Current Trends Asthma -- United States, 1982-1992

Asthma is characterized by variable airflow obstruction with airway hyperresponsiveness; prominent clinical manifestations include wheezing and shortness of breath. During the 1980s, the prevalence of and mortality associated with asthma increased in the United States and other countries (1,2). To describe national trends in disease burden for asthma in the United States, CDC analyzed data for 1982-1992 (the most recent year for which data are available) for deaths, hospital discharges, and self-reported morbidity. This report summarizes the findings of the analysis.

This analysis used data maintained by CDC, including the multiple-cause-of-death file, the National Hospital Discharge Survey, and the National Health Interview Survey. For asthma deaths, the underlying cause was listed as International Classification of Diseases, Ninth Revision, Clinical Modification, code 493. Because of the limited accuracy of diagnosing asthma in persons aged greater than 35 years (3), this analysis presents overall age-adjusted rates and rates for persons aged 5-34 years. Race-specific analyses were restricted to blacks and whites because numbers for other races were too small to enable calculation of stable estimates.

From 1982 through 1991 *, the overall annual age-adjusted death rate ** for asthma increased 40% and steadily, from 13.4 per 1 million population (3154 deaths) to 18.8 per 1 million (5106 deaths). During this period, the rate increased 59% for females (from 15.4 to 24.6) and 34% for males (from 11.7 to 15.7). For persons aged 5-34 years, the rate increased 42%, from 3.4 (401 deaths) to 4.9 (569 deaths) Figure_1. The annual death rate was consistently higher for blacks than for whites. During this period, the rate increased 41% for females (from 3.6 to 4.6) and 43% for males (from 3.7 to 5.3).

The overall annual age-adjusted hospital discharge rate for asthma as the primary diagnosis decreased slightly from 18.4 per 10,000 in 1982 to 17.9 per 10,000 in 1992. For persons aged 5-34 years, the rate was constant in both years (12.8 per 10,000); rates for females were consistently higher than for males, and rates for blacks were consistently higher than for whites.

From 1982 through 1992, the overall annual age-adjusted prevalence rate of self-reported asthma increased 42%, from 34.7 per 1000 to 49.4 per 1000. For persons aged 5-34 years, the rate increased 52%, from 34.6 to 52.6 Figure_2. The rate for males increased by 29% (from 39.7 to 51.4) and for females increased 82% (from 29.4 to 53.6). Reported by: Air Pollution and Respiratory Health Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Three national health objectives for the year 2000 include decreasing disability and hospitalizations for asthma and increasing education about asthma (objectives 11.1, 17.4, and 17.14) (4). Although hospitalization rates for asthma were stable during 1982-1992, both prevalence and death rates increased during this period. Potential explanations for the stable hospitalization rates for asthma, despite the increased prevalence of self-reported disease, include improved outpatient treatment and, because of billing practices, classification of cases of asthma under other diagnostic categories. Prominent racial differences in asthma death rates and hospitalization rates indicate the need for further investigation of potential explanations (e.g., access to appropriate health care and socioeconomic factors).

Although the specific etiology of asthma is unknown, this problem may be associated with familial, infectious, allergenic, environmental, socioeconomic, and psychosocial factors. For example, in 1991, an estimated 6.4 million (63%) of the 10.3 million persons with asthma in the United States resided in areas where at least one National Ambient Air Quality Standard was exceeded (5). Factors associated with risk for death among persons with asthma include medication overuse (6), substance abuse (7), and cigarette smoking (8).

Morbidity and mortality associated with asthma may be affected by patient compliance, patient education, and medical management. In particular, a high proportion of asthma morbidity and mortality may be preventable through patient recognition and aggressive medical management. In 1989, the National Asthma Education Project was implemented to increase awareness about asthma and to improve effective control of asthma by providing physicians and patients with updated treatment information. This program has developed educational materials for patients and physicians about the treatment of asthma during pregnancy, for physicians about educating patients about asthma, and for educators about adding or improving awareness about asthma in schools. Additional information about these or other asthma materials are available from the National Heart, Lung, and Blood Institute Information Center, telephone (301) 251-1222.

References

1. Weiss KB, Wagener DK. Changing patterns of asthma mortality: identifying target populations at high risk. JAMA 1990;264:1683-7.

2. Woolcock AJ. Worldwide differences in asthma prevalence and mortality: why is asthma mortality so low in the USA? Chest 1986;90(suppl):40S-45S.

3. Sears MR, Rea HH, de Boer G, et al. Accuracy of certification of deaths due to asthma: a national study. Am J Epidemiol 1986;124:1004-11.

4. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

5. CDC. Populations at risk from air pollution -- United States, 1991. MMWR 1993;42:301-4.

6. Ernst P, Habbick B, Suissa S, et al. Is the association between inhaled beta-agonist use and life-threatening asthma because of confounding by severity? Am Rev Respir Dis 1993;148:75-9.

7. Greenberger PA, Miller TP, Lifschultz B. Circumstances surrounding deaths from asthma in Cook County (Chicago) Illinois. Allergy Proc 1993;14:321-6.

8. Marquette CH, Saulnier F, Leroy O, et al. Long-term prognosis of near-fatal asthma: a 6-year follow-up study of 145 asthmatic patients who underwent mechanical ventilation for a near-fatal attack of asthma. Am Rev Respir Dis 1992;146:76-81.

* Mortality data were not available for 1992. 

** Intercensal population estimates were used to calculate age-adjusted rates standardized to the 1980 U.S. population.

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