the results are not statistically significant. When compared with other states, asthma mortality in Louisiana is lower than in the northeast and central north states.

Trends in Asthma Mortality in Japan

Asthma mortality has been increasing in many developed countries in recent years, so we have described the epidemiological features of asthma in Japan. Data on all certified asthma deaths from 1950 to 1997 were obtained from The National Vital Statistics, published annually by the Ministry of Health and Welfare. Trends in crude and age-adjusted asthma mortality rates, as well as age-specific mortality rates, were analyzed. Age and birth cohort effects on mortality rates were also examined using multiplicative models. Between 1950 and 1980, crude asthma mortality rates steadily decreased in both sexes and began to level off thereafter. Age-adjusted mortality rates have also decreased since 1950, and showed a persistent downward trend in both sexes even in recent years. Asthma mortality rates were higher in males than in females during the entire study period. When analysis was restricted to those aged 5 to 34 years, an upward trend since 1980 was observed. The multiplicative model showed a rapidly decreasing cohort effect on mortality among those born after 1860. However, the slope increased in the cohorts born after 1950 in both sexes. The age effect increased linearly with advancing age after 50 years in both sexes. Overall asthma mortality rates have been decreasing during the past five decades in Japan, but the mortality rate has increased among the 5–34-year-old age group since 1980. The high fatality rate stemming from the overuse of beta 2-agonists may account for the mortality increase.