PATTERNS OF ASTHMA DEATH AND NEAR-DEATH IN AN INNER-CITY TERTIARY CARE TEACHING HOSPITAL

Although the pathophysiology of asthma is increasingly understood, ast hma deaths continue to increase, especially among non-Caucasians in in ner-city urban areas including East Harlem, which has the highest mort ality rate in the United States. The cause for this increase is uncert ain, but several factors, including poor access to appropriate medical management, the overuse of beta agonists, environmental precipitants, or more severe disease, have been proposed as contributing factors. T he Mount Sinai Hospital is a 1300-bed, tertiary care university hospit al located at the juncture of East Harlem, an inner-city, predominantl y Hispanic and African-American neighborhood, and Carnegie Hill, an af fluent, predominantly Caucasian residential area. We examined asthma d eaths (13) and near-deaths (20) at the Mount Sinai Hospital from 1986 to 1992 to determine risk factors and compared them to an age-and demo graphically matched control group. All of the information was based on retrospective patient chart reviews, and the parameters considered in cluded ethnicity, insurance status, poverty level, and medications inc luding the use of beta agonists. All of the asthma deaths and near-dea ths except 1 occurred in low-income African-American and Hispanic pati ents (x = 16.9) However, steroid and beta-agonist usage were comparabl e in the adverse outcome group compared to the control group. Our resu lts confirm that adverse outcome asthma in East Harlem occurred predom inantly among non-Caucasians of low socioeconomic status. We conclude that ethnicity and socioeconomic status play an important role in asth ma death and near-death at our institution. Patients were followed for asthma at the same institution, which may imply equivalent care, but it is also possible that some aspects of health care, such as follow-u p, access, or reliance on emergency room visits, differed between the two groups. Alternatively, the disease may be more severe in African-A merican and Hispanic patient populations. Attempts to reduce asthma mo rtality have to address these issues.