Whallett E J, Ayres J G
Birmingham University, Medical School, U.K.
Respir Med. 1993 Apr;87(3):183-6. doi: 10.1016/0954-6111(93)90089-i.
To test the hypothesis that labelling shift from acute bronchitis to asthma may be contributing to the rise in deaths from asthma in the U.K., we studied mortality rates for males, females and both sexes combined for all ages and for the 5-34 age group, from published mortality tables from 1950 to 1985. The 5-34 age group mortality from asthma showed the 1960s peak and a more gradual increase from 1975. Mortality (all ages) from acute bronchitis showed a decline over the period, but in the 5-34 age group mortality was remarkably stable from 1950-1974 with a mean rate of 2.61 per million (95% confidence intervals, 2.44-2.78). From 1975 to 1985 the rate declined linearly to 0.75 per million. The number of acute bronchitis deaths 'saved' over this period was 366 compared to the number of excess asthma deaths during the same period (taking the 1974 rate as baseline) of 514. These findings lend support to the hypothesis that, in the 5-34 age group, labelling shift from acute bronchitis to asthma may be a contributing factor to the recent rise in asthma mortality. They also raise the question whether different factors contributing to the rise in asthma may have proportionately different weights of effect according to the age of the patients involved.
为了验证从急性支气管炎到哮喘的诊断标签转换可能是导致英国哮喘死亡率上升这一假设，我们根据1950年至1985年已发表的死亡率表，研究了所有年龄段以及5至34岁年龄组男性、女性及男女合计的死亡率。5至34岁年龄组的哮喘死亡率在20世纪60年代出现峰值，1975年起呈逐渐上升趋势。急性支气管炎的死亡率（所有年龄段）在此期间呈下降趋势，但在5至34岁年龄组中，1950年至1974年死亡率显著稳定，平均死亡率为每百万2.61例（95%置信区间为2.44 - 2.78）。从1975年到1985年，该比率线性下降至每百万0.75例。与同期（以1974年的比率为基线）514例额外的哮喘死亡病例相比，这一时期“减少”的急性支气管炎死亡病例数为366例。这些发现支持了这样一种假设，即在5至34岁年龄组中，从急性支气管炎到哮喘的诊断标签转换可能是近期哮喘死亡率上升的一个促成因素。它们还提出了一个问题，即导致哮喘发病率上升各种不同因素，根据所涉及患者的年龄，其影响权重是否可能按比例有所不同。
