Trends in hospital admissions and mortality rates for asthma in Ecuador: a joinpoint regression analysis of data from 2000 to 2018

Abstract

BackgroundAlthough asthma has emerged as an important public health problem over recent decades in Latin America, there are limited published data on national hospital admission and mortality rates for asthma from countries in the region.ObjectiveTo analyse trends in asthma hospitalisation and mortality rates in Ecuador over a 19-year period from 2000 to 2018.MethodsHospital discharge and death certificates listing asthma, as defined in the International Classification of Diseases 10th Revision codes (J45 and J46), were used to analyse time trends in rates of hospital admissions and mortality for asthma. The data were obtained from the Ecuadorian National Institute of Statistics and Census. Crude and age-standardised rates were estimated for the entire population. Additionally, specific rates by sex, age and region were estimated. We used joinpoint analysis to identify national trends.ResultDuring 2000–2018, a total of 58 250 hospitalisations and 1328 deaths due to asthma were identified. The average annual rates for hospitalisation and mortality attributed to asthma were estimated to be 21 (95% CI 19.3 to 22.8) and 5.2 (95% CI 4.4 to 6.0) per 100 000 population, respectively, over this period. Asthma hospital admissions decreased from 28 to 13.7 per 100 000 population between 2000 and 2018, and asthma mortality decreased from 0.8 to 0.3 per 100 000 population over the same period. Based on jointpoint analysis, two temporal trends were identified for hospital admissions. Between 2000 and 2011, hospital admissions decreased 0.8% per year and between 2011 and 2018 decreased 6.6% per year (p<0.05). On average, hospitalisation rates decreased 3.1% per year (p<0.05) over the entire study period. Mortality rate decreased 5.6% per year (p<0.05) over the 19-year period. Hospitalisation rates were higher among females, those aged 5 to 19 years and those living in the Coast region.ConclusionsOur analysis shows a temporal trend of reduction in rates of hospitalisations and deaths attributed to asthma between 2000 and 2018 in Ecuador, consistent with similar trends elsewhere in the Latin American region. Health registration systems in Latin America need to be improved to provide reliable data for future between and within country comparisons of trends in asthma hospitalisations and deaths.

Asthma, rhinitis and eczema symptoms in Quito, Ecuador: a comparative cross-sectional study 16 years after ISAAC

“…30 These changes can be observed in the decrease of hospitalisations and mortality by asthma in Ecuador in the last 20 years. 31 Age-adjusted hospitalisation rates decreased 54% over the period 2000-2018 from 278 to 129 per million, and mortality rates declined by 68% in the same period, from 11.1 to 3.5 deaths per million. 31 Third, in the last two decades, policies and regulations have been Open access implemented in Quito to improve air quality.…”

“…31 Age-adjusted hospitalisation rates decreased 54% over the period 2000-2018 from 278 to 129 per million, and mortality rates declined by 68% in the same period, from 11.1 to 3.5 deaths per million. 31 Third, in the last two decades, policies and regulations have been Open access implemented in Quito to improve air quality. Because of air quality management and control, traffic-related air pollution has declined in Quito, a decrease that has been associated with a lower incidence of respiratory illness in schoolchildren.…”

Prevalencia y determinantes de asma en adultos en Quito: un estudio transversal

“…In the last two decades, a series of reform policies and processes increased the coverage of the population to social and health 25 . These changes can be seen in the decrease in hospitalisations and mortality from asthma in Ecuador in the last two decades 26 . Age-adjusted hospitalization rates decreased by 54.% from 2000-to 2018, from 278 to 129 per million population, and age-adjusted mortality rates decreased by 68% in the same period, from 11.1 to 3.5 deaths per million population.…”

“…En las últimas dos décadas, una serie de políticas y procesos de reforma generaron una mayor cobertura en la seguridad social y de salud para la población 25 . Estos cambios se pueden observar en la disminución de las hospitalizaciones y mortalidad por asma en Ecuador en las dos últimas décadas 26 . Las tasas de hospitalización ajustadas por edad disminuyeron un 54% en el período 2000-2018 de 278 a 129 por millón y las tasas de mortalidad ajustadas por edad disminuyeron un 68% en el mismo período, de 11.1 a 3.5 muertes por millón.…”

Persistent asthma hospitalisations and deaths require a national asthma prevention plan

“…The only laudable exceptions are regional studies, e.g. in Ecuador [11], confirming a continuous decrease of asthma hospitalisations and deaths consistent with the worldwide trends [10].…”