O2066: Asthma Deaths in the SUID and SDY Case Registry

Background: Asthma accounts for up to 790,000 Emergency Department visits per year and affects up to 6 percent of all children. Most asthma deaths are preventable but it still accounts for a portion of pediatric deaths. Understanding how and why infants, children, and young adults die suddenly and unexpectedly is the goal of the Sudden Unexpected Infant Death (SUID) and Sudden Death in the Young (SDY) Case Registry. Since 2015, the Registry has compiled information about young people (0-20 years) who die suddenly and unexpectedly. Understanding patterns and demographics of pediatric asthma deaths captured in the Registry may lead to novel prevention strategies.

Methods: Data were derived from the Registry which is a population-based surveillance system that compiles information from autopsies and death investigations including information about the circumstances at death and the medical history of the child. Registry cases are categorized using a standardized algorithm. We examined cases categorized as Explained Other per the Registry Algorithm that were either categorized with a cause of asthma or from cases where causes of death from death certificates included the following: Asthma, Influenza, Pneumonia, Other Infection, Other perinatal, Other medical cause, COVID-19, Undetermined if medical or external injury, Not Answered/Unknown. All cases with a diagnosis of asthma and/or death related to asthma were included. We included reactive airway disease if treated with albuterol and the child was over 1 year of age.

Results: Of 5600 Registry cases assessed, 686 were categorized as Explained Other, and of those 98 met our case definition of an asthma deaths. Deaths occurred more frequently in children who are Black (70.4%). Deaths were evenly distributed over age ranges (0 to 4, 5 to 9, 10-14, and 15-20) and occurred slightly more often in males (53.1%) than females (46.9%). Fifty-eight-point two percent of children were indicated to be up to date with vaccinations (40% missing/unknown). Forty eight percent were indicated to be compliant with prescribed medications (38.7% missing/unknown). 11.2% were born prematurely. Most deaths occurred at the child’s home and were witnessed (75.5%) and most often by a parent (67.3%). At the time of incident 23% were noted to have been sleeping. 22.4% of families reported experiencing a barrier to implementing the asthma care plan for the child. Eighteen percent described a barrier to accessing prescribed asthma medication.

Conclusion: Sudden, unexpected pediatric asthma deaths persist in the US. As in previous studies of asthma death, Black children and males died most often. Families experiencing an asthma-related death report barriers to accessing and implementing care for their children including accessing medications. Further prevention of asthma deaths requires the design and implementation of strategies targeting at-risk populations and aimed at addressing educational and care implementation needs and eliminating barriers to accessing care.