Asthma Deaths Among U.S. Adults Aged 15–64 by Industry and Occupation, 1999–2016

In 2015, an estimated 18.4 million U.S. adults had current asthma, and 3,396 adults died of it. An estimated 11%–21% of asthma deaths might be due to exposures at work — and asthma deaths can be prevented with proper management and a quick response to attacks.

CDC's National Institute for Occupational Safety and Health looked at asthma deaths among people aged 15–64 from 1999 to 2016, and at the industries and jobs of those who died.

How the study worked

• Deaths: the National Vital Statistics System's multiple cause-of-death data, 1999–2016, counting deaths with asthma (code J45 in the International Classification of Diseases, 10th Revision) or status asthmaticus (J46) as the underlying cause. Death rates per 1 million people were age-adjusted to the 2000 U.S. Census population.
• Jobs: industry and occupation from death certificates, available from 26 states for 1999, 2003, 2004 and 2007–2012. Certificates record a person's "usual" industry and occupation.
• Proportionate mortality ratios (PMRs) compare the observed number of asthma deaths in an industry or occupation with the number expected from the share of all deaths that are due to asthma, adjusted for age (5-year groups) and race. A PMR above 1 means more asthma deaths than expected. Retired, unemployed and unpaid people, and those with unknown industry or occupation, were left out of this part.

Deaths and death rates, 1999–2016

A total of 33,307 people aged 15–64 died of asthma — an overall rate of 8.89 per million. Of them, 14,296 (42.9%) were male and 19,011 (57.1%) female.

By race, rates were 25.60 per million among Black or African American people, 7.75 among American Indian or Alaska Native, 6.52 among White and 4.92 among Asian or Pacific Islander people; 5.96 among Hispanic or Latino people.

Rates fell over the period:

By state, annual rates ranged from 4.59 per million in Maine to 14.72 in the District of Columbia among males, and from 6.70 in North Dakota to 15.30 in Mississippi among females.

Annual age-adjusted asthma death rate per 1 million people aged 15–64, by sex and state, 1999–2016. CDC.

How many might have been work-related? Applying the 11%–21% estimate:

Some of these deaths might have been prevented by measures against workplace exposures.

Industries and jobs

Industry and occupation were known for 3,393 (97.2%) of the 3,491 asthma deaths in the 26 states in the years covered — 1,398 males and 1,995 females.

Most deaths, by number:

Significantly higher than expected (PMR, with 95% confidence interval):

Why these jobs

• The decline in asthma death rates most likely reflects better asthma management and prevention. One example: replacing powdered latex gloves with powder-free natural rubber latex or non-latex gloves cut latex allergen exposure and greatly reduced work-related asthma among health care workers.
• Health care and social assistance have a higher share of women with current asthma and frequent exposures linked to work-related respiratory disease. National survey data: about 9.1% (1.3 million) of 13.9 million women working in health care and social assistance have current asthma, as do 4.2% (394,000) of 9.4 million men in construction.
• Share of workers frequently exposed to vapors, gas, dust or fumes:

• Agents linked to work-related asthma include cleaners, disinfectants, antibiotics and natural rubber latex for health care workers, and welding fumes and isocyanates (e.g., paints) for construction workers.
• Some elevated PMRs may partly reflect workers leaving jobs whose exposures worsened their asthma for jobs with fewer exposures; likewise, some retired, unemployed or unpaid people may have left work because of workplace exposures.

Work-related asthma covers occupational asthma (new asthma caused by something at work) and work-exacerbated asthma (existing asthma made worse by work).

Limitations

1. Diagnoses could not be checked — some deaths may have been misdiagnosed, though asthma is likely recorded accurately given its impact on patients' lives.
2. There was no way to tell whether a workplace exposure triggered the fatal attack; some attacks may have been triggered outside work.
3. The "usual" job on a death certificate may not be the job where an exposure happened.
4. There was no work history to show changes in employment; retired and unemployed people may have left work because of severe work-related asthma.
5. Only some states, in some years, reported industry and occupation, so the results may not be nationally representative.

What helps

Differences by industry and occupation point to the need to identify workplace exposures, and to diagnose early and treat and manage asthma, above all in the industries and jobs with higher mortality.

• Drug treatment of work-related asthma is similar to that of asthma that is not work-related.
• Finding and eliminating exposures early is the preferred prevention; where elimination is impossible, reducing exposure may be considered.
• An accurate diagnosis and appropriate management for workers with work-related asthma improve outcomes and could prevent deaths.

Resources: CDC's asthma management tools; the American Thoracic Society on evaluating and treating asthma; and OSHA's guidance on diagnosing work-related asthma.

Sources

Based on Patel O, Syamlal G, Wood J, Dodd KE, Mazurek JM, "Asthma Mortality Among Persons Aged 15–64 Years, by Industry and Occupation — United States, 1999–2016," MMWR Morbidity and Mortality Weekly Report, volume 67, Centers for Disease Control and Prevention; a work of the United States government in the public domain. Industry and occupation came from Colorado, Florida, Georgia, Hawaii, Idaho, Indiana, Kansas, Kentucky, Louisiana, Michigan, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Rhode Island, South Carolina, Texas, Utah, Vermont, Washington, West Virginia and Wisconsin.