Asthma-related mortality in the United States, 1999 to 2015: A multiple causes of death analysis

Identification of regional and sex differences in asthma mortality trends in Spanish Autonomous Communities (1980-2022)

OBJECTIVE

Despite global declines in asthma mortality, regional variations and sex disparities persist. This study investigates asthma mortality trends in Spanish Autonomous Communities (ACs) from 1980 to 2022, analyzing data by sex.

METHODS

Data on asthma deaths and population were obtained from the National Institute of Statistics for the study period. Age-standardized mortality rates (ASMRs) were calculated, and joinpoint regression models were applied to identify trends.

RESULTS

Overall, 44,728 asthma deaths occurred, with a steeper decline observed in men (-3.5% per year) compared to women (-0.7% per year). The female-to-male mortality ratio climbed from 0.7 in 1980 to 5.4 in 2016. Both sexes exhibited a significant decrease in ASMRs, with a more substantial decline in males (-6.3%).While all ACs showed a significant decrease in male ASMRs, female trends varied, with significant decreases in 13 ACs and stable trends elsewhere. Joinpoint analysis revealed diverse regional patterns for both sexes, with some ACs experiencing steady declines and others exhibiting periods of slower decline or even stabilization.

CONCLUSION

This study identified concerning regional and sex disparities in Spanish ACs' asthma mortality (1980-2022). While male rates declined significantly across all regions, female rates showed variation, with even increases in some ACs. Targeted interventions addressing these disparities and their underlying causes (healthcare access, management practices, etc.) are crucial.

Trend analysis of asthma mortality and years of life lost from 2004 to 2019 in Southern Iran

Objective

Asthma is a globally important non-communicable disease with major public health consequences. The aim of this study was to determine the mortality rate and years of life lost (YLL) due to asthma in southern Iran.

Methods

All deaths due to asthma in Fars province from the electronic population-based death registration system (EDRS) were obtained. Crude mortality rate, age-standardized mortality rate, YLL and YLL rate data were calculated. The JoinPoint Regression method was used to examine the trend.

Results

During the 16-year study period (2004-2019), 1167 deaths due to asthma occurred in Fars province among which 54.7% (638 cases) were men and 29.6% (346 cases) were in the age group of 70-79 years. Crude mortality rate of asthma had decreased by 121% and 84% in males and females, respectively from 2004 to 2019. The total years of life lost due to asthma during the 16-year study period were 7697 (0.24 per 1000 people) in men, 6882 (0.22 per 1000 people) in women. According to the join point regression analysis, the 16-year trend of YLL rate due to premature mortality was decreasing: the annual percent change (APC) was -5.6% (95% CI -8.2 to -2.9, P = 0.001) for males, -4.4% (95% CI -7.3 to -1.4, P = 0.008) for females.

Conclusion

The trend of mortality and years of life lost due to asthma has decreased significantly during the years of study, although in some age groups, especially the age group of 45-59 years which has the highest number of years of life lost, this trend has been constant and unchanged. It is necessary to conduct other studies to investigate the possible reasons for this unchanged trend in vulnerable age groups.

Pulmonary specialist involvement in critical asthma in the pediatric intensive care unit: A retrospective review

INTRODUCTION

Asthma is one of the most common chronic diseases of childhood. There is a scarcity of published literature on critical asthma, considered acute asthma requiring pediatric intensive care unit (PICU) admission. The goal of this study was to describe the clinical care of children with critical asthma admitted to a single center PICU and to determine whether pulmonary medicine consultation during admission impacted outcomes.

METHODS

Retrospective chart review of known asthma patients aged 4-18 years admitted to a quaternary PICU between 01/2013 and 07/2019 for management of critical asthma.

RESULTS

A total of 179 patients were enrolled with median age of 8 years. Median hospital length of stay (LOS) was 3.2 days and PICU LOS was 1.5 days. A total of 80 (44.7%) patients had a pulmonary medicine consultation. In the pulmonary medicine consultation group versus the no-pulmonary medicine consultation group, there was a significant difference in hospital LOS (4.16 vs. 2.86 days, p value <.0001) and PICU LOS (2.00 vs. 1.00, p value <.0001), escalation of controller medication (66% vs. 21%, p value <.0001), scheduled outpatient pulmonology follow-up (87.5% vs. 45.4%, p value <.0001), and receiving ≥3 courses of systemic steroids in the 12 months after discharge (32.2% vs. 14.7%). There was no difference in attendance of scheduled follow up appointments or in having ≥3 emergency room visits or admissions in the 12 months after discharge.

CONCLUSION

Pulmonary medicine consultation during hospital admission may impact management of critical asthma by increasing escalation of controller medication and scheduled outpatient follow up.

Health Disparities in Environmental and Occupational Lung Disease

Pulmonary health disparities disproportionately impact disadvantaged and vulnerable populations. This article focuses on disparities in disease prevalence, morbidity, and mortality for asthma, chronic obstructive pulmonary disease, pneumoconiosis, and lung cancer. Disparities are categorized by race, age, sex, socioeconomic status, and geographic region. Each category highlights differences in risk factors for the development and severity of lung disease. Risk factors include social, behavioral, economic, and biologic determinants of health (occupational/environmental exposures, psychosocial stressors, smoking, health literacy, health care provider bias, and health care access). Many of these risk factors are complex and inter-related; strategies proposed to decrease disparities require multilevel approaches.

Developing a Standardized and Reusable Method to Link Distributed Health Plan Databases to the National Death Index: Methods Development Study Protocol

BACKGROUND

Certain medications may increase the risk of death or death from specific causes (eg, sudden cardiac death), but these risks may not be identified in premarket randomized trials. Having the capacity to examine death in postmarket safety surveillance activities is important to the US Food and Drug Administration's (FDA) mission to protect public health. Distributed networks of electronic health plan databases used by the FDA to conduct multicenter research or medical product safety surveillance studies often do not systematically include death or cause-of-death information.

OBJECTIVE

This study aims to develop reusable, generalizable methods for linking multiple health plan databases with the Centers for Disease Control and Prevention's National Death Index Plus (NDI+) data.

METHODS

We will develop efficient administrative workflows to facilitate multicenter institutional review board (IRB) review and approval within a distributed network of 6 health plans. The study will create a distributed NDI+ linkage process that avoids sharing of identifiable patient information between health plans or with a central coordinating center. We will develop standardized criteria for selecting and retaining NDI+ matches and methods for harmonizing linked information across multiple health plans. We will test our processes within a use case comprising users and nonusers of antiarrhythmic medications.

RESULTS

We will use the linked health plan and NDI+ data sets to estimate the incidences and incidence rates of mortality and specific causes of death within the study use case and compare the results with reported estimates. These comparisons provide an opportunity to assess the performance of the developed NDI+ linkage approach and lessons for future studies requiring NDI+ linkage in distributed database settings. This study is approved by the IRB at Harvard Pilgrim Health Care in Boston, MA. Results will be presented to the FDA at academic conferences and published in peer-reviewed journals.

CONCLUSIONS

This study will develop and test a reusable distributed NDI+ linkage approach with the goal of providing tested NDI+ linkage methods for use in future studies within distributed data networks. Having standardized and reusable methods for systematically obtaining death and cause-of-death information from NDI+ would enhance the FDA's ability to assess mortality-related safety questions in the postmarket, real-world setting.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/21811.

Global Mapping of Research Trends on Interventions to Improve Health-Related Quality of Life in Asthma Patients

Globally, approximately 335 million people are being affected by asthma. Given that asthma is a chronic airway condition that cannot be cured, the disease negatively impacts physical health and results in losses of productivity of people experiencing asthma, leading to decrease in quality of life. This study aims at demonstrating the research trends worldwide and identifying the research gaps in interventions for improving quality of life of patients with asthma. Bibliometric approach and content analysis, which can objectively evaluate the productivity and research landscapes in this field, were utilized. In this study, we systematically quantified the development of research landscapes associated with interventions for improving quality of life of people experiencing asthma. Along with the gradual growth in the number of publications, these research topics have relatively expanded in recent years. While the understanding of the pathophysiology, diagnosis and treatment of asthma has been well-established, recent research has showed high interest in the control and management of asthma. Findings of this study suggest the need for more empirical studies in developing countries and further investigation into the effects of environment factors on asthma outcomes, as well as the economic burden of asthma.

Multi-city study on air pollution and hospital outpatient visits for asthma in China

BACKGROUND

The proportion of asthma patients with mild to moderate exacerbations is far greater than the number who experience episodes that are severe enough to require emergency room visits or hospital admission. However the routinely collected data from hospitals is absent in the past.

OBJECTIVE

To evaluate associations between short-term exposures to air pollutants and hospital outpatient visits for asthma in China.

METHODS

We obtained data for 143,057 asthma outpatient visits from the largest hospitals in 17 Chinese cities, between Jan 01 2013 and Dec 31 2015. We used daily concentrations of air pollutants measured by the China National Environmental Monitoring Centre. We used a time-stratified case-crossover design, and fitted conditional logistic regression models to determine the associations.

RESULTS

Particulate matter ≤10μm in diameter (PM10) and nitrogen dioxide (NO2) were associated with increased risks of hospital outpatient visits for asthma on the same day, while the effects were delayed for particulate matter ≤2.5μm in diameter (PM2.5) and sulphur dioxide (SO2). For the cumulative effect model at lag05 days, 10 μg/m3 increase in air pollutants concentrations were correlated with hospital outpatient visits for asthma with odds ratios (ORs) and 95% confidence intervals 1.004 (1.000-1.008) for PM2.5, 1.005 (1.002-1.008) for PM10, 1.030 (1.021-1.040) for NO2, and 1.015 (1.008-1.021) for SO2. Almost one in nine (10.9%; 7.7, 13.9%) hospital outpatient visits for asthma were attributable to NO2.

CONCLUSION

Short-term exposures to PM2.5, PM10, NO2 and SO2 were associated with hospital outpatient visits for asthma in China.

Comparisons between 2015 US asthma prevalence and two measures of asthma burden by racial/ethnic group

Objective: Asthma affects approximately 20,383,000 Americans and costs the US $56 billion dollars annually. Asthma burden is not uniform across different racial/ethnic groups. Although annual asthma prevalences by racial/ethnic group are provided by the CDC, these numbers do not account for the influence of other sociodemographic and clinical factors. In this study, we evaluated several measures of asthma burden that controlled for sociodemographic and clinical factors and compared them to 2015 CDC asthma prevalences by racial/ethnic group. Methods: We obtained unadjusted asthma predictions directly from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. To estimate average adjusted predictions (AAP) and adjusted predictions at the means (APM) for asthma, we controlled for sociodemographic and clinical factors through logistic models and subsequently calculated marginal probabilities for these results. Results: We found substantial differences at the national and state level between unadjusted prevalences and AAPs and APMs for asthma by race/ethnicity group. In addition, states that had the highest and lowest unadjusted prevalences differed from states that had the highest and lowest AAPs and APMs. For unadjusted prevalences, AAPs, and APMs, we found that states that had the highest prevalences or probabilities of asthma for Whites tended to have the widest disparities between the estimates for Whites and those of other races. Conclusions: The study's results highlight the need to account for sociodemographic and clinical factors when addressing asthma burden by racial/ethnic group across the US.

Never mind the biologics, just take the inhalers

"It is a basic truth of the human condition that everybody lies. The only variable is about what." In paediatric asthma, patients don't take their treatments and doctors rarely ask the right questions. The end result is far too many child deaths. http://ow.ly/OaGK30kFtsD.