Asthma mortality in Israel 1971-1990

Background: One of the enigmas in asthma is that our improved understanding of the pathophysiology and the introduction of new modalities to treat asthma has not led to a parallel decrease in asthma mortality. On the contrary, morbidity and mortality from asthma have increased since the mid-seventies in most of the western countries. This trend of increased asthma mortality rate was not observed in Israel in a survey that examined the changes in asthma mortality rate in Israel during 1960-1986. A small but statistically insignificant increase in asthma mortality rate during the last years of that survey solicited for reexamination and extension of the survey. Objectives: The purpose of the present study was to evaluate the changes in the asthma mortality rate in Israel during the years 1971-1990. Methods: We extracted the statistical data on asthma mortality rate in Israel during the 1971-1990 period. Because of the small numbers each year and the variations in asthma mortality rate between years, the data were analyzed after grouping the asthma mortality rate into 5-year periods. Results: The rates, expressed as deaths per 100,000 population per year, were 0.43, 0.18, 0.39, and 0.40 in the 5- to 34-year-old group for the periods 1971-1975, 1976-1980, 1981-1985, and 1986-1990, respectively. We found a statistically significant increase in asthma mortality rate during the 1981-1985 and 1986-1990 periods as compared with 1975-1980 in the young (<34 years old) population. The increase in asthma mortality rate was greater among males. The mortality rate in the older population (35-64 year olds) decreased during 1976-80 as compared with 1971-1975 but did not change thereafter. The rates were 10.4, 4.8, 4.5, and 4.4 cases per 100,000 for 1971-1975, 1976-80, 1981-85, and 1986-90, respectively. Conclusions: Asthma mortality rate increased in Israel in the young age group (5-34 years) during 1980-1990. This is similar to reports from many other countries with advanced medical care systems. The decrease of asthma mortality rate in 1976-80 probably reflect the general improvement in medical care in Israel during these years.