An International Comparison of Asthma Morbidity and Mortality in US Soldiers (Part 5)There were significant differences in sex, age, and race between the deaths at the two locations. The largest increase in mortality, for Europe vis-d-vis CONUS, was observed for male subjects, nonblack subjects, and those over the age of 24 yr (p<0.01 in all cases). The largest increases in the incidence of death were observed for male subjects who experienced an 8.7-fold higher mortality in Europe, and for those older than 24 yr, with a 8.5-fold higher rate. The rate for female subjects and for those less than 25 yr was approximately twice as high in Europe. Black subjects experienced nearly proportionate mortality for the two locations. The proportion experiencing hospital deaths, as opposed to out-of-the-hospital deaths or “dead on arrivaT (DOA), potentially reflecting access to care, was also not statistically different (p>0.1). further

The time distribution was signficantly different (p<0.05, FET), with both deaths in CONUS occurring in the first half of the interval, while all deaths in Europe occurred in the last half. In fact, three of the five deaths in Europe occurred over two years in one of 11 hospital catchment areas. Population data for such areas are unavailable, but this suggests that clustering cannot be ruled out. Fifty percent of the deaths in Europe occurred in the third quarter, and 83 percent occurred in the second and third quarters combined. The figures for CONUS are 25 and 50 percent, respectively. The difference is not significant, but it is consistent with the seasonal pattern of hospital discharges observed previously.
Discussion
This investigation was prompted by the concern expressed in several military communities in Europe that the incidence of asthma and exacerbations of asthma was greater than one would expect based on CONUS experience. This concern was not focused exclusively on the active-duty subjects but included all family members; however, this investigation was restricted to soldiers because, regrettably, the Army does not maintain demographic information on soldiers* families, thereby precluding the determination of epidemiologic denominators for this group, which includes all of the children and most of the adolescents who are known to experience prevalence and incidence rates for asthma that are as high, or perhaps even a bit higher, than in the age group examined here.

 

Category: Main / Tags: asthma, pulmonary function, respiratory disease