Trends in Hospitalizations and Mortality From Asthma in Costa Rica Over a 12- to 15-year Period

doi:10.1016/j.jaip.2013.09.010

The Journal of Allergy and Clinical Immunology: In Practice

Volume 2, Issue 1, January–February 2014, Pages 85-90

https://doi.org/10.1016/j.jaip.2013.09.010 Get rights and content

Background

Little is known about trends in morbidity and/or mortality due to asthma in Latin America.

Objective

To examine trends in hospitalizations and mortality due to asthma from 1997-2000 to 2011 in Costa Rica.

Methods

The rates of hospitalization due to asthma were calculated for each sex in 3 age groups from 1997 to 2011. The number of deaths due to asthma was first calculated for all groups and then for each sex in 3 age groups from 2000 to 2011. All analyses were conducted over the entire period and separately for the periods before and after a National Asthma Program (NAP) in 2003. Data also were available for prescriptions for beclomethasone since 2004. All analyses were conducted by using Epi Info.

Results

Substantial reductions were found in hospitalizations and deaths due to asthma in Costa Ricans (eg, from 25 deaths in 2000 to 5 deaths in 2011). Although, the percentage decrement in the rates of hospitalization for asthma in subjects <20 years old was similar before and after the NAP, the reduction in both deaths due to asthma and rates of asthma hospitalizations in older subjects were more pronounced after the NAP, when prescriptions for beclomethasone were also increased by approximately 129%.

Conclusion

In Costa Rica, there was a marked decrement in hospitalizations and mortality due to asthma from 1997-2000 to 2011. In younger subjects, this is likely due to guidelines that, since 1988, recommend inhaled corticosteroids for persistent asthma. In older adults, the NAP probably enhanced reductions in hospitalizations and deaths due to asthma through inhaled corticosteroid use.

Section snippets

Methods

As part of the Costa Rican nationwide health care system, the Caja Costarricense del Seguro Social collects complete information on all hospitalizations and deaths that occur at public hospitals or health care centers (which care for approximately 4.5 million people). Information on hospitalizations and deaths due to asthma (as coded by the treating physicians) as well as prescriptions for 3 medications (beclomethasone, montelukast, and formoterol) approved by the Caja Costarricense del Seguro

Results

Between 1997 and 2011, there were 56,002 hospitalizations for asthma in Costa Rica. Of these 56,002 hospitalizations, 35,714 (64%) were for subjects younger than 20 years. The total number of asthma hospitalizations in Costa Rica in both children and adults decreased by approximately 53% from 1997 (n = 5207) to 2011 (n = 2459). The sex-adjusted rates of hospitalizations for asthma in Costa Rica in the 3 age groups from 1997 to 2011 are shown in Figure 1. Although the sex-adjusted rate of asthma

Discussion

We found substantial reductions in the rate of hospitalizations for and deaths due to asthma in Costa Ricans over a 12- to 15-year period (1997-2000 to 2011). Whereas, the percentage decrement in the rates of hospitalization for asthma in subjects 20 years old and younger was similar before and after implementation of the NAP, both the percentage reduction in the total number of deaths due to asthma in older subjects (either >35 years old or >40 years old) and the percentage decrement in the

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: J. C. Celedón's contribution to this work was supported by grants HL073373, HL079966, and HL117191 from the US National Institutes of Health and by an endowment from the Heinz Foundation.

: Conflicts of interest: J. C. Celedón has received research support from the National Institutes of Health, has received consultancy fees from Genentech, and has received royalties from UpToDate. The rest of the authors declare that they have no relevant conflicts of interest.

^∗: These authors contributed equally to this work.

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Original ArticleTrends in Hospitalizations and Mortality From Asthma in Costa Rica Over a 12- to 15-year Period

Background

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Chest

Lancet

J Pediatr

J Allergy Clin Immunol

Epidemiological studies of the very high prevalence of asthma and related symptoms among school children in Costa Rica from 1989 to 1998

Pediatr Allergy Immunol

Dust mite exposure modifies the effect of functional IL10 polymorphisms on allergy and asthma exacerbations

J Allergy Clin Immunol

Guia de Diagnostico y Tratamiento del Niño Asmatico. Guia Pediatrica Basica de Diagnostico y Tratamiento I Infecciones respiratorias Agudas II Asma BronquialApoyo a los Recursos Humanos en el Plan de Supervivencia Infantil PASCAP OPS/OMS

Inhaled steroids and the risk of hospitalization for asthma

JAMA

Original Article
Trends in Hospitalizations and Mortality From Asthma in Costa Rica Over a 12- to 15-year Period