Trends in Asthma Mortality in the United States: 1999 to 2015

Asthma is a chronic lung disease that is estimated to affect 26 million people in the United States as of 2016 (1).As the U.S. population ages, there are more elderly patients older than 65 years who have asthma.Aging has been associated with changes in asthma pathophysiology, symptoms, and response to therapy (2).Higher morbidity and mortality have been associated with this population.The reasons for this are multifaceted.These patients tend to underperceive their symptoms, and they are underdiagnosed and undertreated.Asthma in the elderly has been associated with more severe and difficult-to-treat asthma, and it is associated with higher inhaled corticosteroid and long-acting b-agonist use compared with adult patients with asthma aged 45 years and younger (3).Asthma mortality is highest in the population older than 65 years, even after adjusting for other age-related comorbidities (4).Differences in asthma severity have also been observed in women and black patients.Women have more severe asthma, higher hospitalization rates, and higher mortality rates (4, 5).Black patients with asthma have poorer asthma control, more emergency room visits, and more treatment failures (6, 7).In this letter, we investigate the trends in asthma mortality in the United States from 1999 to 2015 and explore the variation in different age groups, sex, and race.Some of the results of this study have been previously reported in the form of an abstract (8). Methods and ResultsWe conducted a population-based study using data collected by the CDC's National Asthma Control Program on asthma prevalence, and the CDC's Wide-Ranging Online Data for Epidemiologic Research (WONDER), based on death certificates for US residents from 1999 to 2015.Results were adjusted for * P , 0.001 versus T1.