Sly R M, O'Donnell R
Section of Allergy and Immunology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Ann Allergy Asthma Immunol. 1997 Apr;78(4):347-54. doi: 10.1016/S1081-1206(10)63195-X.
Rates of death from asthma in the United States have increased since 1978.
To identify and evaluate recent trends in asthma mortality.
Analysis of data from the National Center for Health Statistics identifying asthma (ICD 493) as the underlying cause of death in the 50 United States and the District of Columbia with rates of death from asthma by age, race, and sex and age-adjusted rates of death by race. The Bureau of the Census provided population data by age, race, and sex that permitted calculation of rates of death at 5 through 34 years of age. The Departments of Health of Australia, Canada, Great Britain, and New Zealand provided numbers of deaths from asthma and population data from which we have calculated rates of death.
Rates of death from asthma in the United States increased from .8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989 and have been 1.9 or 2.0 since then until an increase to 2.1 in 1994. A significant difference in regression over groups indicates a difference in average rates between 1979 through 1987 compared with 1988 through 1994. Rates of death from asthma have been much higher for white females than white males with an increasing disparity. Rates of death from asthma at 5 through 34 years of age have been much greater in blacks than whites with no significant change in rates across time from 1980 through 1994. Age-adjusted rates for blacks over all ages increased from 1.5 in 1977 and 1978 to 3.5 in 1988 with rates no higher than that until an increase to 3.7 in 1994. Age-adjusted rates for whites increased from .5 in 1977 to 1.2 by 1989 with none higher than that since then through 1994. Comparison of slopes indicates a significantly greater increase for blacks than whites (F = 68.296, P < .0001). Equality of slopes tests indicate significantly greater age-adjusted rates of increase for each race separately for 1979 through 1987 compared with 1988 through 1994.
Since 1988 rates of death from asthma in the United States for most ages have stabilized at rates more than 50% higher than those of 1979, but there has been only a suggestion of stabilization of rates at 5 through 34 years of age, ages at which certification of death as due to asthma is most accurate. Rates of death have been much higher for blacks than whites, and among whites rates have increased more for females than males. These differences might be due to difference in prevalence or severity of differences in accuracy of diagnosis. Improvements in management would reduce asthma mortality.
自1978年以来，美国哮喘死亡率呈上升趋势。
确定并评估哮喘死亡率的近期趋势。
分析美国国家卫生统计中心的数据，将哮喘（国际疾病分类代码493）确定为美国50个州及哥伦比亚特区的潜在死因，按年龄、种族和性别统计哮喘死亡率，并按种族计算年龄调整死亡率。美国人口普查局提供了按年龄、种族和性别划分的人口数据，据此计算5至34岁的死亡率。澳大利亚、加拿大、英国和新西兰的卫生部门提供了哮喘死亡人数和人口数据，我们据此计算了死亡率。
美国哮喘死亡率从1977年和1978年的每10万人0.8例增至1989年的2.0例，此后一直维持在1.9或2.0例，直到1994年增至2.1例。不同组间回归存在显著差异，表明1979年至1987年与1988年至1994年的平均死亡率有所不同。白人女性的哮喘死亡率远高于白人男性，且差距不断扩大。5至34岁黑人的哮喘死亡率远高于白人，1980年至1994年期间死亡率无显著变化。所有年龄段黑人的年龄调整死亡率从1977年和1978年的1.5例增至1988年的3.5例，此后直至1994年均未高于该水平。白人的年龄调整死亡率从1977年的0.5例增至1989年的1.2例，此后直至1994年均未高于该水平。斜率比较表明，黑人的增幅显著高于白人（F = 68.296，P < .0001）。斜率平等性检验表明，与1988年至1994年相比，1979年至1987年各种族的年龄调整增长率分别显著更高。
自1988年以来，美国大多数年龄段的哮喘死亡率稳定在比1979年高出50%以上的水平，但5至34岁年龄段的死亡率仅略有稳定迹象，而在这个年龄段将死亡原因确认为哮喘最为准确。黑人的死亡率远高于白人，在白人中，女性的死亡率增幅高于男性。这些差异可能是由于患病率或诊断准确性差异的严重程度不同所致。改善管理措施将降低哮喘死亡率。
