Medical Research Institute of New Zealand, Wellington, New Zealand.
Department of Medicine, University of Otago Wellington, Wellington, New Zealand.
Lancet. 2017 Sep 2;390(10098):935-945. doi: 10.1016/S0140-6736(17)31448-4. Epub 2017 Aug 7.
International time trends in asthma mortality have been strongly affected by changes in management and in particular drug treatments. However, little is known about how asthma mortality has changed over the past decade. In this study, we assessed these international trends.
We collated age-standardised country-specific asthma mortality rates in the 5-34 year age group from the online WHO Mortality Database for 46 countries. To be included in the analysis, we specified that a country must have 10 years of complete data in the WHO Mortality Database between 1993 and 2012. In the absence of consistent and accurate asthma prevalence and prescribing data, we chose to use a locally weighted scatter plot smoother (LOESS) curve, weighted by the individual country population in the 5-34-year age group to show the global trends in asthma mortality rates with time.
Of the 46 countries included in the analysis of asthma mortality, 36 were high-income countries, and 10 were middle-income countries. The LOESS estimate of the global asthma mortality rate was 0·44 deaths per 100 000 people (90% CI 0·39-0·48) in 1993 and 0·19 deaths per 100 000 people (0·18-0·21) in 2006. Despite apparent further reductions in some countries and regions of the world, there was no appreciable change in global asthma mortality rates from 2006 through to 2012, when the LOESS estimate was also 0·19 deaths per 100 000 people (0·16-0·21).
The trend for reduction in global asthma mortality observed since the late 1980s might have stalled, with no appreciable difference in a smoothed LOESS curve of asthma mortality from 2006 to 2012. Although better implementation of established management strategies that have been shown to reduce mortality risk is needed, to achieve a further substantive reduction in global asthma mortality novel strategies will also be required.
The Medical Research Institute of New Zealand, which is supported by Health Research Council of New Zealand Independent Research Organisation.
哮喘死亡率的国际时间趋势受到管理方面的变化，尤其是药物治疗的强烈影响。然而，对于过去十年中哮喘死亡率的变化情况知之甚少。在这项研究中，我们评估了这些国际趋势。
我们从世界卫生组织在线死亡率数据库中收集了 46 个国家 5-34 岁年龄组特定国家的年龄标准化哮喘死亡率数据。为了进行分析，我们指定一个国家必须在 1993 年至 2012 年期间在世界卫生组织死亡率数据库中有 10 年的完整数据。由于缺乏一致和准确的哮喘流行率和处方数据，我们选择使用局部加权散点图平滑（LOESS）曲线，按 5-34 岁年龄组的个别国家人口加权，以显示哮喘死亡率随时间的全球趋势。
在纳入哮喘死亡率分析的 46 个国家中，有 36 个是高收入国家，10 个是中等收入国家。1993 年，全球哮喘死亡率的 LOESS 估计值为每 10 万人 0.44 人（90%CI 0.39-0.48），2006 年为每 10 万人 0.19 人（0.18-0.21）。尽管世界上一些国家和地区的情况明显有所改善，但全球哮喘死亡率从 2006 年到 2012 年并没有明显变化，LOESS 估计值也为每 10 万人 0.19 人（0.16-0.21）。
自 20 世纪 80 年代末以来，全球哮喘死亡率呈下降趋势，但到 2012 年，LOESS 平滑曲线的哮喘死亡率没有明显差异，这一趋势可能已经停滞。尽管需要更好地实施已被证明可以降低死亡率风险的既定管理策略，但要进一步实质性地降低全球哮喘死亡率，还需要新的策略。
新西兰医学研究所，该研究所由新西兰健康研究理事会独立研究组织资助。
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