title: Trends in hospitalizations and mortality from asthma in Costa Rica over a 12- to 15-year period.
abstract: BACKGROUND
  Little is known about trends in morbidity and/or mortality due to asthma in Latin America.
  
  
  OBJECTIVE
  To examine trends in hospitalizations and mortality due to asthma from 1997-2000 to 2011 in Costa Rica.
  
  
  METHODS
  The rates of hospitalization due to asthma were calculated for each sex in 3 age groups from 1997 to 2011. The number of deaths due to asthma was first calculated for all groups and then for each sex in 3 age groups from 2000 to 2011. All analyses were conducted over the entire period and separately for the periods before and after a National Asthma Program (NAP) in 2003. Data also were available for prescriptions for beclomethasone since 2004. All analyses were conducted by using Epi Info.
  
  
  RESULTS
  Substantial reductions were found in hospitalizations and deaths due to asthma in Costa Ricans (eg, from 25 deaths in 2000 to 5 deaths in 2011). Although, the percentage decrement in the rates of hospitalization for asthma in subjects <20 years old was similar before and after the NAP, the reduction in both deaths due to asthma and rates of asthma hospitalizations in older subjects were more pronounced after the NAP, when prescriptions for beclomethasone were also increased by approximately 129%.
  
  
  CONCLUSIONS
  In Costa Rica, there was a marked decrement in hospitalizations and mortality due to asthma from 1997-2000 to 2011. In younger subjects, this is likely due to guidelines that, since 1988, recommend inhaled corticosteroids for persistent asthma. In older adults, the NAP probably enhanced reductions in hospitalizations and deaths due to asthma through inhaled corticosteroid use.
authors.affiliation: Division of Pediatric Pulmonology, Hospital Nacional de Niños, San José, Costa Rica; Department of Pediatrics, Hospital Nacional de Niños, San José, Costa Rica.
authors.forename: Manuel
authors.initials: M
authors.lastname: Soto-Martínez
authors.affiliation: Division of Pediatric Pulmonology, Hospital Nacional de Niños, San José, Costa Rica.
authors.forename: Lydiana
authors.initials: L
authors.lastname: Avila
authors.affiliation: Department of Pediatrics, Hospital Nacional de Niños, San José, Costa Rica.
authors.forename: Natalia
authors.initials: N
authors.lastname: Soto
authors.affiliation: Department of Pharmaco-epidemiology, Caja Costarricense Seguro Social, San José, Costa Rica.
authors.forename: Albin
authors.initials: A
authors.lastname: Chaves
authors.affiliation: Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Celedón
authors.affiliation: Division of Pediatric Pulmonology, Hospital Nacional de Niños, San José, Costa Rica; Department of Pediatrics, Hospital Nacional de Niños, San José, Costa Rica. Electronic address: msotoq@hnn.sa.cr.
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Soto-Quiros
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001249:Asthma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D001507:Beclomethasone / Q000008:administration & dosage; D002648:Child; D003364:Costa Rica; D011307:Drug Prescriptions; D017723:Drug Utilization Review / Q000639:trends; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D017678:Sex Distribution; D013997:Time Factors; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids; D001507:Beclomethasone
keywords: Asthma; COPD; Chronic obstructive pulmonary disease; Costa Rica; HNN; Hospital Nacional de Niños; Hospitalizations; ICS; Inhaled corticosteroids; Mortality; NAP; National Asthma Program