Asthma Mortality, Puerto Rico 2010 – 2015
Mortality due to asthma is mainly attributed to long periods of unwieldy management patterns of the condition. Poor asthma management can be caused by a series of preventable factors such as lack of knowledge or misapplication of asthma control guidelines by health care providers, lack of a written action plan, the patient’s lack of awareness of the condition’s severity, and lack of access to specialists or medications (D. H. Wilson et al., 2007).
Outcome Project, in collaboration with the Puerto Rico Asthma Project Chronic Disease Division of the Puerto Rico Department of Health, has recently gathered asthma mortality data to analyze asthma-related death distributions over time and according to certain demographics.
The goal of this analysis was to identify any trends in the distribution of asthma-related deaths or groups at particularly high risk of experiencing asthma-related deaths. This surveillance work can then be used to detect any changes in endemic rates in Puerto Rico, and to design prevention strategies for this disease.
The complete report describing these trends including its associated methods, results and discussion, can be found here.
Below are several findings from the results of this analysis that merit discussion.
Asthma death counts
A total of 415 asthma deaths were recorded in Puerto Rico between 2010 and 2015. When asthma related deaths were analyzed by year, a non-monotonic trend was observed over this period. Asthma-related deaths decreased from 89 in 2011 to 37 in 2013. Subsequently, an increase of 100 asthma-related deaths was recorded in the year 2014, decreasing to 89 deaths in 2015.
Crude asthma death rates
During the time period of observation the asthma death rate was lowest in the year 2013, with a rate of 1.03 per 100,000 individuals. The highest asthma death rate was recorded in the year 2014, at a rate of 2.83 per 100,000 individuals. Evaluating the confidence intervals between the highest and lower rates, a statistically significant difference in rates was observed.
When death rates were evaluated by age group, we found the lowest death rate to be among the 0-24 age group, at a rate of 0.06 per 100,000 individuals. The highest asthma death rate was recorded in the 65+ age group, at a rate of 7.77 per 100,000 individuals. The difference in rates between the two aforementioned age groups was statistically significant.
With regard to education level, those who had not graduated from high school had the highest asthma death rates at 4.64 per 100,000 individuals. Those with Bachelor’s degrees had the lowest asthma death rates at 0.5 per 100,000 individuals. The differences in rates between the two aforementioned education levels were statistically significant.
Age standardized asthma death rates
The 2015 Puerto Rico age-adjusted mortality rate using the 2010 US reference population was 2.18 per 100,00 individuals. When the yearly Puerto Rico’s crude rates was compared with the yearly age-standardized rates, a small difference between the two rates by year was observed. The 2015 US age-adjusted mortality rate using the 2010 US reference population was 1.06 per 100,000 individuals. When compared the US and Puerto Rico age-adjusted mortality rate for the year 2015 was observed a 1.12 times higher asthma mortality risk in Puerto Rico than in the US.
Disease mapping – Asthma deaths
The top five municipalities with the highest observed asthma-related deaths during the observation period were San Juan, Bayamón, Ponce, Mayagüez, and Arecibo with 36, 25, 22, 18, and 17 deaths, respectively. The municipalities of Ceiba, Culebra, Luquillo, Maunabo, and Rincón did not report any asthma-related deaths during the observed period. When analyzing asthma-related death rates during the observation period, it was observed that the top five municipalities with the highest age-adjusted rates were Las Marías, Mayagüez, Hormigueros, Añasco, and Lajas with 3.53, 3.33, 3.24, 3.19, and 3.13 deaths per 100,000 individuals, respectively. Lastly, the top five municipalities with the highest age-adjusted SMR during the observation period were Las Marías, Añasco, Moca, San Sebastían, and Mayagüez with 1.72, 1.67, 1.61, 1.59, and 1.56 respectively.Overall, it appears that the north-center, northwest and west regions of Puerto Rico were at higher risk of asthma-related deaths than other areas of the island.
Asthma is a common and important chronic health condition worldwide, and its prevalence is predicted to increase from 45% to 59% by 2025 (Masoli et al., 2004). Currently, it is estimated that asthma is responsible for 250,000 deaths per year in the United States (Masoli et al., 2004). The morbidity and mortality associated with this disease places an extreme burden on national health systems and results in a loss of quality of life for countless individuals, including in Puerto Rico. Fortunately, effective prevention and control measures exist for this disease.
The present analysis showed that several time trends and differences by key risk factors exist with regard to asthma mortality rates in Puerto Rico, indicating that through public health surveillance, appropriate public health control measures may be effectively implemented. Effective public health control measures may include improving support of treatment plans for patients and improving access to care among the overall and key populations in Puerto Rico. (Peters et al., 2007)
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