A Preliminary Investigation of Asthma Mortality in Schools

By Greiling, Andrea K.; Boss, Leslie P. et al. | Journal of School Health, October 2005 | Go to article overview

A Preliminary Investigation of Asthma Mortality in Schools


Greiling, Andrea K., Boss, Leslie P., Wheeler, Lani S., Journal of School Health


In the United States, in 2003, approximately 5.0 million children aged 5 to 17 years had active asthma, representing one of the most prevalent diseases in school children. (1) Of these, 3.1 million children had at least 1 asthma episode, (2) equaling at least 353 asthma episodes in this country every hour. During the years 1999 to 2002, an average of 159 children aged less than 15 years died of asthma each year. (1)

The annual cost of treating asthma in those under 18 years of age in 1994 was estimated to be $3.2 billion. (3) Additionally, in 1996, the direct medical expenditure for school-aged children with asthma was $1009.8 million, or $401 per child with asthma, and the total economic impact of asthma for that year alone was $1993.6 million. (4) The burden and cost of the disease have resulted in an intense effort to minimize the effects of asthma by improving medical and self-management and by controlling factors known to exacerbate asthma (eg, environmental allergens, irritants, concurrent disease states, and improper utilization of inhaled asthma medications). (5,6)

Asthma deaths among children are rare. (7) Between 1990 and 2001, 2484 children aged 5 to 19 years died from asthma. (8) Although asthma mortality rates in childhood are lower than in older age groups, (2) a childhood death is always a tragedy and causes need to be understood. Several studies (9-13) have identified preventable of avoidable factors associated with near-fatal asthma attacks and asthma mortality in children (including deficiencies in professional and self-management, the presence of psychiatric disorders in the child, significant denial, psychosocial pathology, and delays in seeking care). In about 60% of children who die from asthma, the final episode is sudden in onset (not preceded by milder symptoms) and fatal within 1 hour. (14)

The impact of asthma in the classroom is significant. Several studies have shown that childhood asthma is associated with an increased risk for school problems, including increased school absence, graduate failure, and learning disabilities, (15-17) and that the risk is amplified by increasing severity of the disease. (18) While the impact of asthma morbidity in the classroom is documented throughout formal research channels, data on fatal asthma episodes in schools are not. This investigation sought to identify and describe school-associated asthma deaths and the circumstances surrounding those deaths that have occurred in the United States since 1990. Outcomes included demographic variables, time frames, situations at the time of death, and information on the settings where deaths occurred.

METHODS

Case Definition

A school-associated asthma death was defined as the occurrence of a fatal asthma attack or the precipitating event prior to a fatal asthma attack that occurred between January 1990 and December 2003 in a student in one of the following locations: (1) on the school campus of a public of private primary or secondary school, (2) while the student was en route to of from school, or (3) while the student was en route to of attending a school-sponsored event (eg, field trip or sporting event).

Case Identification and Confirmation

Two case-finding strategies were employed. The first included a systematic search of the LexisNexis database, a resource bank with information on legal research, government periodicals, public records, and national and local news. For the purposes of this effort, LexisNexis was used to search nationwide newspaper reports on asthma deaths that met the case definition. The second strategy solicited voluntary reports from the Centers for Disease Control and Prevention's state asthma contacts, local American Lung Association (ALA) affiliates, National Association of State School Nurse Consultants, Asthma & Allergy Network-Mothers of Asthmatics (AANMA), state child death review committees, and state departments of education. …

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