An International Comparison of Asthma Morbidity and Mortality in US Soldiers (Part 7)Woolcock reported comparative mortality for the United States and West Germany as of 1980. The allages mortality in the former was 0.2/100,000 population and 0.4/100,000 in the latter. The US age-specific mortality for those between the ages of 20 and 40 yr was similar to the all-ages mortality. The US figure is approximately ten times higher than the results reported herein; whereas for soldiers serving in Europe, mortality is only three times less than that reported for local nationals. A more recent estimate of US mortality is given in a report by Evans et al, in which the age-specific mortality for ages 15 to 34 yr is 0.4/ 100,000 for calendar year 1982, a rate more than 16 times higher than the value reported herein. there

The lower rates observed in this study most likely represent the “healthy-worker” effect, in that persons with severe asthma are less likely to seek or qualify for military service. The absence of children in the current data set should have the effect of increasing estimated mortality, if anything, since children exhibit uniformly lower rates than adults. The race-specific and sex-specific rates for the same year reveal that mortality is much higher in black subjects (1.1 to 1.5) and of a similar magnitude for male and female subjects, with no apparent difference in rates for those above and below 24 yr of age. This contrasts with the findings reported here, in which mortality is lower in black subjects, in those under 25 yr, and in male subjects, although the latter is less pronounced in Europe than in CONUS. The reasons for these discrepancies are far from clear but may reflect the fact that soldiers are not simply a random sample of the general US population. There is a further paradox in that male subjects, exhibiting lower overall mortality, display the greatest increase in Europe compared to CONUS. Although the denominators are large, total deaths are relatively few, suggesting that the estimates reported herein may be somewhat unstable, precluding definitive analysis at the present time.

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