ASTHMA AND RESPIRATORY FAILURE MORTALITY ACROSS PEDIATRIC AND ADULT POPULATIONS: A 22-YEAR US ANALYSIS (1999-2020)

MIAN ZAHID JAN KAKAKHEL; MUHAMMAD Ismail; MARIO Gonzalez; ASAD ALI AHMED CHEEMA; MOHAMED FAWZI Hemida; ABU HURAIRA BIN GULZAR; HASAN Ilyas; MUHAMMAD USMAN Haider; ISHTIAQ Ahmad; MADHO Mal; MUHAMMAD SIRTAJ Afridi; HAMNA Jawad; JIBRAN Ikram; ABDUL Qadeer; SHERIF Eltawansy

doi:10.1016/j.chest.2025.07.016

PURPOSE: This study aims to analyze long-term trends in asthma mortality with respiratory failure across pediatric and adult populations in the U.S. from 1999 to 2020. By examining demographic and geographic disparities, the research seeks to identify high-risk populations and critical time points for intervention. The findings will inform targeted public health strategies to reduce asthma-related mortality and improve healthcare outcomes, particularly among vulnerable groups such as Black individuals and residents of the South. METHODS: Mortality data for asthma with respiratory failure (ICD-10 codes J45-J46, J96) were extracted from the CDC WONDER database for 1999-2020. The analysis included pediatric data (ages 1-14 years) and adult data (ages 45 years and older). Age-adjusted mortality rates were calculated per 100,000 US population. JoinPoint regression software (version 5.3) was used to analyze trends, calculating average annual percent change (AAPC) and annual percent change (APC) with corresponding 95% confidence intervals and p-values. RESULTS: Adult Population (45+ years), between 1999 and 2020, adult asthma mortality with respiratory failure exhibited a fluctuating trend, marked by an initial decline followed by a significant increase (AAPC=2.50, p<0.001). Mortality decreased until 2007 (APC=-2.16, p<0.001) before rising sharply (APC=5.47, p<0.001). This pattern was observed in both sexes, though males ultimately experienced a higher mortality rate in 2020 (121.54 per million) than females (115.11 per million). Mortality varied across age groups, with the sharpest increase seen in the 45-54 age group from 2018-2020 (APC=14.88, p=0.004). Racial disparities were evident. Black adults experienced a substantial mortality increase from 2015 onwards (APC=9.22, p<0.001), reaching the highest rate in 2020 (201.51 per million). White adults experienced a more complex trend, with periods of both decline and increase. Asian/Pacific Islander adults experienced the lowest mortality overall (52.3 per million in 2020). Metropolitan areas saw a higher mortality rate (113.27 per million) than non-metropolitan areas (94.77 per million) in 2020. Pediatric Population (1-14 years): A significant overall increase in pediatric asthma mortality with respiratory failure was observed from 1999-2020 (APC=0.72, p=0.005). The AAMR fluctuated, peaking in 2015. Females showed a higher APC (1.03, p=0.02) than males (0.55, p=0.08), though males had a consistently higher AAMR. Regional variations were apparent, with the South experiencing the highest APC (1.52, p=0.002) and AAMR in 2020. Children aged 5-14 had a higher mortality burden (APC=1.10, p=0.003) than those aged 1-4. Racial disparities were striking, with Black children experiencing significantly higher mortality (APC=1.23, p=0.0004; AAMR=9.29 per million) compared to White children (AAMR=1.37 per million). Mortality increased in metropolitan areas (APC=0.49, p=0.03). While both adult and pediatric populations experienced increasing trends in asthma mortality with respiratory failure, the pediatric increase was more consistent while the adult trend was marked by a shift from decline to increase around 2007. Racial disparities were pronounced in both groups, with Black individuals experiencing the highest mortality rates. CONCLUSIONS: Asthma mortality with respiratory failure is rising, especially since 2007 in adults. Targeted interventions are crucial, particularly for Black individuals and Southern regions. Further research is needed. CLINICAL IMPLICATIONS: Targeted interventions can reduce asthma mortality, especially in high-risk groups like Black individuals and Southerners.

ASTHMA AND RESPIRATORY FAILURE MORTALITY ACROSS PEDIATRIC AND ADULT POPULATIONS: A 22-YEAR US ANALYSIS (1999-2020)

View Online

Abstract

Details

Metrics