Changing patterns of asthma mortality: identifying target populations at high risk

Article Abstract:

Correct analysis of trends in diseases and mortality requires careful work. Sometimes, the apparent increase in a disease might reflect improvements in its recognition and diagnosis, rather than a real increase in incidence. However, this does not appear to be the case for the increase in deaths due to asthma, which occurred during the 1980s. Almost 10 million Americans are affected by asthma; children, blacks, and the poor are disproportionately affected. (The rate of asthma among blacks is twice that of whites.) An analysis of the US Vital Records from 1968 through 1987 revealed a 7.8 percent annual decline in asthma-related mortality in children and young adults during the 1970s. This decline was more rapid among women and nonwhites. However, the 1980s witnessed a reversal of this trend when asthma deaths increased at a rate of 6.2 percent per year. Children seemed to suffer the most; the mortality rate for those under 15 years of age rose more rapidly than for patients between 15 and 34. The increased mortality rates seem to be similar for whites and nonwhites. However, the distribution of the increase in mortality is not geographically uniform. Much of the nation's asthma mortality can be accounted for by increases in New York City and Cook County, Illinois (the Chicago area). The mortality rate for asthma in New York City was 10.1 per million population between 1982 and 1985, almost three times that of the nation as a whole. Only mortality data was included in this study; it is not known if other health problems related to asthma have shown a similar increase over the past decade. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Changing patterns of asthma hospitalization among children: 1979 to 1987

Article Abstract:

The National Hospital Discharge Survey has revealed a disturbing increase in the number of children hospitalized for asthma. During the period from 1979 to 1987, asthma-related hospitalizations for children under 17 years of age rose an average of 4.5 percent per year. The hospitalization rate was highest for younger children; an annual increase of 5.0 percent was observed for children 4 years and under, in contrast with the 2.9 percent annual rise for those from 5 to 17 years. Blacks suffered an increase 1.8 times that of whites. The reason for the increase in asthma-related hospitalizations is not known. It seems that it is not due to a greater likelihood to diagnosing asthma, rather than bronchitis. If this were the case, the rise in asthma hospitalizations should be accompanied by a reduction in the hospitalizations for bronchitis. This was not the case; hospitalizations due to bronchitis have not declined. Some of the increased hospitalization rate may be due, however, to an increased recognition among physicians of the value of treating younger children with asthma. It is also possible that environmental pollutants may play a role. Although the total suspended particulates in the air has decreased over the last decade, there are no data specifically on particulates less than 10 microns in diameter, which are most significant for lower respiratory tract disease. It is not known whether similar increases in asthma are occurring in other nations, nor is it known what further health problems will ensue as this group of children grow older. (Consumer Summary produced by Reliance Medical Information, Inc.)

Children, Demographic aspects, Hospitalization, Pediatric respiratory diseases

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Reflections on the rise in asthma morbidity and mortality

Article Abstract:

Two articles in the October 3, 1990 issue of The Journal of the American Medical Association document the rise in illness and death due to asthma. Some of the increase may be due to the replacement of version eight with version nine of the International Classification for Diseases, which now recommends that asthmatic bronchitis be coded as asthma rather than bronchitis. Nevertheless, there is much reason to think that some of the observed rise represents a true increase in the prevalence of asthma. Although there are significant methodological differences, studies in other nations, such as England, France, Denmark, and Germany, also indicate an increase in asthma. Several nations even experienced epidemics of asthma in the 1960s and 1970s. At the height of a second epidemic in New Zealand, the mortality rate of asthma was 10 times that of the US. There is a significant predominance of asthma among blacks and the poor in the US; this suggests that access to medical care may be an important factor. The increase in morbidity and mortality from asthma underscores the necessity that the optimal treatment for asthma be identified. The long-term consequences of inhaled corticosteroids, widely used outside the US, is not yet established, and some recent concerns about the safety of beta-agonist bronchodilators, the popular treatment in the US, must be resolved. (Consumer Summary produced by Reliance Medical Information, Inc.)

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