The increasing burden of asthma acute care in Singapore: an update on 15-year population-level evidence

Laura Huey Mien Lim; Wenjia Chen; Joseph Emil Amegadzie; Hui Fang Lim

doi:10.1186/s12890-023-02797-7

The increasing burden of asthma acute care in Singapore: an update on 15-year population-level evidence

BMC Pulm Med. 2023 Dec 12;23(1):502. doi: 10.1186/s12890-023-02797-7.

Authors

Laura Huey Mien Lim¹, Wenjia Chen², Joseph Emil Amegadzie³, Hui Fang Lim^{4

5}

Affiliations

¹ Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, 117549, Singapore.
² Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, 117549, Singapore. wenjiach@nus.edu.sg.
³ Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
⁴ Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, NUHS Tower Block, 1E, Kent Ridge Road, 119228, Singapore.
⁵ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E, Kent Ridge Road Level 11, 119228, Singapore.

Abstract

Background: In Singapore, there is currently scarce population-based research informing the recent trends of asthma-related healthcare burdens. In this study, we investigated the past 25-year trends of asthma-related hospitalisations, emergency department (ED) visits and deaths in Singapore and projected the future burdens from 2023 to 2040.

Methods: We acquired annually-measured data from the Singapore Ministry of Health Clinical and National Disease Registry, containing 25-year asthma-related hospitalisation and death rates as well as 15-year ED visit rates. We conducted change-point analysis and generalised linear modelling to identify time intervals with stable trends and estimate asthma-related healthcare utilisation and mortality rates. To project future asthma-related burdens, we developed a probabilistic model which combined projections of future population size with the estimated rate outcomes from the last stable period.

Results: Our results show that the asthma hospitalisation rate in Singapore had remained at approximately 80 episodes per 100,000 from 2003 to 2019 and are likely to grow by 1.7% each year (95% CI: 0.7, 5.0%), leading to a total of 163,633 episodes from 2023 to 2040 which corresponds to an estimated $103,075,820 based on 2022 USD. Besides, Singapore's asthma-related ED visit rate was 390 per 100,000 in 2019 and is expected to decline by 3.4% each year (95% CI: - 5.8, 0.0%), leading to a total of 208,145 episodes from 2023 to 2040 which corresponds to USD$15,053,795. In contrast, the 2019 asthma-related mortality rate in Singapore was approximately 0.57 per 100,000 and is likely to stay stably low (change per year: -1.3, 95% CI: - 11.0, 4.3%). Between 2023 and 2040, Singapore's estimated total number of asthma-related deaths is 638 episodes.

Conclusions: Currently, the burden of asthma acute care in Singapore is high; Singapore's asthma-related hospitalisation and ED visit rates are relatively higher than those of other developed economies, and its asthma admission rate is expected to increase significantly over time, possibly indicating excess resource use for asthma. The established national asthma programme in Singapore, together with recent efforts in reinforcing primary care at the national level, provides opportunities to reduce avoidable asthma admissions.

Keywords: Asthma; COVID-19; Cost of illness.

MeSH terms

Asthma* / epidemiology
Asthma* / therapy
Hospitalization*
Humans
Models, Statistical
Singapore / epidemiology