Asthma mortality rates higher in China than in the US, but the gap is closing
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Key takeaways:
- Researchers examined data from the Global Burden of Disease Study 2019.
- Mortality increased with age in both countries.
- Smoking in China and high BMI in the U.S. were the leading risk factors.
China had a higher asthma mortality rate than the United States between 1990 and 2019, driven by smoking, high BMI and age, but this gap narrowed with time, according to a study published in the Chinese Medical Journal.
Crude mortality rates in both countries also have seen a downward trend during this period, Xiaochen Li, MD, researcher, department of pulmonary and critical care medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, and colleagues wrote.
The researchers analyzed deaths, mortality rates and age-standardized mortality rates (ASMRs) between 1990 and 2019 as reported by the Global Burden of Disease Study 2019 (GBD 2019).
Annual deaths in China ranged from 24,750 to 40,432 during this period. Crude mortality rates and ASMRs due to asthma fell from 1990 to 2019, with the low of 24,750 (95% CI, 20,245-30,769) occurring in 2019.
Males in China had a lower crude mortality rate than females in 1990, but it has been lower for females since 1992, with that gap gradually widening. Also, males had consistently higher ASMRs than females during the full period.
Asthma deaths fell by 18.8% between 1990 and 2019, reaching 4,071 (95% CI, 3,353-4,367) in the U.S. Crude mortality rates and ASMRs generally decreased during this period as well, with increases between 1993 and 1995 and between 2015 and 2016.
Crude mortality rates and ASMRs remained higher for females compared with males between 1990 and 2019 in the United States as well.
Although China had higher crude mortality rates and ASMRs than the United States during the study period, the gap in ASMRs has markedly narrowed, the researchers wrote. Also, females in China have had a lower mortality rate than females in the United States since 2017.
Across the total population and for females in China, both aged 10 years and older, mortality rates increased with age in each 5-year period of the 1990 to 2019 timeframe. Mortality rates for males aged 15 years and older increased with age, with an inflection point for those aged 90 to 94 years.
Mortality rates for the total population and for males and females both in the United States also increased with age in each 5-year period, with a slightly downward trend over time for people aged 0 to 84 years and higher mortality for people aged 95 years and older in 2019 compared with 1990.
The decrease in mortality over time for each age group happened faster in China than it did in the United States, with much lower mortality rates for children aged younger than 5 years in China since 2002, the researchers said.
Additionally, people in China with asthma aged younger than 60 years have had lower mortality than those in the United States since 1994. People with asthma in China aged younger than 70 years also have had lower mortality than those in the United States since 2011.
Looking at the total population in China aged younger than 95 years, mortality rates decreased for those aged 0 to 19 years and then started increasing at age 20 years. Mortality also increased exponentially with age for those aged 60 years and older for both sexes except for males aged 95 to 100 years.
Additionally, females had higher mortality than males in the group aged 0 to 44 years, but males then had higher mortality in the group aged 45 to 100 years.
There was an exponential increase in mortality in the United States among males and females alike aged 80 to 100 years as well, with a rapid increase in mortality for females aged 40 to 54 years. Females had lower mortality than males in the group aged 0 to 29 years and then higher mortality in the group aged 30 to 100 years.
Mortality increased faster with age in China than it did in the United States with a greater difference between the two countries in males than in females. Specifically, males aged 50 to 100 years in China had greater mortality and females aged 35 to 69 years in China had lower mortality than those in the United States.
Smoking was the leading risk factor for death from asthma in China, followed by high BMI and occupational asthmagens. However, mortality due to occupational asthmagens fell by 85.036%, mortality related to smoking fell by 72.854%, and mortality related to high BMI fell by 50.592% between 1990 and 2019.
High BMI was the leading risk factor for deaths from asthma in the United States, with smoking and occupational asthmagens following. But mortality attributable to these factors also fell in the Unted States during the study period, including decreases of 64.648% for smoking, 38.473% for occupational asthmagens and 33.855% for high BMI.
Overall, the researchers said, China had higher mortality rates for asthma than the United States between 1990 and 2019, but this gap gradually narrowed over the study period, with differences based on sex, age and risk factors.
These data also may inform asthma interventions that target populations most at risk, the researchers continued, including those who smoke, who have high BMI and who are exposed to occupational asthmagens, as well as the elderly.
Reference:
- Chinese Medical Journal article reveals key insights on the trends of asthma mortality. https://www.eurekalert.org/news-releases/1008893. Published Nov. 22, 2023. Accessed Dec. 7, 2023.
Perspective
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Asthma, like other chronic lung diseases, has had some therapeutic advances over the last 20 years. Unfortunately, those advances are at times counterbalanced by issues such as access to care, compliance with therapies and the changing environment with which individuals have to deal. The increasing number of wildfires and the continued prevalence of poor air quality especially in areas of industrialized countries are key reasons for exacerbations in diseases such as asthma, which lead to ED visits, hospitalizations and, at times, death.
Any time there are decreased deaths from a disease that should be able to be well controlled with current medical advances, it is encouraging. We need to stay on top of this situation through the development of medical interventions and equitable social determinants of health as mentioned above because we know that where people live and what resources they have access to make a difference in their quality of life and ability to live well and longer with their asthma.
I see two major areas where we can work to decrease asthma mortality. Working within societies at local, regional, national and global levels to improve the social determinants of health to all particularly enhancing access to and compliance with care for asthmatic individuals should improve their quality of life and longevity. The other major issue needs to be working on improving the air we breathe as well as combating the effect that climate change has on air quality through the increased number of wildfires, longer allergen seasons and the extremes in weather such as floods, hurricanes and droughts, which can disrupt medical services to those in need.
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