Observations on emerging patterns of asthma in our society,☆☆

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Abstract

Epidemiologic studies of temporal and geographic variation in asthma morbidity have identified asthma as an important public health concern. Knowledge gained from these studies has resulted in intense focus on this condition by agencies such as the National Institutes of Health and the World Health Organization. In this report, studies of recent asthma trends and patterns are explored. These studies show increases in US prevalence through 1994. Data on measures of morbidity show complex longitudinal patterns but are notable for large differences in emergency department services and hospitalizations by age and race. Very recent trends for US asthma mortality suggest widening of an existing racial gap. Limited comparisons are possible between these US trends and international trends but do suggest that US increases in prevalence and mortality rates may reflect world-wide patterns. Also, within the US, it is clear that geographic variation exists in asthma prevalence, morbidity, and mortality rates. Changes in certain environmental risk factors and exposures may contribute to recent trends, but little information is available relating specific risk factors to either longitudinal asthma trends, geographic variability, or high-risk populations. (J Allergy Clin Immunol 1999;104:S1-9.)

Section snippets

WHAT ARE THE TRENDS IN ASTHMA MORBIDITY IN THE UNITED STATES?

The major measures of asthma morbidity currently under surveillance in the US include prevalence, emergency department (ED) visits, hospitalizations, and mortality. In addition, data on quality of life and economic impact are also becoming available.

ARE THE PATTERNS OF ASTHMA MORBIDITY IN THE UNITED STATES SIMILAR TO INTERNATIONAL TRENDS?

Direct comparisons of the trends in asthma morbidity between the United States and other countries are very limited. Studies of the trends in asthma prevalence differ in methodology both between countries and even within countries. Very few countries conduct nationwide surveillance of asthma morbidity as measured by emergency care or hospitalizations. However, high quality vital records systems have been in operation in many countries for decades. Therefore, most of the international

WHAT IS THE GEOGRAPHIC VARIATION IN ASTHMA MORBIDITY, AND SPECIFICALLY, IS THERE A DISPROPORTIONATE BURDEN EXPERIENCED WITHIN URBAN ENVIRONMENTS?

Over the past several years, there has been a dramatic increase in our knowledge of the geographic variations in asthma morbidity. Most recently, the results of two important international studies have contributed to this knowledge, the European Community Respiratory Health Survey (ECRHS)26 and the International Study of Asthma and Allergies in Childhood (ISAAC).27

The ECRHS studied asthma prevalence among adults age 20 to 44 years across 48 study centers located primarily in Western Europe.28

WHAT ARE SOME OF THE FACTORS ASSOCIATED WITH THESE EMERGING PATTERNS OF ASTHMA MORBIDITY?

A detailed discussion of the epidemiologic studies that support causal relations between risk factors and temporal or geographic trends is beyond the scope of this report. However, there are several comprehensive reviews on this topic that may be of interest.10, 19, 41, 42 Below is a brief discussion of some of the factors possibly contributing to the current patterns of asthma morbidity.

It has been proposed that some of the increase in asthma prevalence may be attributed to enhanced diagnostic

WHAT CAN BE DONE TO REDUCE ASTHMA MORBIDITY?

The rapidly growing body of descriptive epidemiologic studies of asthma is beginning to define important patterns of asthma morbidity. Principal among these findings is that current US national surveillance suggests that asthma prevalence is increasing. This increase also appears to be occurring in other countries as well. However, there is limited international data on trends in asthma morbidity. Yet, with the exception of certain subpopulations who appear to be at high risk, the trends in US

References (62)

  • DM Mannino et al.

    Surveillance for asthma, United States, 1960-1995

    Mor Mortal Wkly Rep CDC Surveill Summ

    (1998)
  • Health Services and Mental Health Administration, National Center for Health Statistics

    Plan and operation of the health and nutrition examination survey, United States 1971-1973

  • Public Health Services, National Center for Health Statistics US

    Plan and operation of the second national health and nutrition examination survey, 1976-1980

  • R Evans et al.

    National trends in morbidity and mortality of asthma in the US: prevalence, hospitalization and death from asthma over two decades: 1965-1984

    Chest

    (1991)
  • FL McCaig et al.

    Plan and operation of the National Hospital Ambulatory Medical Survey

    (1994)
  • SM Schappert

    Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1995

    National Center for Health Statistics, Vital Health Statistics

    (1997)
  • EJ Graves et al.

    Detailed diagnoses and procedures. National Hospital Discharge Survey, 1996. National Center for Health Statistics

    Vital Health Statistics

    (1998)
  • KB Weiss et al.

    Breathing better or wheezing worse? The changing epidemiology of asthma morbidity and mortality

    Annu Rev Public Health

    (1993)
  • Asthma—United States, 1980-1987

    MMWR Morb Mortal Wkly Rep

    (1990)
  • KB Weiss et al.

    Changing patterns in US asthma mortality: identifying populations at high risk

    JAMA

    (1990)
  • MR Sears et al.

    Accuracy of certification of deaths due to asthma: a national study

    Am J Epidemiol

    (1986)
  • LW Barger et al.

    Further investigation into the recent increase in asthma death rates: a review of 41 asthma deaths in Oregon in 1982

    Ann Allergy

    (1987)
  • KB Weiss et al.

    An economic evaluation of asthma in the United States

    N Engl J Med

    (1992)
  • R Beasley et al.

    International trends in asthma mortality

  • MR Sears

    Worldwide trends in asthma mortality

    Bull Int Union Tuberc Lung Dis

    (1991)
  • N Pearce et al.

    Measuring asthma prevalence

  • M. Alderson

    Trends in morbidity and mortality from asthma

    Popul Trends

    (1987)
  • CE Bucknall et al.

    Emergency admissions increasing in Scotland

    BMJ

    (1994)
  • T Tuuponen et al.

    Trends in hospitalization among asthmatic children in Finland from 1972 to 1986

    Eur J Pediatr

    (1993)
  • K Wilkins et al.

    Trends in rates of admission to hospital and death from asthma among children and young adults in Canada during the 1980s

    Can Med Assoc J

    (1993)
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    Reprint requests: Kevin Weiss, MD, Director, Center for Health Services Research, Rush Primary Care Institute, 1653 W Congress Pkwy, Kidston Bldg, Room 802, Chicago, IL 60612.

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