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554 Asthma mortality in maryland, 1979–1985
551
552
CIRCUMSTANCES SURROUNDING DEATH DUE TO ASTHMA IN CHILDREN: A CASE-CONTROLLED STUDY. Bruce D. Miller, M.D. and Robert C. Strunk, M.D., Denver, CO and St. Louis, MO This study examines the circumstances before and surrounding asthma deaths of 12 children (SM, 4F, mean age I4 yrs) compared to 12 controls who survived a life-threatening asthma attack (PM, 3F, mean age on all 24 subjects was obtained 13.8). Information from structured interviews with families and physicians and review of medical records. We examined patient-parent factors, psychosocial profiles, physician factors, and asthma severity, control and management for the six month period preceeding the acute episode, Additionally, we examined factors surrounding the acute episode; these included fatigue, time of day, occurrence during sleep, adequacy of care, assessment of symptoms, progression of symptoms, emergency treatment, and vomiting during attack. Results showed no significant differences in overall severity or long-term management of asthma between the two groups. However, index cases had more psychosocial risk factors (p=O.O5) and greater hopelessness/despair (p=O.O4) prior to the attack. Index cases had more attacks occuring during sleep (p=O.O3), but less vomiting during the acute attack (p=O.Ol). Emergency care was either not obtained or was inadequate in the index group as compared to controls (p=O.OOOl). Step-wise discriminant analysis correctly identified 12 index cases and 10 controls. Our results demonstrate that delays in the initiation of emergency care, either due to the rapid progression of symptoms or to inadequate assessment, were critical to the outcome. Furthermore, our data suggest that there may be inherent differences in the mechanisms of the acute attacks between the groups.
553
INVESTIGATION OF A CLUSTER OF ASTHMA DEATHS IN G.S. Birkhead, M.CT TEENAGERS. N.J. Attaway,
554
DEMOGRAPHYOF DEATHS FROM ASTHMA, 1979-84.
2R
Michael Sly, M.D., Washington, D.C. Data from the National Center for Health Statistics indicate deaths from asthma increased from 2598 in 1979 to 3564 in 1984. Rates of death from asthma increased from 1.2/100,000 general population to 1.5. Rates for males increased from 1.0 to 1.3; those for females, from 1.3 to 1.7. Rates for blacks increased from 1.8 to 2.5; those for whites, from 1.1 to 1.4. Age adjusted death rates increased from 0.9 to 1.1, while those for blacks increased from 1.9 to 2.6 and those for whites from 0.8 to 1.0. There have been increases in all regions of the U.S.A. Metropolitan death rates increaked from 1.23 in 1980 to 1.50 in 1984; notunetropolitan rates, from 1.42 to 1.55. Although norunetropolitan rates of death from asthma have remained stable, metropolitan deaths have accounted for similar shares of deaths from asthma from 198084 for those 5-34 years of age (87% of deaths in blacks and 73% of those in whites in 1984). In 1980 81% of blacks and 73% of whites lived in metropolitan areas. From 1979 through 1984 at least 45-49% of deaths from asthma in blacks and 52-552 of those in whites occurred at hospitals, but death certificates did not indicate the locations of 22-25% of deaths. Higher rates of death from asthma among blacks suggest underutilization or lack of accessibility of health care. The large proportion of hospital deaths suggests delays or other inadequacies of treatment at hospitals.
Townsend, R.C. Strunk, St. Louis, MO, and Atlanta, GA. We had the opportunity of studying a cluster of five asthma deaths that occurred in St. Louis from June 1 to August 8, 1987. Case records were reviewed and timing of deaths were evaluated in light of vital records for the area, ER visits and admissions for asthma, weather conditions, levels of pollens, molds and and patterns of respiratory viruses pollutants, in the community. The children were all black, ages lo-19 yrs, 3F and 2M. All had moderate to severe asthma. Poor compliance and disruption of medical care was noted in the records of 4/S; in the other the severity of asthma was All had worsening in the week unrecognized. before their deaths that was not treated and then had sudden decompensation over l/2 hr or Theophylline levels were (3 pg/ml in the less. 4 cases measured (no common preparation was used). The cluster of 5 deaths in a 3-mthperiod was significantly increased over typical rates for St. Louis (0.65/3mth)(p
ASTHMA MORTALITY IN MARYLAND, 1979-85. FJ M.D.. Ph.D. and E Diamond. Ph.D. Balt&rne,Muyland ASthIIXllIKld.itydataWCEanalyzediIlMaryland
(1979-85) by age, sexand race aswell as placeof death. The data were derived hm the Marylaud Centerfor Mean Mcatali Rates(per Wpopulation) &mm AIllaces 10.7 12.5 white 8.2 ii:: 16.5 18.3 16.5 21.7 Hack Between 1979-85there were 315 asthmadeaths: 122 iu malesaud 193in females. Asthma death ratesincreasedby 38% between 1979 and 1982 with no further overall increasetbmugh 1985. Iute~~tiugly, the burden of this iuerease(85%) was carried by females. White females notedasteadybzrease in rate firm 5.6 (per 106population) iu 1979 to 15.6 in 1985. The ratesin blackfemales went from 18.0 in 1979 to a peak 28.0 in 1982; their rate deaased to 16.0 in 1985. Overall,the deathrate in blacks (18.3) was twice that of whites (8.2), but asnoted in earlier studies,black malesand femalesbetween ages1545 had deathrates 10.5 and 8.9 times higher respectivelythan their wbiteeountuparts. Inthissameagegmupthedeathrate for femalesof both mceswas 2.4 times higher than that of males. Iu Marylaud mcst asthmadeaths (76%) occurrediu the hospital (or EmergencyRoom). Approximately 20% ocxwml outsidethe hospital and 3.5% were dead on arrival at the hospital. Thus, the rise iu asthmamcntdity iu Maryland between 1979 and 1985 wasdiqnqmtkmtiy higher in femalesof both races. Young blacks(15-45) of both sexeswere 10 timesmoIelikelytodieoftheirasthma.
306
552
CIRCUMSTANCES SURROUNDING DEATH DUE TO ASTHMA IN CHILDREN: A CASE-CONTROLLED STUDY. Bruce D. Miller, M.D. and Robert C. Strunk, M.D., Denver, CO and St. Louis, MO This study examines the circumstances before and surrounding asthma deaths of 12 children (SM, 4F, mean age I4 yrs) compared to 12 controls who survived a life-threatening asthma attack (PM, 3F, mean age on all 24 subjects was obtained 13.8). Information from structured interviews with families and physicians and review of medical records. We examined patient-parent factors, psychosocial profiles, physician factors, and asthma severity, control and management for the six month period preceeding the acute episode, Additionally, we examined factors surrounding the acute episode; these included fatigue, time of day, occurrence during sleep, adequacy of care, assessment of symptoms, progression of symptoms, emergency treatment, and vomiting during attack. Results showed no significant differences in overall severity or long-term management of asthma between the two groups. However, index cases had more psychosocial risk factors (p=O.O5) and greater hopelessness/despair (p=O.O4) prior to the attack. Index cases had more attacks occuring during sleep (p=O.O3), but less vomiting during the acute attack (p=O.Ol). Emergency care was either not obtained or was inadequate in the index group as compared to controls (p=O.OOOl). Step-wise discriminant analysis correctly identified 12 index cases and 10 controls. Our results demonstrate that delays in the initiation of emergency care, either due to the rapid progression of symptoms or to inadequate assessment, were critical to the outcome. Furthermore, our data suggest that there may be inherent differences in the mechanisms of the acute attacks between the groups.
553
INVESTIGATION OF A CLUSTER OF ASTHMA DEATHS IN G.S. Birkhead, M.CT TEENAGERS. N.J. Attaway,
554
DEMOGRAPHYOF DEATHS FROM ASTHMA, 1979-84.
2R
Michael Sly, M.D., Washington, D.C. Data from the National Center for Health Statistics indicate deaths from asthma increased from 2598 in 1979 to 3564 in 1984. Rates of death from asthma increased from 1.2/100,000 general population to 1.5. Rates for males increased from 1.0 to 1.3; those for females, from 1.3 to 1.7. Rates for blacks increased from 1.8 to 2.5; those for whites, from 1.1 to 1.4. Age adjusted death rates increased from 0.9 to 1.1, while those for blacks increased from 1.9 to 2.6 and those for whites from 0.8 to 1.0. There have been increases in all regions of the U.S.A. Metropolitan death rates increaked from 1.23 in 1980 to 1.50 in 1984; notunetropolitan rates, from 1.42 to 1.55. Although norunetropolitan rates of death from asthma have remained stable, metropolitan deaths have accounted for similar shares of deaths from asthma from 198084 for those 5-34 years of age (87% of deaths in blacks and 73% of those in whites in 1984). In 1980 81% of blacks and 73% of whites lived in metropolitan areas. From 1979 through 1984 at least 45-49% of deaths from asthma in blacks and 52-552 of those in whites occurred at hospitals, but death certificates did not indicate the locations of 22-25% of deaths. Higher rates of death from asthma among blacks suggest underutilization or lack of accessibility of health care. The large proportion of hospital deaths suggests delays or other inadequacies of treatment at hospitals.
Townsend, R.C. Strunk, St. Louis, MO, and Atlanta, GA. We had the opportunity of studying a cluster of five asthma deaths that occurred in St. Louis from June 1 to August 8, 1987. Case records were reviewed and timing of deaths were evaluated in light of vital records for the area, ER visits and admissions for asthma, weather conditions, levels of pollens, molds and and patterns of respiratory viruses pollutants, in the community. The children were all black, ages lo-19 yrs, 3F and 2M. All had moderate to severe asthma. Poor compliance and disruption of medical care was noted in the records of 4/S; in the other the severity of asthma was All had worsening in the week unrecognized. before their deaths that was not treated and then had sudden decompensation over l/2 hr or Theophylline levels were (3 pg/ml in the less. 4 cases measured (no common preparation was used). The cluster of 5 deaths in a 3-mthperiod was significantly increased over typical rates for St. Louis (0.65/3mth)(p
ASTHMA MORTALITY IN MARYLAND, 1979-85. FJ M.D.. Ph.D. and E Diamond. Ph.D. Balt&rne,Muyland ASthIIXllIKld.itydataWCEanalyzediIlMaryland
(1979-85) by age, sexand race aswell as placeof death. The data were derived hm the Marylaud Centerfor Mean Mcatali Rates(per Wpopulation) &mm AIllaces 10.7 12.5 white 8.2 ii:: 16.5 18.3 16.5 21.7 Hack Between 1979-85there were 315 asthmadeaths: 122 iu malesaud 193in females. Asthma death ratesincreasedby 38% between 1979 and 1982 with no further overall increasetbmugh 1985. Iute~~tiugly, the burden of this iuerease(85%) was carried by females. White females notedasteadybzrease in rate firm 5.6 (per 106population) iu 1979 to 15.6 in 1985. The ratesin blackfemales went from 18.0 in 1979 to a peak 28.0 in 1982; their rate deaased to 16.0 in 1985. Overall,the deathrate in blacks (18.3) was twice that of whites (8.2), but asnoted in earlier studies,black malesand femalesbetween ages1545 had deathrates 10.5 and 8.9 times higher respectivelythan their wbiteeountuparts. Inthissameagegmupthedeathrate for femalesof both mceswas 2.4 times higher than that of males. Iu Marylaud mcst asthmadeaths (76%) occurrediu the hospital (or EmergencyRoom). Approximately 20% ocxwml outsidethe hospital and 3.5% were dead on arrival at the hospital. Thus, the rise iu asthmamcntdity iu Maryland between 1979 and 1985 wasdiqnqmtkmtiy higher in femalesof both races. Young blacks(15-45) of both sexeswere 10 timesmoIelikelytodieoftheirasthma.
306