Decrease in asthma mortality rate in Israel from 1991-1995: Is it related to increased use of inhaled corticosteroids?,☆☆

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Abstract

Background: Asthma mortality rates (AMRs) during the last several decades increased in many countries with developed medical services, including Israel. The reasons for this trend were never established. Recent data suggested that this trend is changing. Objectives: We sought to compare the AMR in Israel during 1991-1995 with that of the previous decade and to investigate a possible correlation between mortality rates and use of inhaled corticosteroids (ICSs) and β2-agonists. Methods: Statistical data on the AMR in Israel during 1981-1995 were extracted. Data were analyzed for 5- and 10-year periods (1981-1990) and compared with a 5-year period (1991-1995). Data on ICS and β2-agonist sales were extracted from the marketing companies’ official reports. Results: The mean AMR per 100,000 population per year during 1981-1990 in the 5- to 34-year-old group was 0.393 ± 0.055 and decreased to 0.202 ± 0.046 during the 1991-1995 period (P = .03). There was no significant difference between changes in mean AMR in the 35- to 64-year-old or in the 5- to 64-year-old group during the same periods (4.568 vs 4.063 and 2.480 vs 2.133). The mean ICS unit sales rates (per 100,000 population per year) between 1982-1990 and 1991-1995 were 21.70 and 190.45, respectively (P < .05). The correlation between ICS sales and AMR was –0.631 (P = .016). Sales of β2-agonists did not change significantly during the study period. Conclusions: We identified a trend of decreased AMRs in Israel during 1991-1995. The decline in AMRs paralleled the increase in ICS sales, whereas the sales of inhaled β2–agonists did not change significantly. One may speculate that the decrease in AMR may be the result of better anti-inflammatory treatment, as reflected by the increased use of ICSs. The feasibility of reducing AMRs in a country such as Israel, with low AMRs to start with, by improving medical treatment is encouraging. (J Allergy Clin Immunol 2000;105:71-4.)

Section snippets

METHODS

The annual AMR was derived from the Department of National Health Statistic’s publications for the years 1971-1995.

Deaths from asthma were diagnosed in accordance with the International Classification of Diseases coding. It should be noted that the coding was changed in 1979. To avoid overestimation of changes in death rates from asthma after 1979, before that date we included cases reported under bronchial asthma, chronic bronchitis, and emphysema.3 After 1979, all 3 entities were reported

RESULTS

The absolute number of deaths under the codes of obstructive lung diseases for each 5-year period is shown in Table I.

. Absolute number of deaths attributed to obstructive lung disease

Empty CellAge groups
5-34 y35-64 y
1971-197533434
1976-198017205
1981-198541218
1986-199044226
1991-199526245

The mean AMR in the 5- to 34-year-old population decreased to 0.202 ± 0.046 during 1991-1995 compared with 0.388 ± 0.066 and 0.398 ± 0.091 during 1981-1985 and 1986-1990, respectively. This figure is significantly lower

DISCUSSION

We observed a decrease in AMR in Israel during 1991-1995 compared with the preceding decade. This decrease was significant only in the 5- to 34-year-old group, and it paralleled an increase in sales of ICSs.

The AMR in Israel was low compared with that of Western countries. There are no data regarding the validity of asthma death certificates in Israel; however, studies from England and Northern Ireland revealed that asthma death certificates are more accurate in the younger age group.17, 18 To

Acknowledgements

We thank S. Shir (Glaxo-Wellcome Israel), Amir El-Chasid (Teva, distributer of Astra in Israel), and L. Choppe (Trading Pharma representative of Schering-Plough in Israel) for supplying the data about drug sales in Israel; R. C. Strunk, MD, for critical review and helpful comments; Yael Villa, PhD, for the statistical analysis; and Anji Agajany for secretarial assistance.

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    Reprint requests: Yitzhak Katz, MD, Pulmonary and Allergy Institute, Assaf Harofeh Medical Center, Zerifin 70300, Israel.

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