Medical examiner asthma death autopsies: a distinct subgroup of asthma deaths with implications for public health preventive strategies.
OBJECTIVE
Asthma deaths have been increasing in the United States and worldwide. We studied medical examiner asthma death autopsy (MEADA) records for the state of Maryland, compared selected characteristics with state and national total asthma deaths (TADs), and comprehensively reviewed relevant literature to define characteristics of asthma deaths and to provide insight for the design of future preventive strategies directed at this subgroup.


METHODS
Protocols for autopsy and clinical data.


METHODS
The Office of the Chief Medical Examiner of the State of Maryland.


METHODS
All MEADAs in the state of Maryland from 1988 through 1992.


METHODS
Descriptive analysis.


RESULTS
Maryland MEADAs (63 cases) represented 16.62% of Maryland TADs (379 cases). Most common characteristics of individuals on whom autopsies were performed: inner-city residence; single; black male; 15 to 54 years old; history of asthma; no other significant medical condition; fatal episode more likely to begin at home; pronounced dead at hospital; time of death between midnight and 6 AM; no particular seasonality; and typical gross and/or microscopic pathology. Analysis also revealed that 17.46% of deceased asthma patients had a history of drug abuse; 12.69% had positive toxicology for drugs of abuse; 9.52% were infants and young children up to 4 years old, all of whom were found, unresponsive, at home; and white females comprised the highest number of TADs but the lowest number of MEADAs.


CONCLUSIONS
Asthma education programs focused on asthmatic inner-city black males, especially those with a history of drug abuse, and on parents of inner-city asthmatic infants and children may be a useful preventive strategy. International, national, and regional MEADA databases may also be of use in the design and monitoring of preventive strategies directed at this subgroup.
Department of Pathology, University of Maryland School of Medicine, Baltimore, USA.
J B
JB
Weitzman
N F
NF
Kanarek
J E
JE
Smialek
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications / Q000401:mortality* / Q000473:pathology; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003334:Coroners and Medical Examiners; D005006:Ethnicity / Q000193:education; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017533:Marital Status; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D011634:Public Health / Q000193:education; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000150:complications; D014505:Urban Population