638 - Anaphylaxis in Focus: Examining Mortality Trends in the United States from 1999-2020

Publication Number: 638.4007

Ernestina H.. Bioh Hansen-Sackey, Valley Children's Healthcare, Madera, CA, United States; Fredrick Dapaah-Siakwan, Valley Children's Healthcare, Madera, CA, United States

Background: Anaphylaxis is a growing health problem globally impacting up to 5% of the United States (US) population. Fatalities related to anaphylaxis are rare, leading to limited research on the epidemiology of anaphylaxis-related mortality in the US.

Objective: To examine recent temporal trends and the geographic, racial, and age differences in anaphylaxis-related (AR) mortality in the US from 1999-2020 with a nationally representative database.

Design/Methods: We conducted a retrospective, serial cross-sectional analysis of national death certificate data from the CDC's WONDER website from 1999-2020 examining deaths with anaphylaxis (ICD-10 codes T78.0, T78.2, T80.5, T88.6) listed as a contributing cause of death. Death counts less than 20 were excluded per CDC guidelines. The exposure was the year of death. The outcome was the anaphylaxis-related age-adjusted mortality rate (AR-AAMR), overall, and stratified by age, gender, race/ethnicity and census region expressed per 1,000,000 population. Subgroup statistical differences were evaluated using Mann-Whitney U or ANOVA as appropriate. Trends were assessed with linear regression and correlation coefficient (R). P< 0.05 indicated statistical significance.

Results: There were 5208 AR deaths out of a population of 6.7 billion, resulting in AR-AAMR of 0.7 per 1,000,000. Most deaths occurred in males (54.6%), individuals aged ≥35 (86.1%), non-Hispanic White persons (NHW) [73.0%], and deaths were more likely to be related to unspecified anaphylaxis (77.0%) and anaphylaxis related to correctly administered medications (18.0%).
The AR-AAMR was significantly higher in males (0.83), non-Hispanic Black persons (NHB) [1.06] and in those aged ≥35 (1.2). The overall AR-AAMR decreased from 0.8 in 1999 to 0.6 in 2002, and thereafter increased to 0.8 in 2020 (P < 0.03, R = 0.46). The AR-AAMR increased in males (0.8 to 0.9; P< 0.01, R = 0.61), NHW (P < 0.01, R = 0.50), the West region (0.6 to 0.7; P< 0.03, R=0.47), and in those aged ≥35 (1.2 to 1.4; P< 0.01, R = 0.53). However, there was no significant change in the AR-AAMR for those aged ≤14, 15 -34 years (0.4 to 0.3, P=0.75, R=0.07), females (0.7 to 0.8, P=0.1, R=0.38), and NHB (1.0 to 1.2; P=0.2, R=0.32).

Conclusion(s): The overall AR-AAMR in the US increased during the study period and across various demographic groups except for females, NHB and those aged < 35. Fatalities were mainly linked to unspecified anaphylaxis and anaphylaxis related to correctly administered medications. Further research using data with more granularity may be crucial in understanding fatalities which may highlight critical areas for preventive efforts.

Table 1. Demographic characteristics, types of anaphylaxis-related mortality, and their age-adjusted mortality rates in the United States, 1999 - 2020


Fig 1: Temporal trends in anaphylaxis-related age-adjusted mortality rate in the United States, 1999-2020