Rate and place of death from asthma among different ethnic groups in Israel: national trends 1980 to 1997

At-home asthma mortality unchanged despite declining mortality in other settings: US death certificate data (2000-2019)

BACKGROUND

Asthma mortality rates in the United States have declined since 1999; however, asthma mortality by place of death has not been comprehensively evaluated.

OBJECTIVE

To evaluate temporal trends in asthma mortality rates and place of death in the United States.

METHODS

We conducted a population-based analysis using data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research platform to evaluate deaths with asthma as the underlying cause (2000-2019) among US residents of all ages. Absolute numbers of asthma-related deaths were described by place of death. Counts were applied to US Census Bureau population counts to calculate mortality rates per 100,000 persons.

RESULTS

In the 20-year period evaluated, 67,695 asthma deaths were registered in the United States. An overall 32% decline in the asthma mortality rate was observed, from 1.43 to 0.98 per 100,000 persons from 2000 to 2019, respectively. Although asthma mortality rates declined in all medical facility locations, the at-home asthma mortality rate remained stable (0.32 and 0.34 per 100,000 persons in 2000 and 2019, respectively). Consequently, the proportion of at-home asthma deaths increased from 23% in 2000 to 2001 to 36% in 2018 to 2019. The distribution of place of death varied by age, sex, race, ethnicity, and geographic region.

CONCLUSION

Despite an overall decline in asthma mortality in the United States, at-home asthma mortality has remained unchanged. In recent years, more than one-third of asthma deaths have occurred at home. These findings warrant further study and underscore the importance of increased efforts to identify and treat uncontrolled asthma across demographic groups.

Decline in asthma prevalence and severity in Israel over a 10-year period

BACKGROUND

The prevalence of asthma has increased in western countries towards the end of the last century, but recently seems to have stabilized.

OBJECTIVE

To evaluate trends in the prevalence and severity of asthma that occurred in Israel over the past decade.

METHODS

The medical records of 17-year-old boys, eligible for national service, between 1999 and 2008 were reviewed. National annual hospitalization and death rates for asthma were extracted.

RESULTS

Three hundred thousand medical records were reviewed. During the study period, lifetime asthma prevalence decreased from 9.7 to 8.1% (p = 0.002). The point prevalence of moderate-to-severe and mild persistent asthma decreased significantly from 0.88 and 3.41% to 0.36 and 2.44%, respectively, during this period. The prevalence of intermittent asthma and asthma in clinical remission for more than 3 years did not change significantly. The annual hospitalization rate for asthma decreased from 13.0 to 7.5 per 10,000 population (p < 0.0001), whilst the annual death rate due to asthma decreased between 1999 and 2008 from 2.1 to 1.4 per 100,000 population (p = 0.003).

CONCLUSIONS

The prevalence of asthma in Israeli teenage boys decreased significantly over the last decade. In addition, asthma hospitalization and asthma-related death rates in the total population also decreased.

Asthma fatalities at the Emergency Department of the Singapore General Hospital

BACKGROUND

Bronchial asthma is one of the most common chronic diseases in Singapore and the prevalence is increasing. Despite this, the worldwide mortality rate from asthma has been noted to be low at an average of 2.0 per 100,000 people in developed countries such as the United States. Risk factors for fatal asthma attacks that have been described include excessive use of short acting beta-agonists, errors in clinical judgement, poor compliance, psychosocial disorders, use of three or more groups of asthma medication and indicators of asthma severity.

AIM

We aim to study the incidence of asthma deaths occurring in the emergency department of a tertiary care hospital in Singapore.

METHODS

Of the total number of patients at the Department of Emergency Medicine in Singapore General Hospital from January 1999 to June 2005, eight fatalities were attributed to exacerbation of bronchial asthma. The characteristics of these patients are described.

RESULTS

A low incidence of asthma-related deaths is found in Singapore.

Trends in adrenaline (EpiPen) dispensing in Israel in 1997-2004

BACKGROUND

The prevalence of allergic diseases has increased over the last 20 years in the Western world. Reports on the growing use of adrenaline auto-injectors (EpiPen and EpiPen Jr) in several countries may point to increased rates of anaphylactic reactions, increased awareness of the risk of anaphylaxis or both.

OBJECTIVES

To evaluate the dispensing rate of EpiPen units in Israel from 1997 to 2004.

METHODS

The database of the General Health Services (Clalit) was searched to determine the number of EpiPen units dispensed each year from 1997 to 2004. Data on mortality from anaphylaxis were derived from the Central Bureau of Statistics using International Classification of Diseases, 10th revision codes.

RESULTS

The dispensing rate of EpiPen units rose gradually from 1689 in 1997 to 2981 in 2004; an overall increase of 76%. No case of death from anaphylaxis was reported from 1998 to 2000.

CONCLUSIONS

The dispensing rate of adrenaline auto-injectors has increased considerably over the last 8 years in Israel, although to a lesser degree than in other countries. This is probably a reflection of updated medical policies, in accordance with the clinical guidelines for the management of anaphylaxis and improved public education. Further studies are needed to determine the prevalence of anaphylactic reactions in Israel.

Predictors associated with the place of death in a country with increasing hospital deaths

OBJECTIVES

To evaluate the contribution of type of illness, socio-demographic factors, and area of residence to the place of death in a country with increasing hospital deaths.

DESIGN

Descriptive study of hospital deaths using a 10-year death registration database from the Korean National Statistical Office.

SETTING AND PARTICIPANTS

Through the National Vital Statistics System, 2,402,259 deaths were registered in Korea from 1992 to 2001.

MEASUREMENT AND MAIN RESULTS

There was a significant trend toward an increase in the proportion of hospital deaths, from 16.6% in 1992 to 39.9% in 2001. The proportion of deaths at home decreased over that period, from 72.9 to 49.2%. The risk of hospital death versus home death was lower for those aged 75 years and over (adjusted odds ratio: 0.212; 95% confidence interval: 0.210-0.214) compared with those <55 years, and for people who were highly educated (2.04; 2.02-2.06), had white-collar jobs (1.55; 1.54-1.57), and resided in areas with more available hospital beds (2.46; 2.42-2.51). Compared with other causes of death, the risk of dying in hospital was higher for patients with ischaemic heart disease (1.83; 1.79-1.86), cancer (1.25; 1.23-1.26) and chronic lower respiratory disease (1.21; 1.18-1.23).

CONCLUSIONS

Trends in place of death are influenced by available hospital beds, socio-demographic factors and the nature of the terminal disease, in a country with increasing hospital deaths. These associations should be viewed within the context of culture and local health care systems.

Trends in adolescent asthma in Israel

There has been observed a worldwide increase in childhood asthma and this short communication reviews current research on adolescent asthma in Israel. Several studies have found an overall asthma prevalence of 7.8% for Jewish children, 4.9% for Arab children and 3.7% for the total population, while 7.8% was found in Bedouin children in the south of Israel. For the 1980-1997 period for the 5-34 year age group the AMR (asthma mortality rate) per 100,000 was found to be 0.226 with no significant difference between Jews and Arabs. This is a decrease as a result of increase in the use of inhaled corticosteroids (ICS) and a better anti-inflammatory treatment.

Myocardial injury during standard treatment of an adult with status asthmaticus

Asthma affects 5%-10% of adults in the United States. Older adults (> 65 years) with asthma have higher rates of fatal asthma than younger adults. The occurrence of a respiratory emergency, such as status asthmaticus, would seem likely to create a situation of cardiopulmonary dysfunction conducive to myocardial ischemia. However, multiple studies of fatal or near-fatal asthma have failed to incriminate myocardial infarction as a contributing factor. We report a patient without underlying coronary artery disease who sustained myocardial injury consistent with myocardial ischemia and infarction during status asthmaticus while receiving recommended treatment without intravenous sympathomimetics or theophylline.