Chest
Volume 135, Issue 4, April 2009, Pages 1045-1049
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Clinical Commentary
International Trends in Asthma Mortality Rates in the 5- to 34-Year Age Group: A Call for Closer Surveillance

https://doi.org/10.1378/chest.08-2082Get rights and content

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Materials and Methods

To be included in the analysis, countries had to have data available prior to 1980 to ensure that long-term trends in mortality could be determined. In accordance with standard practice, asthma mortality rates have been confined to the 5- to 34-year age group because the correct assignment of asthma mortality is firmly established in this group.14 Although most deaths occur in the older age group, the accuracy of asthma as the cause of death progressively declines with increasing age because of

Results

Figure 1 shows asthma mortality rates for the 20 countries included in the analysis and the smoothed fit with 90% confidence intervals. The data set of the asthma mortality rates for the individual countries per year is shown in Table 1. There was a mean 53% increase in asthma mortality rates from 0.55 per 100,000 in 1960 and 1961 to a peak of 0.84 per 100,000 in 1966 and 1967 (see Table E1 in online supplementary material). This trend was followed by a progressive decline to a nadir of 0.45

Discussion

Death from asthma is a complex phenomenon, and many factors relevant to the cause of asthma mortality have changed in different degrees in different countries during the period studied. Despite this complexity, it is possible to propose a unifying hypothesis to explain these international time trends, namely that they predominantly relate to changes in drug treatment.

It is well recognized that epidemics of asthma mortality occurred in at least six countries in the 1960s due to the widespread

References (26)

  • N Pearce et al.

    Epidemiology of asthma mortality

  • W Castle et al.

    Serevent nationwide surveillance study: comparison of salmeterol with salbutamol in asthmatic patients who require regular bronchodilator treatment

    BMJ

    (1993)
  • FD Martinez

    Safety of long-acting β-agonists: an urgent need to clear the air

    N Engl J Med

    (2005)
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    Dr. Beasley has been a member of the GlaxoSmithKline and Novartis International Advisory Boards and has received research funding from GlaxoSmithKline, Novartis, and MedSafe (New Zealand government). No conflict of interest exists for the other authors.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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