(31) National Trends and Racial Disparities in Pediatric Asthma-Related Mortality in the United States, 1999-2020

Background: Asthma-related deaths in children are rare and population-based studies that evaluate recent trends and disparities in pediatric asthma-related mortality are scarce.

Objectives: To evaluate the national trends and racial, gender, and geographic differences in asthma-related mortality in children in the United States from 1999 to 2020.

Design/Methods: We conducted a retrospective cross-sectional study of national death certificate data from the CDC WONDER database. We included children aged 2-21 years with asthma (ICD-10 codes J45 and J46) as a contributing cause of death in the multiple cause of death dataset. We excluded children aged < 2 years to avoid the inclusion of bronchiolitis. The exposure variable was year of death and the outcomes were asthma-related crude mortality rate (ACMR), overall, and stratified by gender, race, and census region. ACMR was calculated per 1,000,000 children. The race analysis was limited to only Non-Hispanic Black (NHB) and Non-Hispanic White (NHW). Mann-Whitney U test and ANOVA were used for group comparisons of ACMR as appropriate. We used NHB to NHW ACMR ratio to measure racial differences in ACMR. Trends were evaluated with Joinpoint regression and expressed as average annual percentage change (AAPC) with 95% confidence interval (CI).

Results: Out of 1.8 billion children, 7,310 aged 2-21 years had asthma-related deaths (overall ACMR of 4.1 per 1,000,000 population). The ACMR differed by gender (males, 4.9 vs females, 3.1; P< 0.001), race (NHB, 12.8 vs NHW, 2.4; P< 0.001) [Figure 1], and census region (highest in the Midwest, 4.7 and lowest in the West, 3.1; P< 0.001). From 1999 to 2020, the change in the overall ACMR was not significant (4.8 to 5; AAPC 0%; CI: -0.6, 1.1%). However, the ACMR increased in NHB from 12.2 to 15.4 (AAPC 1.3%; CI: 0.5, 2.1%). From 2005 to 2020, the ACMR increased for females (2.4 to 4.3; AAPC 2.5%; CI: 0.9, 10.6%) and the Midwest region (3.5 to 6.6; AAPC 2.7%; CI: 1.3, 5.5%). The changes for males, NHW, and the other census regions were not significant. The overall NHB to NHW ACMR was 5.3 and there was no significant change during the study period (3.9 to 4.7; AAPC 0.4%; CI: -1.1, 2.7%).

Conclusion: There was no significant change in the overall asthma-related mortality in children. The ACMR differed by gender, race, and geographic region. The racial disparity suggests persistence of racial differences in access to and presentation for care and the recognition of the severity of asthma.