Abstract

In 2015, an estimated 18.4 million U.S. adults had current asthma, and 3,396 adult asthma deaths were reported (1). An estimated 11%–21% of asthma deaths might be attributable to occupational exposures (2). To describe asthma mortality among persons aged 15–64 years,* CDC analyzed multiple cause-of-death data† for 1999–2016 and industry and occupation information collected from 26 states§ for the years 1999, 2003, 2004, and 2007–2012. Proportionate mortality ratios (PMRs)¶ for asthma among persons aged 15–64 years were calculated. During 1999–2016, a total of 14,296 (42.9%) asthma deaths occurred among males and 19,011 (57.1%) occurred among females. Based on an estimate that 11%–21% of asthma deaths might be related to occupational exposures, during this 18-year period, 1,573–3,002 asthma deaths in males and 2,091–3,992 deaths in females might have resulted from occupational exposures. Some of these deaths might have been averted by instituting measures to prevent potential workplace exposures. The annual age-adjusted asthma death rate** per 1 million persons aged 15–64 years declined from 13.59 in 1999 to 9.34 in 2016 (p<0.001) among females, and from 9.14 (1999) to 7.78 (2016) (p<0.05) among males. The highest significantly elevated asthma PMRs for males were for those in the food, beverage, and tobacco products manufacturing industry (1.82) and for females were for those in the social assistance industry (1.35) and those in community and social services occupations (1.46). Elevated asthma mortality among workers in certain industries and occupations underscores the importance of optimal asthma management and identification and prevention of potential workplace exposures.
National Vital Statistics System’s multiple cause-of-death data for 1999–2016 were analyzed to examine asthma mortality among persons aged 15–64 years. Asthma deaths were identified from death certificates using International Classification of Diseases, 10th Revision underlying cause-of-death codes J45 (asthma) and J46 (status asthmaticus). Death rates per 1 million persons aged 15–64 years by sex, race, ethnicity, and year were age-adjusted using the 2000 U.S. Census standard population. Time trends were assessed using a first-order autoregressive linear regression model to account for the serial correlation. Industry and occupation information available from 26 states for the years 1999, 2003, 2004, and 2007–2012†† was coded§§ using the U.S. Census 2000 Industry and Occupation Classification System. PMRs, adjusted by 5-year age groups and race, were generated by industry and occupation for males and females. In addition, 95% confidence intervals (CIs) were calculated assuming Poisson distribution of the data. Retired, unemployed, and nonpaid workers and those with information that was unknown or not reported for industry or occupation were excluded from PMR analyses.
During 1999–2016, a total of 33,307 U.S. decedents aged 15–64 years had asthma or status asthmaticus assigned as the underlying cause of death (Table 1) for an overall death rate of 8.89 per 1 million persons. The highest asthma death rates were among adults aged 55–64 years (16.32 per 1 million persons), females (9.95 per 1 million persons), persons who were not Hispanic or Latino (9.39 per 1 million), and blacks or African Americans (25.60 per 1 million persons). The age-adjusted asthma death rate per 1 million persons aged 15–64 years decreased 24.6% from 11.41 in 1999 to 8.60 in 2016 (p<0.01). The age-adjusted asthma death rates among females aged 15–64 years decreased from 13.59 per 1 million in 1999 to 9.34 in 2016 (p<0.001), and among males decreased from 9.14 (1999) to 7.78 (2016) (p<0.05). By state, annualized age-adjusted asthma death rates ranged from 4.59 per 1 million in Maine to 14.72 in the District of Columbia for males and from 6.70 per 1 million in North Dakota to 15.30 in Mississippi for females (Figure).
Industry and occupation data were available for 3,393¶¶ (97.2%) of 3,491 asthma deaths, (1,398 of 1,435 [97.4%] males and 1,995 of 2,056 [97.0%] females) among persons aged 15–64 years that occurred in residents of 26 states during 1999, 2003, 2004, and 2007–2012 (Table 2). By industry, the highest number of asthma deaths occurred among males in the construction industry (184; 13.2% of asthma deaths in males) and among females in the health care industry (279; 14.0% of asthma deaths in females). By occupation, the highest number of asthma deaths occurred among male construction trades workers (149; 10.7%) and among female office and administrative support workers (186; 9.3%). By industry, PMRs were significantly elevated among males working in food, beverage, and tobacco products manufacturing (1.82; CI = 1.22–2.61), other retail trade (1.65; CI = 1.29–2.10), and miscellaneous manufacturing (1.45; CI = 1.13–1.86); and among females working in social assistance (e.g., individual and family services and child day care services) (1.35; CI = 1.00–1.79). By occupation, the PMR was significantly elevated among female community and social services workers (1.46; CI = 1.02–2.01).

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