Asthma deaths among coloured and white South Africans: 1962 to 1988

doi:10.1016/S0954-6111(05)80347-6

Respiratory Medicine

Volume 88, Issue 3, March 1994, Pages 195-202

https://doi.org/10.1016/S0954-6111(05)80347-6 Get rights and content

To determine whether death rates from asthma have been rising in South Africa, asthma mortality rates among coloured and white South Africans were calculated from official figures for the years 1962–1988. Sharp increases in the 1960s were noted in both groups. Since the early 1970s whites rates have generally shown a downward trend. In contrast, coloured rates have remained high, with a marked excess of male deaths. In the age stratum 5–34 years, there has been considerable fluctuation, with the long-term trend being slightly downward. Some increase in death rates occurred among the young in the early 1980s, but coloureds in this age group have shown falling rates in the most recent years. Coloured death rates in the younger age stratum have, however, continued to exceed whites rates, although by a decreasing margin, and have been high by international comparison. These group disparities are unlikely to be due to differences in certification or in coding. Variation in prevalence or severity of asthma may explain some of the disparity. However, these group differences, taken with well-known inequalities in medical care, suggest that preventable determinants of asthma deaths related to access to and quality of medical care may be important and accordingly a target for preventive strategies.

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Socio-epidemiological aspects of respiratory allergic diseases in Southern Africa
2012, World Allergy Organization Journal
Citation Excerpt :
In a study carried out in 1991, in Zimbabwe, children of different race but with similar socioeconomic background demonstrated that the prevalence of bronchial hyperresponsiveness was similar between black and white children of a similar social status [72]. A very important study aimed to determine whether death rates from asthma have been rising in South Africa calculated asthma mortality rates among colored and white South Africans from official figures for the years 1962 to 1988 [73]. Sharp increases in the 1960s were noted in both groups.
The prevalence of respiratory allergic diseases has been increasing in Southern Africa both in urban and in rural environments. Various factors may contribute toward this situation, namely, exposure to aeroallergens, such as grass pollens and house dust mites. However, other irritant environmental triggers, such as exposure to tobacco smoke and certain indoor and outdoor fumes, may also play a relevant part. Furthermore, certain parasitic and mycobacterial infections may act as allergic disease risk modifiers, although such an influence should be confirmed. Finally, certain cultural and socioeconomic factors may also influence accessibility to healthcare and adherence to treatment of these diseases.
Respiratory disease: Does ethnicity matter?
2004, Primary Care Respiratory Journal
Asthma management and perceptions in rural South Africa
2001, Annals of Allergy, Asthma and Immunology
Many First World countries have endeavored to measure the impact of asthma on individuals with asthma and, in addition to this quality of life evaluation, have attempted to define the quality of care for this common chronic illness.
The primary objective of this research probe was to assist the National Asthma Program in South Africa with the formulation and delivery of its outreach program to rural asthmatic patients.
A discussion/questionnaire document was compiled by Partners in Research from established literature. All interviews were conducted in either the clinics, hospitals, or respondents' homes. Both adult asthmatic patients and parents of pediatric asthmatic patients were interviewed. Interviewing took place at seven rural health clinics across South Africa. Each interview included extensive demographic details, questions on asthma definition, symptoms and symptom triggers, family history, age at diagnosis, frequency of symptoms, and treatment.
Thirty-five adult asthmatic patients and 27 parents of pediatric asthmatic patients were interviewed. Of the adults, 40% reported wheezing at least once a week (despite diagnosis and treatment) and 19% of children reported similar symptom exacerbations. Fifty-one percent of adults and 56% of children were awakened at least once a week by cough or wheeze. Quality of life measurement reflected that, on average, 37% of responders were frightened during an acute asthma attack, and 68% of parents reported fearing the death of their asthmatic children. Fifty-one percent of adults and 33% of children had been hospitalized at least once for asthma. Although respondents claimed regular training in use of inhaler device, only 43% of adults completed each step correctly.
There is a great deal of fear and ignorance surrounding asthma and, therefore, there is a real need for a greater level of patient education even in the rural areas of South Africa. In rural South Africa, attention should be paid to nurses, because they play a greater role than doctors in management and education of asthma.
Fatal and near-fatal asthma questionnaire: Prelude to a national registry
1999, Journal of Allergy and Clinical Immunology
Background: Asthma mortality rates continue to be unacceptably high in the United States. As a follow-up to the initiatives proposed by the Asthma Mortality Task Force in 1987, the Committee on Asthma Mortality of the American Academy of Allergy, Asthma, and Immunology developed a questionnaire on fatal and near-fatal asthma. Objective: This study assessed completeness of answers from participating physicians and described characteristics of patients with fatal and near-fatal asthma. Methods: There were 111 survey items intended to characterize patients with fatal or near-fatal exacerbations of asthma. The questionnaire was sent to the members of the American Academy of Allergy, Asthma, and Immunology (approximately 3900), and a total of 143 usable questionnaires were received. Results: Responding physicians had information on most items in the questionnaire; the mean number of responses was 120 of 143 possible, with a median of 128 and a range of 40 to 143. Patient demographics, description of the event, identification of overall risk for the event, use of medications, and characteristics of asthma management had the most complete responses (median response rates were 126-143). Presence of factors contributing to the event had fewer responses (range, 44-125). The physicians frequently had information on some psychologic characteristics (eg, 108 responses for depression and/or hopelessness and 127 responses for social support) but less information on several others (eg, 62 responses for family dysfunction). Statistical analysis of the completed surveys indicated that only 2 characteristics distinguished fatal from near-fatal asthma: progression in minutes (adjusted odds ratio, 4.89; 95% confidence interval, 2.05-12.90) and absence of a past history of intubation (adjusted odds ratio, 3.55; 95% confidence interval, 1.55-8.97). Conclusions: There is a need to gather further data on patients with fatal and near-fatal events to design appropriate prospective studies on asthma morbidity and mortality rates. Physicians can contribute important information about these patients. Gathering such data would be enhanced by establishing a national registry on fatal and near-fatal asthma. (J Allergy Clin Immunol 1999;104:763-8.)
Factors associated with emergency department dependence of patients with asthma
1997, Chest
Dependence on crisis-oriented care rather than continuous ambulatory care for asthma is thought to contribute to asthma morbidity and mortality. We contrasted the characteristics of patients who depend on emergency department (ED) care for the management of their asthma exacerbations to the characteristics of patients employing self-management plans in an ambulatory setting.
In prospective fashion, we used a structured interview and charted information to survey two cohorts of patients suffering from an acute exacerbation of asthma: those seen in a hospital ED (n=80) and those seen in an ambulatory asthma care facility (Asthma Center [AC]) (n=40) at the same hospital. We looked for differences in socioeconomic characteristics, asthma severity, asthma knowledge, and asthma self-management skills between groups.
There were no significant differences in mean age (SD) (ED vs AC: 36.65 [13.8] vs 40 [13.8] years) or female to male ratio (ED vs AC: 2/1 vs 2.5/1) between the two groups. There were no major differences in ethnic origin, educational status, marital status, smoking history, employment status, number of children in the household, possession of an extended health insurance plan, sick leave benefits, and child care availability between the two groups. Patients seeking ED care were more likely to have resided in the city for <5 years (34% vs 8%; p<0.05), and more likely to be living alone (35% vs 15%; p<0.05). Significantly more patients from the ED group had a below average gross annual income (55% vs 3%; p<0.05). There were several significant differences between groups in their knowledge of asthma and its therapy. Most striking, 79% of AC patients reported having a predetermined crisis plan vs just 23% of ED patients (p<0.001). Although measurements of airflow (percent predicted FEV₁) were significantly lower in the ED group than the AC group (mean, 50% vs 78.4%; p<0.001), other indexes reflecting the degree of asthma severity over the long term such as past use of oral steroids, history of hospitalization, or ICU admission for asthma and the mean total days of disability within the preceding year were not significantly different between the two groups. Most of the ED patients had more than one previous visit to the ED for asthma exacerbation within the preceding year while most exacerbations of AC patients had been treated in the ambulatory care setting. Only 17% of ED patients initiated or increased inhaled or oral steroids before seeking medical care vs 89% of AC patients (p<0.001).
We conclude that a subgroup of asthmatics depends primarily on crisis-oriented care for the management of asthma. These patients are more likely to have lower income, to live alone, and to have resided at their current address for less time than patients seeking less urgent ambulatory care. Moreover, such patients are less knowledgeable about asthma and its management and are less likely to have a predetermined crisis plan.
Asthma mortality in Mauritius: 1982-1991
1997, Annals of Allergy, Asthma and Immunology
Bronchial asthma is a common problem in the island of Mauritius and its prevalence seems to be increasing.
In order to appreciate the magnitude of the problem, patterns of asthma mortality were studied during a period of 10 years.
All death certificates issued in the island from 1982 to 1991 were reviewed and all cases of asthma deaths were selected.
The global asthma mortality rate was found to be 20/100,000 in 1982, and it decreased to 12/100,000 in 1991. Similarly, the asthma death rate for the 1 to 4 year age group decreased from 20/100,000 in 1982 to 5/100,000 in 1991. For the 5 to 34 year age group, it decreased form 2.6/100,000 in 1982 to 1.02/100,000 in 1991. There was no statistically significant difference between the various ethnic groups.
Our study showed that in a developing country such as Mauritius, asthma death rates may be high but may show decreasing trends. Nevertheless, it is generally perceived that the prevalence of the disease is increasing.

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View full text

Asthma deaths among coloured and white South Africans: 1962 to 1988

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

J Allergy Clin Immunol

Respir Med

Lancet

Lancet

J Allergy Clin Immunol

Lancet

Mortality from asthma: a new epidemic in New Zealand

BMJ

International trends in asthma mortality: 1970–1985

Chest

Changing pattern of asthma mortality

JAMA

Beta agonists and asthma mortality: deja vu

Clin Exp Allergy

Deaths from asthma in Cape Town, 1980–1982

S Afr Med J

African vital statistics-a black hole?

S Afr Med J

Rekonstruksie van die sensusouderdomstrukture van die Suid-Afrikaanse swart bevolking: 1936 tot 1985

Central Statistical Service. Deaths: Whites, Coloured and Asians. Report nos. 45/1965 (1959–1962) to 03-09-01

Rekonstruksie van die sensusouderdomstrukture van die Suid-Afrikaanse asier-, blanke en kleurlingbevolkings: 1946 tot 1985

Central Statistical Service. South African Statistics 1990