Epidemiology of asthma

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As of 2011, approximately 235 million people worldwide were affected by asthma,[1] and roughly 250,000 people die per year from asthma-related causes.[2] Low and middle income countries make up more than 80% of the mortality.[3] Prevalences vary between countries from 1% to 18%.[2] Asthma tends to be more prevalent in developed than in developing countries.[2] Rates are lower in Asia, Eastern Europe, and Africa.[4] Within developed countries it is more common among those who are economically disadvantaged, but in contrast in developing countries it is more common amongst the affluent.[2][5] The reason for these differences is not well known.[2]

While asthma is twice as common in boys as in girls,[2] severe asthma occurs at equal rates.[6] Among adults, however, asthma is twice as common in women as in men.[6][7]

## Contents

* 1 Increasing frequency
* 2 Region specific data
* 2.1 United States
* 2.2 United Kingdom
* 2.3 Canada
* 2.4 Latin and Central America
* 2.5 Japan
* 2.6 Asia
* 2.7 International migration
* 2.8 Regional differences
* 3 Social determinants
* 3.1 Gender
* 4 Notes

## Increasing frequency

The prevalence of childhood asthma in the United States has increased since 1980, especially in younger children.

Rates of asthma have increased significantly between the 1960s and 2008 [8][9] with it being recognized as a major public health problem since the 1970s.[4] Some 9% of US children had asthma in 2001, compared with just 3.6% in 1980. The World Health Organization (WHO) reports that some 10% of the Swiss population have asthma as of 2007, compared with 2% some 25–30 years ago.[10] In the United States the age-adjusted prevalence of asthma increased from 7.3 to 8.2 percent during the years 2001 through 2009.[11]

## Region specific data

### United States

Asthma affects approximately 7% of the population of the United States and causes approximately 4,210 deaths per year.[12][13][14] In 2005, asthma affected more than 22 million people, including 6 million children, and accounted for nearly 500,000 hospitalizations that same year.[15] In 2010, asthma accounted for more than one-quarter of admitted emergency department visits in the U.S. among children aged 1–9 years, and it was a frequent diagnosis among children aged 10–17 years.[16] From 2000 through 2010, the rate of pediatric hospital stays for asthma declined from 165 to 130 per 100,000 population, respectively, whereas the rate for adults remained about 119 per 100,000 population.[17]

Asthma prevalence in the U.S. is higher than in most other countries in the world, but varies drastically between ethnic populations.[18] Asthma prevalence is highest in Puerto Ricans, Latino, African Americans, Filipinos, Irish Americans, and Native Hawaiians, and lowest in Mexicans and Koreans.[19][20][21][22] Rates of asthma-related hospital admissions in 2010 were more than three times higher among African American children and two times higher for African American and Latino adults compared with White and Asian and Pacific Islander people.[17][22] Also, children who are born in low-income families have higher risk of asthma.[23]

Asthma prevalence also differs between populations of the same ethnicity who are born and live in different places.[24] U.S.-born Mexican populations, for example, have higher asthma rates than non-U.S. born Mexican populations that are living in the U.S.[25]

### United Kingdom

Asthma affects approximately 5% of the United Kingdom's population.[26] In England, an estimated 261,400 people were newly diagnosed with asthma in 2005; 5.7 million people had an asthma diagnosis and were prescribed 32.6 million asthma-related prescriptions.[27]

### Canada

Data depicts an increasing trend in asthma prevalence among Canada's population. In 2000-2001 asthma prevalence was monitored at 6.5%; by 2010-2011 a 4.3% increase was shown, with asthma prevalence totaling 10.8% of Canada's population.[28]

Furthermore, asthma prevalence varies among the provinces of Canada; the highest prevalence is Ontario at 12.1%, and the lowest is Nunavut at 3.8%.[28] Though there is an overall decrease in the incidence of new asthma cases in Canada, prevalence is rising. This can be attributed to a decrease in case-specific mortality due to improved management and control of asthma and its symptoms.

### Latin and Central America

It is approximated that 40 million Latin Americans live with asthma.[29]

In some reports, urban residency within Latin America has been found to be associated with an increased prevalence of asthma.[29] Childhood asthma prevalence was found to be higher than 15 percent in a majority of Latin American countries.[30] Similarly, a study published relating to asthma prevalence in Havana, Cuba estimated that approximately 9 percent of children under the age of 15 are undiagnosed for asthma, possible due to lack of resources in the region.[29]

### Japan

The prevalence of asthma in adults in Japan is rapidly increasing, however there is a significant difference for the children in Japan. The mean prevalence of asthma in Japan has increased from about 1% to 10% or higher in children and to about 6–10% in adults since the 1960s.[31] There has been a 1.5 fold increase in the prevalence of asthma per decade in Japan from the 1960s.[31] Three surveys done from 1985, 1999 and 2006 show adult asthma is increasing, while the same surveys indicate that the prevalence of asthma in children is decreasing.[32] To compare this to another Asia-Pacific country the estimated prevalence of asthma in male and female children in Mongolia in a 2009 ISSAC study was 20.9% and 21.0%[33]

### Asia

Data regarding the epidemiology of asthma in the continent of Asia as whole is scarce, particularly regarding adult populations. However, similarly to much of the rest of the globe, prevalence of childhood asthma appears to be rising. Systematic childhood studies, such as the International Study of Asthma and Allergies in Childhood (ISAAC), provide data regarding the epidemiology of asthma among Asia's youth population. Asthma prevalence among Asia's adult population is less clear in comparison due to the comparatively higher monitoring of younger populations. However, the data available points to a positive correlation between age and asthma prevalence. Findings indicate that the prevalence of asthma among the Asian adult population is less than 5%; while findings pertaining to elderly populations illustrate a rate somewhere between 1.3 and 15.3%.[34]

### International migration

In a review of studies on the prevalence of asthma among migrant populations, those born in high-income countries were found to have higher rates of asthma than migrants. Second-generation migrants had a higher risk of asthma than first-generation migrants, and the prevalence of asthma increases with longer time of residence in the host country.[35] This confirms the role of the environment in the development of asthma.

### Regional differences

A survey was conducted by the ISSAC Steering Committee from 1992 to 1993 in adults aged 22 to 44, comparing the prevalence of asthma in 10 developed countries. The population differences between these countries should be noted. The United States population in 1992 was 256.9 million, 14.5 times that of Australia (17.5 million), and 4.5 times that of the United Kingdom (57.51 million).[36][37][38] However, Australia and the UK have a higher prevalence than the US by 2.4 times on the lower end and 4.6 times on the higher end. In another study taken in 1992 for Japan the prevalence of asthma in Japan was 13%[39] with a population of 124.2 million.[40]

Country/group | Years | Age
group | Prevalence
(%)

|
|
|

Japan  | 05  | 20–44  | 8.1
Australia  | 92–93  | 20–44  | 28.1
Australian Aboriginal  | 90–91  | 20–84  | 11.1

[clarification needed] | 92–93  | 20–44
20–44  | 27.0
30.3
Germany  | 92–93  | 20–44  | 17.0
Spain  | 92–93  | 20–44  | 22.0
France  | 92–93  | 20–44  | 14.4
USA  | 92–93  | 20–44  | 25.7
Italy  | 92–93  | 20–44  | 9.5
Iceland  | 92–93  | 20–44  | 18.0
Greece  | 92–93  | 20–44  | 16.0

## Social determinants

Disparities in the prevalence of asthma have been shown between different socioeconomic statuses.[41] In the United States, socioeconomic status is associated with race, due to population trends, Black and Hispanic populations are more likely to have asthma, due to higher concentrations in low-income areas. In other areas of the world, the same trend that lower socioeconomic status is related to higher severity of asthma symptoms. Airway reactivity and symptoms for children of low socioeconomic status in Canada tend to be higher than those of higher-income areas.[41] The contrast between residents of rural and suburban areas can be seen in a study of Kenya[42] and Ethiopia,[43] where prevalence of asthma is lower in rural areas, and higher in urban areas. A similar trend can be seen in the United States, where an urban-rural gradient shows the increase in the prevalence of asthma closer to the inner city.[44]

A study published by BMC Pulmonary Medicine shows the relation between those who live in large urban, small urban, and rural areas. Large urban can be classified as the inner-city, and small urban is related to suburban areas. The inner city and rural communities have several commonalities that are important when determining socioeconomic status. They are both more likely to have higher poverty rates, and higher mortality rates, thus having a lower health status than suburban residents.[45] It was found that asthma prevalence in large urban areas was 20.9%, small urban was 21.5%, and rural was 15.1%. However, it is important to acknowledge that rural residents experienced more asthma-like symptoms (wheezing, whistling, and coughing) than those in urban areas, rural residents had 5% more asthma like symptoms.[44] Also, residents in large urban areas were less likely to use medical services for asthma symptoms.[44]

Multiple factors contribute to socioeconomic disparities, income and education, pollutant exposures and allergens are uncontrollable influences on an individual. Stressors related to neighborhood violence and safety, behavioral risk factors, and lack of access to adequate medications and healthcare also contribute to an increased prevalence of asthma. Low income alone accounts for a significant increase in poor asthma outcomes, including severity, lung function, and morbidity rates.[46]

Secondhand smoke is a common exposure for asthmatic children in low-income households. Children who live with at least one smoker are more likely to have asthma than those who don't.[47] People living below the poverty line and with less education have a higher second-hand smoke exposure than those who do not.[48] Also, those with blue-collar jobs are more likely to be exposed at work, as well as those with service jobs (servers and bartenders) are exposed to smoke at businesses that do not have smoking restrictions.

### Gender

Globally, there are 136 million women with asthma, 57% of the 235 million people living with asthma. In addition to being more common among women, women experience more severe symptoms and are more likely to die from asthma.[49] The severity and frequency of asthma complications is related to both gender and age. Although asthma is more prevalent and more severe in boys among children, many women experience a significant worsening of symptoms around and after puberty.[50] The timing of the change in prevalence and severity around puberty suggest that asthma pathogenesis is related to sex hormones or hormone levels.[51]

## Notes

1. ↑ "World Health Organization Fact Sheet Fact sheet No 307: Asthma". 2009. https://www.who.int/mediacentre/factsheets/fs307/en/.
2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 GINA 2011, pp. 2–5
3. ↑ World Health Organization. "WHO: Asthma". https://www.who.int/mediacentre/factsheets/fs307/en/.
4. ↑ 4.0 4.1 Murray and Nadel's textbook of respiratory medicine. (5th ed.). Philadelphia, PA: Saunders/Elsevier. 2010. pp. Chapter 38. ISBN 978-1-4160-4710-0.
5. ↑ Uphoff, E (2015). "A systematic review of socioeconomic position in relation to asthma and allergic diseases". European Respiratory Journal 46 (2): 364–374. doi:10.1183/09031936.00114514. PMID 25537562.
6. ↑ 6.0 6.1 Bush A, Menzies-Gow A; Menzies-Gow (December 2009). "Phenotypic differences between pediatric and adult asthma". Proc Am Thorac Soc 6 (8): 712–9. doi:10.1513/pats.200906-046DP. PMID 20008882.
7. ↑ "Testosterone explains why women more prone to asthma". May 8, 2017. https://www.sciencedaily.com/releases/2017/05/170508112433.htm.
8. ↑ "Observations on emerging patterns of asthma in our society". J. Allergy Clin. Immunol. 104 (2 Pt 2): S1–9. August 1999. doi:10.1016/S0091-6749(99)70268-X. PMID 10452783.
9. ↑ "Is the prevalence of asthma declining? Systematic review of epidemiological studies". Allergy 65 (2): 152–67. February 2010. doi:10.1111/j.1398-9995.2009.02244.x. PMID 19912154.
10. ↑ World Health Organization (2007) (PDF). Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. World Health Organization. pp. 15–20, 49. ISBN 978-92-4-156346-8. https://www.who.int/gard/publications/GARD_Manual/en/index.html. Retrieved 2010-05-14.
11. ↑ "Vital signs: asthma prevalence, disease characteristics, and self-management education: United States, 2001--2009". MMWR Morb. Mortal. Wkly. Rep. 60 (17): 547–52. May 2011. PMID 21544044.
12. ↑ Fanta CH (March 2009). "Asthma". New England Journal of Medicine 360 (10): 1002–14. doi:10.1056/NEJMra0804579. PMID 19264689.
13. ↑ "Clinical practice. Emergency treatment of asthma". N. Engl. J. Med. 363 (8): 755–64. August 2010. doi:10.1056/NEJMcp1003469. PMID 20818877.
14. ↑ "Recent trends in asthma hospitalization and mortality in the United States". J Asthma 42 (5): 373–8. June 2005. doi:10.1081/JAS-62995. PMID 16036412.
15. ↑ NHLBI Guideline 2007, p. 1
16. ↑ Wier LM, Hao Y, Owens P, Washington R. Overview of Children in the Emergency Department, 2010. HCUP Statistical Brief #157. Agency for Healthcare Research and Quality, Rockville, MD. May 2013. [1]
17. ↑ 17.0 17.1 "Trends in Pediatric and Adult Hospital Stays for Asthma, 2000-2010.". HCUP Statistical Brief (Rockville, MD: Agency for Healthcare Research and Quality) (169). January 2014. PMID 24624462. http://hcup-us.ahrq.gov/reports/statbriefs/sb169-Asthma-Trends-Hospital-Stays.jsp. Retrieved 2014-03-28.
18. ↑ "Population disparities in asthma". Annu Rev Public Health 26: 89–113. 2005. doi:10.1146/annurev.publhealth.26.021304.144528. PMID 15760282.
19. ↑ "Heterogeneity of childhood asthma among Hispanic children: Puerto Rican children bear a disproportionate burden". Pediatrics 117 (1): 43–53. January 2006. doi:10.1542/peds.2004-1714. PMID 16396859.
20. ↑ "Asthma prevalence in Hispanic and Asian American ethnic subgroups: results from the California Healthy Kids Survey". Pediatrics 118 (2): e363–70. August 2006. doi:10.1542/peds.2005-2687. PMID 16882779.
21. ↑ "Native Hawaiians mortality, morbidity, and lifestyle: comparing data from 1982, 1990, and 2000". Pac Health Dialog 11 (2): 120–30. September 2004. PMID 16281689.
22. ↑ 22.0 22.1 Israel, Elliot; Cardet, Juan-Carlos; Carroll, Jennifer K.; Fuhlbrigge, Anne L.; She, Lilin; Rockhold, Frank W.; Maher, Nancy E.; Fagan, Maureen et al. (2022-02-26). "Reliever-Triggered Inhaled Glucocorticoid in Black and Latinx Adults with Asthma" (in en). New England Journal of Medicine 386 (16): 1505–1518. doi:10.1056/NEJMoa2118813. PMID 35213105.
23. ↑ "C-FERST Issue Profile: Childhood Asthma". 2016-03-30. https://www.epa.gov/c-ferst/c-ferst-issue-profile-childhood-asthma.
24. ↑ "Immigration to the United States and acculturation as risk factors for asthma and allergy". J. Allergy Clin. Immunol. 116 (1): 38–41. July 2005. doi:10.1016/j.jaci.2005.04.033. PMID 15990770.
25. ↑ "Associations of acculturation and country of birth with asthma and wheezing in Mexican American youths". J Asthma 43 (4): 279–86. May 2006. doi:10.1080/0277090060022869. PMID 16809241.
26. ↑ "50 years of asthma: UK trends from 1955 to 2004". Thorax 62 (1): 85–90. January 2007. doi:10.1136/thx.2006.066407. PMID 17189533.
27. ↑ "Trends in the epidemiology of asthma in England: a national study of 333,294 patients". J R Soc Med 103 (3): 98–106. March 2010. doi:10.1258/jrsm.2009.090348. PMID 20200181.
28. ↑ 28.0 28.1 Canada, Public Health Agency of (2018-05-01). "Asthma and Chronic Obstructive Pulmonary Disease (COPD) in Canada, 2018". https://www.canada.ca/en/public-health/services/publications/diseases-conditions/asthma-chronic-obstructive-pulmonary-disease-canada-2018.html#a1.2.
29. ↑ 29.0 29.1 29.2 "Asthma in Latin America". Thorax 70 (9): 898–905. September 2015. doi:10.1136/thoraxjnl-2015-207199. PMID 26103996.
30. ↑ "Regional variation in asthma symptom prevalence in Latin American children". The Journal of Asthma 47 (6): 644–50. August 2010. doi:10.3109/02770901003686480. PMID 20642377.
31. ↑ 31.0 31.1 Ichinose, Masakazu; Sugiura, Hisatoshi; Nagase, Hiroyuki; Yamaguchi, Masao; Inoue, Hiromasa; Sagara, Hironori; Tamaoki, Jun; Tohda, Yuji et al. (2017-04-01). "Japanese guidelines for adult asthma 2017" (in en). Allergology International 66 (2): 163–189. doi:10.1016/j.alit.2016.12.005. ISSN 1323-8930. PMID 28196638.
32. ↑ Iwanaga, Takashi; Tohda, Yuji (October 2016). "Epidemiology of asthma in Japan". Nihon Rinsho. Japanese Journal of Clinical Medicine 74 (10): 1603–1608. ISSN 0047-1852. PMID 30551268.
33. ↑ Yoshihara, Shigemi; Munkhbayarlakh, Sonomjants; Makino, Sohei; Ito, Clyde; Logii, Narantsetseg; Dashdemberel, Sarangerel; Sagara, Hironori; Fukuda, Takeshi et al. (2016-01-01). "Prevalence of childhood asthma in Ulaanbaatar, Mongolia in 2009" (in en). Allergology International 65 (1): 62–67. doi:10.1016/j.alit.2015.07.009. ISSN 1323-8930. PMID 26666488.
34. ↑ "Epidemiology of adult asthma in Asia: toward a better understanding". Asia Pacific Allergy 4 (2): 75–85. April 2014. doi:10.5415/apallergy.2014.4.2.75. PMID 24809012.
35. ↑ Cabieses, B (2014). "A Systematic Review on the Development of Asthma and Allergic Diseases in Relation to International Immigration: The Leading Role of the Environment Confirmed". PLOS ONE 9 (8). doi:10.1371/journal.pone.0105347. PMID 25141011. Bibcode: 2014PLoSO...9j5347C.
36. ↑ "Statistical Abstract of the United States: 1992" (in EN-US). United States Census Bureau. https://www.census.gov/library/publications/1992/compendia/statab/112ed.html.
37. ↑ "Population, total - Australia | Data". https://data.worldbank.org/indicator/SP.POP.TOTL?locations=AU.
38. ↑ "Population, total - United Kingdom | Data". https://data.worldbank.org/indicator/SP.POP.TOTL?locations=GB.
39. ↑ Ichinose, Masakazu; Sugiura, Hisatoshi; Nagase, Hiroyuki; Yamaguchi, Masao; Inoue, Hiromasa; Sagara, Hironori; Tamaoki, Jun; Tohda, Yuji et al. (2017-04-01). "Japanese guidelines for adult asthma 2017" (in en). Allergology International 66 (2): 163–189. doi:10.1016/j.alit.2016.12.005. ISSN 1323-8930. PMID 28196638.
40. ↑ "Population, total - United Kingdom, Japan | Data". https://data.worldbank.org/indicator/SP.POP.TOTL?locations=GB-JP.
41. ↑ 41.0 41.1 Litonjua, Augusto A.; Carey, Vincent J.; Weiss, Scott T.; Gold, Diane R. (1999). "Race, socioeconomic factors, and area of residence are associated with asthma prevalence" (in en). Pediatric Pulmonology 28 (6): 394–401. doi:10.1002/(SICI)1099-0496(199912)28:6<394::AID-PPUL2>3.0.CO;2-6. ISSN 1099-0496. PMID 10587412. https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1099-0496(199912)28:6<394::AID-PPUL2>3.0.CO;2-6.
42. ↑ Odhiambo, J.A.; Ng'ang'a, L.W.; Mungai, M.W.; Gicheha, C.M.; Nyamwaya, J.K.; Karimi, F.; MacKlem, P.T.; Becklake, M.R. (1998-11-01). "Urban–rural differences in questionnaire-derived markers of asthma in Kenyan school children". European Respiratory Journal 12 (5): 1105–1112. doi:10.1183/09031936.98.12051105. ISSN 0000-0000. PMID 9864005.
43. ↑ Yemaneberhan, Haile; Bekele, Zegaye; Venn, Andrea; Lewis, Sarah; Parry, Eldryd; Britton, John (July 1997). "Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia". The Lancet 350 (9071): 85–90. doi:10.1016/s0140-6736(97)01151-3. ISSN 0140-6736. PMID 9228959.
44. ↑ 44.0 44.1 44.2 Lawson, Joshua A.; Rennie, Donna C.; Cockcroft, Don W.; Dyck, Roland; Afanasieva, Anna; Oluwole, Oluwafemi; Afsana, Jinnat (2017-01-05). "Childhood asthma, asthma severity indicators, and related conditions along an urban-rural gradient: a cross-sectional study". BMC Pulmonary Medicine 17 (1): 4. doi:10.1186/s12890-016-0355-5. ISSN 1471-2466. PMID 28056923.
45. ↑ Blumenthal, Susan J.; Kagen, Jessica (2002-01-02). "The Effects of Socioeconomic Status on Health in Rural and Urban America". JAMA 287 (1): 109. doi:10.1001/jama.287.1.109-JMS0102-3-1. ISSN 0098-7484.
46. ↑ Cardet, Juan Carlos; Louisias, Margee; King, Tonya S.; Castro, Mario; Codispoti, Christopher D.; Dunn, Ryan; Engle, Linda; Giles, B. Louise et al. (February 2018). "Income is an independent risk factor for worse asthma outcomes" (in en). Journal of Allergy and Clinical Immunology 141 (2): 754–760.e3. doi:10.1016/j.jaci.2017.04.036. PMID 28535964.
47. ↑ Ciaccio, Christina E.; DiDonna, Anita; Kennedy, Kevin; Barnes, Charles S.; Portnoy, Jay M.; Rosenwasser, Lanny J. (2014-11-01). "Secondhand tobacco smoke exposure in low-income children and its association with asthma" (in en). Allergy and Asthma Proceedings 35 (6): 462–466. doi:10.2500/aap.2014.35.3788. ISSN 1088-5412. PMID 25584913.
48. ↑ CDCTobaccoFree (2021-04-23). "Cigarette and Tobacco Use Among People of Low Socioeconomic Status" (in en-us). https://www.cdc.gov/tobacco/disparities/low-ses/index.htm.
49. ↑ "Asthma and Lung UK report - Asthma is worse for women (27 April 2022)" (in en-GB). 27 April 2022. https://www.pslhub.org/learn/patient-safety-in-health-and-care/womens-health/asthma-and-lung-uk-report-asthma-is-worse-for-women-27-april-2022-r6694/.
50. ↑ Shah, Ruchi; Newcomb, Dawn C. (2018). "Sex Bias in Asthma Prevalence and Pathogenesis". Frontiers in Immunology 9: 2997. doi:10.3389/fimmu.2018.02997. ISSN 1664-3224. PMID 30619350.
51. ↑ Yung, Jeffrey A.; Fuseini, Hubaida; Newcomb, Dawn C. (2018-05-01). "Hormones, sex, and asthma" (in English). Annals of Allergy, Asthma & Immunology 120 (5): 488–494. doi:10.1016/j.anai.2018.01.016. ISSN 1081-1206. PMID 29410216. PMC 5936670. https://www.annallergy.org/article/S1081-1206(18)30023-1/fulltext.

References

* National Asthma Education and Prevention Program (NAEPP) (2007). "Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma". National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.
* "British Guideline on the Management of Asthma". British Thoracic Society. 2009. http://www.brit-thoracic.org.uk/Portals/0/Guidelines/AsthmaGuidelines/sign101 revised June 09.pdf.
* "Global Strategy for Asthma Management and Prevention". Global Initiative for Asthma. 2011. http://www.ginasthma.org/uploads/users/files/GINA_Report2011_May4.pdf.

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