International correlations between indicators of prevalence, hospital admissions and mortality for asthma in children

Background There are extensive data on the prevalence of childhood asthma world-wide but the relationships between asthma symptom prevalence, mortality and hospital admissions have not been investigated. Methods The International Study of Asthma and Allergies in Childhood (ISAAC) used a standard questionnaire to measure the 12-month period prevalence of asthma symptoms by parental report in 67 year olds in 40 countries, and by self-report in 1314 year olds in 60 countries. The initial survey was in the mid 1990s (Phase One) and this was repeated in the early 2000s (Phase Three). We correlated the prevalence values of any wheeze and severe wheeze with national data on mortality and hospital admissions for asthma in 514 year olds. Results All correlations with prevalence were positive. In 1314 year olds, the correlations between severe wheeze in Phase One and contemporaneous mortality and hospital admission rates were r = 0.32 (P = 0.047) and r = 0.73 (P = 0.003), respectively. In 6-7 year olds in Phase One, the correlation with severe wheeze and mortality was r = 0.42 (P = 0.024). In 14 countries the correlation between admission and mortality rates in the 5-14 year age group was r = 0.53 (P = 0.054). Conclusions There are consistently positive associations between asthma symptom prevalence, admissions and mortality. The prevalence of asthma symptoms in children obtained from local questionnaire studies may provide a guide to estimate the incidence of severe episodes of asthma in countries with incomplete data on hospital admissions or mortality, or vice versa.