FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 331:1542-1546 December 8, 1994 Number 23 Next

	Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The rate of mortality from asthma has increased substantially in the United States since 1978. We analyzed the patterns of the rates of death from asthma in Philadelphia between 1969 and 1991.

Methods The rates of death from asthma were analyzed and compared with trends in the concentrations of major air pollutants: ozone, carbon monoxide, nitrogen dioxide, particulate matter (particles <10 microm in diameter), and sulfur dioxide. Univariate and multivariate analyses were used to study the rates of death from asthma from 1985 to 1991 and their association with race, poverty, sex, and other factors.

Results The rate of death from asthma decreased from 1.68 per 100,000 people in 1969 to 0.68 per 100,000 in 1977, but then increased to 0.92 per 100,000 in 1978 and 2.41 per 100,000 in 1991. Between 1965 and 1990, the concentrations of major air pollutants declined substantially. From 1985 to 1991, 258 people were identified for whom asthma was the primary cause of death. According to multivariate analysis, the rates of death from asthma from 1985 to 1991 were significantly higher in census tracts with higher percentages of blacks (P = 0.032), Hispanics (P = 0.013), female residents (P<0.001), and people with incomes in the poverty range (P<0.001).

Conclusions The rates of death from asthma have increased in Philadelphia, whereas concentrations of major air pollutants have declined. The rates are highest in census tracts with the highest percentages of poor people and minority residents, particularly blacks. Public health efforts should target urban areas where the risk of death from asthma is highest.

Source Information

From the Department of Medicine, Division of Allergy and Immunology (D.M.L.), and the Department of Humanities, Social Sciences, and Biometrics (M.P.), Hahnemann University Hospital, Philadelphia. Presented in part at the annual meeting of the American Academy of Allergy and Immunology, Chicago, March 16, 1993.

Address reprint requests to Dr. Lang at Hahnemann University, Mail Stop 107, Division of Allergy and Immunology, Broad and Vine Sts., Philadelphia, PA 19102-1192.

Full Text of this Article

This article has been cited by other articles:

• Wright, R. J., Subramanian, S.V. (2007). Advancing a Multilevel Framework for Epidemiologic Research on Asthma Disparities. Chest 132: 757S-769S [Abstract] [Full Text]  
• Eggleston, P. A. (2007). The Environment and Asthma in US Inner Cities. Chest 132: 782S-788S [Abstract] [Full Text]  
• Diette, G. B., Rand, C. (2007). The Contributing Role of Health-Care Communication to Health Disparities for Minority Patients With Asthma. Chest 132: 802S-809S [Abstract] [Full Text]  
• Erickson, S. E., Iribarren, C., Tolstykh, I. V., Blanc, P. D., Eisner, M. D. (2007). Effect of Race on Asthma Management and Outcomes in a Large, Integrated Managed Care Organization. Arch Intern Med 167: 1846-1852 [Abstract] [Full Text]  
• Szilagyi, P. G., Dick, A. W., Klein, J. D., Shone, L. P., Zwanziger, J., Bajorska, A., Yoos, H. L. (2006). Improved Asthma Care After Enrollment in the State Children's Health Insurance Program in New York. Pediatrics 117: 486-496 [Abstract] [Full Text]  
• Halterman, J. S., Conn, K. M., Forbes-Jones, E., Fagnano, M., Hightower, A. D., Szilagyi, P. G. (2006). Behavior Problems Among Inner-City Children With Asthma: Findings From a Community-Based Sample. Pediatrics 117: e192-e199 [Abstract] [Full Text]  
• Hunninghake, G. M., Weiss, S. T., Celedon, J. C. (2006). Asthma in Hispanics. Am. J. Respir. Crit. Care Med. 173: 143-163 [Abstract] [Full Text]  
• Hakonarson, H., Bjornsdottir, U. S., Halapi, E., Bradfield, J., Zink, F., Mouy, M., Helgadottir, H., Gudmundsdottir, A. S., Andrason, H., Adalsteinsdottir, A. E., Kristjansson, K., Birkisson, I., Arnason, T., Andresdottir, M., Gislason, D., Gislason, T., Gulcher, J. R., Stefansson, K. (2005). Profiling of genes expressed in peripheral blood mononuclear cells predicts glucocorticoid sensitivity in asthma patients. Proc. Natl. Acad. Sci. USA 102: 14789-14794 [Abstract] [Full Text]  
• Carroll, K. N., Griffin, M. R., Gebretsadik, T., Shintani, A., Mitchel, E., Hartert, T. V. (2005). Racial Differences in Asthma Morbidity During Pregnancy. Obstet Gynecol 106: 66-72 [Abstract] [Full Text]  
• Fisher, E. B., Strunk, R. C., Sussman, L. K., Sykes, R. K., Walker, M. S. (2004). Community Organization to Reduce the Need for Acute Care for Asthma Among African American Children in Low-Income Neighborhoods: The Neighborhood Asthma Coalition. Pediatrics 114: 116-123 [Abstract] [Full Text]  
• Schweitzer, L., Valenzuela, A. Jr. (2004). Environmental Injustice and Transportation: The Claims and the Evidence. Journal of Planning Literature 18: 383-398 [Abstract]  
• Halterman, J. S., Szilagyi, P. G., Yoos, H. L., Conn, K. M., Kaczorowski, J. M., Holzhauer, R. J., Lauver, S. C., Neely, T. L., Callahan, P. M., McConnochie, K. M. (2004). Benefits of a School-Based Asthma Treatment Program in the Absence of Secondhand Smoke Exposure: Results of a Randomized Clinical Trial. Arch Pediatr Adolesc Med 158: 460-467 [Abstract] [Full Text]  
• Wright, R. J., Mitchell, H., Visness, C. M., Cohen, S., Stout, J., Evans, R., Gold, D. R. (2004). Community Violence and Asthma Morbidity: The Inner-City Asthma Study. Am. J. Public Health 94: 625-632 [Abstract] [Full Text]  
• Burchard, E. G., Avila, P. C., Nazario, S., Casal, J., Torres, A., Rodriguez-Santana, J. R., Toscano, M., Sylvia, J. S., Alioto, M., Salazar, M., Gomez, I., Fagan, J. K., Salas, J., Lilly, C., Matallana, H., Ziv, E., Castro, R., Selman, M., Chapela, R., Sheppard, D., Weiss, S. T., Ford, J. G., Boushey, H. A., Rodriguez-Cintron, W., Drazen, J. M., Silverman, E. K. (2004). Lower Bronchodilator Responsiveness in Puerto Rican than in Mexican Subjects with Asthma. Am. J. Respir. Crit. Care Med. 169: 386-392 [Abstract] [Full Text]  
• McFadden, E. R. Jr. (2003). Acute Severe Asthma. Am. J. Respir. Crit. Care Med. 168: 740-759 [Abstract] [Full Text]  
• Newacheck, P. W., Stein, R. E. K., Bauman, L., Hung, Y.-Y., for the Research Consortium on Children With Chron, (2003). Disparities in the Prevalence of Disability Between Black and White Children. Arch Pediatr Adolesc Med 157: 244-248 [Abstract] [Full Text]  
• Riekert, K. A., Butz, A. M., Eggleston, P. A., Huss, K., Winkelstein, M., Rand, C. S. (2003). Caregiver-Physician Medication Concordance and Undertreatment of Asthma Among Inner-City Children. Pediatrics 111: e214-220 [Abstract] [Full Text]  
• Hovell, M. F., Meltzer, S. B., Wahlgren, D. R., Matt, G. E., Hofstetter, C. R., Jones, J. A., Meltzer, E. O., Bernert, J. T., Pirkle, J. L. (2002). Asthma Management and Environmental Tobacco Smoke Exposure Reduction in Latino Children: A Controlled Trial. Pediatrics 110: 946-956 [Abstract] [Full Text]  
• Halterman, J. S., Yoos, H. L., Kaczorowski, J. M., McConnochie, K., Holzhauer, R. J., Conn, K. M., Lauver, S., Szilagyi, P. G. (2002). Providers Underestimate Symptom Severity Among Urban Children With Asthma. Arch Pediatr Adolesc Med 156: 141-146 [Abstract] [Full Text]  
• Wu, A. W., Young, Y., Skinner, E. A., Diette, G. B., Huber, M., Peres, A., Steinwachs, D. (2001). Quality of Care and Outcomes of Adults With Asthma Treated by Specialists and Generalists in Managed Care. Arch Intern Med 161: 2554-2560 [Abstract] [Full Text]  
• Ford, J. G., Meyer, I. H., Sternfels, P., Findley, S. E., McLean, D. E., Fagan, J. K., Richardson, L. (2001). Patterns and Predictors of Asthma-Related Emergency Department Use in Harlem. Chest 120: 1129-1135 [Abstract] [Full Text]  
• Almeida, J. P., Lwebuga-Mukasa, J. S. (2001). Geographic Variations in Asthma Mortality in Erie and Niagara Counties, Western New York, 1991-1996. Am. J. Public Health 91: 1394-1395 [Full Text]  
• Kips, J C, Pauwels, R A (2001). Low dose inhaled corticosteroids and the prevention of death from asthma. Thorax 56: ii74-78 [Full Text]  
• Krishnan, J. A., Diette, G. B., Skinner, E. A., Clark, B. D., Steinwachs, D., Wu, A. W. (2001). Race and Sex Differences in Consistency of Care With National Asthma Guidelines in Managed Care Organizations. Arch Intern Med 161: 1660-1668 [Abstract] [Full Text]  
• Kelly, H. W. (2001). The Management of Acute Severe Asthma. Journal of Pharmacy Practice 14: 91-107 [Abstract]  
• Gregerson, M. B. (2000). The Curious 2000-Year Case of Asthma. Psychosom. Med. 62: 816-827 [Abstract] [Full Text]  
• Busse, W. W. (2000). A 47-Year-Old Woman With Severe Asthma. JAMA 284: 2225-2233 [Full Text]  
• ANDREW ALIGNE, C., AUINGER, P., BYRD, R. S., WEITZMAN, M. (2000). Risk Factors for Pediatric Asthma . Contributions of Poverty, Race, and Urban Residence. Am. J. Respir. Crit. Care Med. 162: 873-877 [Abstract] [Full Text]  
• PLATTS-MILLS, T. A. E., BLUMENTHAL, K., PERZANOWSKI, M., WOODFOLK, J. A. (2000). Determinants of Clinical Allergic Disease . The Relevance of Indoor Allergens to the Increase in Asthma. Am. J. Respir. Crit. Care Med. 162: S128-133 [Full Text]  
• Adams, R. J, Smith, B. J, Ruffin, R. E (2000). Factors associated with hospital admissions and repeat emergency department visits for adults with asthma. Thorax 55: 566-573 [Abstract] [Full Text]  
• Winkelstein, M. L., Huss, K., Butz, A., Eggleston, P., Vargas, P., Rand, C. (2000). Factors Associated with Medication Self Administration in Children with Asthma. CLIN PEDIATR 39: 337-345 [Abstract]  
• Rome, L. A., Lippmann, M. L., Dalsey, W. C., Taggart, P., Pomerantz, S. (2000). Prevalence of Cocaine Use and Its Impact on Asthma Exacerbation in an Urban Population. Chest 117: 1324-1329 [Abstract] [Full Text]  
• Rona, R. J (2000). Asthma and poverty. Thorax 55: 239-244 [Full Text]  
• Halterman, J. S., Aligne, C. A., Auinger, P., McBride, J. T., Szilagyi, P. G. (2000). Inadequate Therapy for Asthma Among Children in the United States. Pediatrics 105: 272-276 [Abstract] [Full Text]  
• Addington, W. W., Weiss, K. B. (1999). Chicago's Response to the Public Health Challenge of Urban Asthma. Chest 116: 132S-134S [Full Text]  
• Weiss, K. B., Grant, E. N. (1999). The Chicago Asthma Surveillance Initiative: A Community-Based Approach to Understanding Asthma Care. Chest 116: 141S-145S [Abstract] [Full Text]  
• Weiss, K. B., Grant, E. N., Li, T. (1999). The Effects of Asthma Experience and Social Demographic Characteristics on Responses to the Chicago Community Asthma Survey-32. Chest 116: 183S-189S [Abstract] [Full Text]  
• Russo, M. J., McConnochie, K. M., McBride, J. T., Szilagyi, P. G., Brooks, A. M., Roghmann, K. J. (1999). Increase in Admission Threshold Explains Stable Asthma Hospitalization Rates. Pediatrics 104: 454-462 [Abstract] [Full Text]  
• VEEN, J. C. C. M.i.`t, SMITS, H. H., HIEMSTRA, P. S., ZWINDERMAN, A. E., STERK, P. J., BEL, E. H. (1999). Lung Function and Sputum Characteristics of Patients with Severe Asthma During an Induced Exacerbation by Double-Blind Steroid Withdrawal. Am. J. Respir. Crit. Care Med. 160: 93-99 [Abstract] [Full Text]  
• Smith, L. J. (1999). Newer Asthma Therapies. ANN INTERN MED 130: 531-532 [Full Text]  
• VEEN, J. C. C. M.i.'t, SMITS, H. H., RAVENSBERG, A. J. J., HIEMSTRA, P. S., STERK, P. J., BEL, E. H. (1998). Impaired Perception of Dyspnea in Patients with Severe Asthma . Relation to Sputum Eosinophils. Am. J. Respir. Crit. Care Med. 158: 1134-1141 [Abstract] [Full Text]  
• ZORATTI, E. M., HAVSTAD, S., RODRIGUEZ, J., ROBENS-PARADISE, Y., LAFATA, J. E., MCCARTHY, B. (1998). Health Service Use by African Americans and Caucasians with Asthma in a Managed Care Setting. Am. J. Respir. Crit. Care Med. 158: 371-377 [Abstract] [Full Text]  
• APTER, A. J., REISINE, S. T., AFFLECK, G., BARROWS, E., ZUWALLACK, R. L. (1998). Adherence with Twice-daily Dosing of Inhaled Steroids . Socioeconomic and Health-belief Differences. Am. J. Respir. Crit. Care Med. 157: 1810-1817 [Abstract] [Full Text]  
• Harrison, B D W (1998). Psychosocial aspects of asthma in adults. Thorax 53: 519-525 [Full Text]  
• Squillace, S., Sporik, R., Rakes, G, Couture, N, Lawrence, A, Merriam, S, Zhang, J, Platts-Mills, A. (1997). Sensitization to dust mites as a dominant risk factor for asthma among adolescents living in central Virginia. Multiple regression analysis of a population-based study. Am. J. Respir. Crit. Care Med. 156: 1760-1764 [Abstract] [Full Text]  
• Platts-Mills, T. A., Woodfolk, J. A. (1997). Rise in Asthma Cases. Science 278: 997-1001 [Full Text]  
• Grana, J., Preston, S., McDermott, P. D., Hanchak, N. A. (1997). The Use of Administrative Data to Risk-Stratify Asthmatic Patients. American Journal of Medical Quality 12: 113-119 [Abstract]  
• Swanson, K. A. (1997). Meeting Patient Needs in Asthma Education. Journal of Pharmacy Practice 10: 211-221 [Abstract]  
• Beausoleil, J. L., Weldon, D. P., McGeady, S. J. (1997). beta 2-Agonist Metered Dose Inhaler Overuse: Psychological and Demographic Profiles. Pediatrics 99: 40-43 [Abstract] [Full Text]  
• du Bois, R M (1995). Recent Advances: Respiratory medicine. BMJ 310: 1594-1597 [Full Text]  
• Jay, S. J., Kane, G. C., Petsonk, E. L., Castellan, R. M., Wagner, G. R., Silverstein, M. D., Yunginger, J. W., Lang, D. M., Polansky, M., Buist, A. S., Vollmer, W. M. (1995). Patterns of Mortality from Asthma. NEJM 332: 1379-1381 [Full Text]  
• (1994). ASTHMA MORTALITY REVISITED. JWatch General 1994: 3-3 [Full Text]  
• Buist, A. S., Vollmer, W. M. (1994). Preventing Deaths from Asthma. NEJM 331: 1584-1585 [Full Text]