Hospitalisation

According to AIHW Asthma webpage:

From 2014–15 to 2023–24:

• the rate of hospitalisations decreased, from around 165 to 120 per 100,000 population (age-standardised rate: 169 in 2014-15 to 123 in 2023-24)
• the proportion of overnight hospitalisations decreased from 69% to 65%, while the average length of overnight stays remained relatively stable over the period, and was 2.6 days in 2023–24 (Figure 2).
• It should be noted that the rate of hospitalisations over the past few years has been affected by the COVID‑19 pandemic.

Age-standardised hospitalisation rates (asthma as principal diagnosis):

Worldwide incidence of asthma readmission is up to 40% (ref 1, intro).

NSW (ref 1,3)

A retrospective longitudinal study looking at 48,217 asthma hospitalisations in children aged 2-17 years reported that over 1 in 5 children hospitalised for asthma in NSW between 2007 and 2022 were readmitted for asthma within a year, costing an average AU$2593 per readmission. (ref 1)

The study included all children born in NSW between 2005 and 2015 who had at least one asthma hospitalisation across NSW between 2007 and 2022.

Findings (ref 1):

• 21.6% of children were readmitted to hospital due to asthma within 12 months
• readmitted children were younger than non-readmitted ones (mean age 3.8 vs 4.37) with 81% of readmitted children being aged 2-4 years (vs 65% of non-readmitted)
• overall incidence rate for the first asthma readmission within the 12 months was 23.8 per 100 person-years (95% CI 22.6 to 25.1)
• the incidence rate of asthma readmission was twice as high in children 2-4 years and went down with age up to the age group (28.7 per 100 person-years for 2-4 yo; 14.7 for 5-9 yo; 11.2 for 10-14 yo) but then increased again in older adolescents (18.0 per 100 person-years in 15-17 yo)
• the readmission incidence rate was highest in the first month following hospitalisation

• readmission incidence rate was higher in the more disadvantaged areas and major cities, implying socioeconomic disparities with higher population density, traffic congestion, and environmental pollution

• First readmission cost on average AU$2593 in direct medical cost per episode,  but increased with age up to 10-14yo: lowest cost in children 2-4 yo (AU$2867 per episode) and highest cost in children 10-14 yo (AU$4392 per episode).
• the medical cost of first asthma readmissions within 12 months was AU$ 15.6million.

Possible reasons:

• Hospital discharge without proper disease management, guideline-discordant asthma care, lack of education including reviewing inhaler technique and adequate counselling during discharge have been demonstrated to influence the risk of asthma readmission within the first few months of index hospitalisation
• Causal factors for higher readmission rate in younger children may include the high incidence of respiratory infections, particularly viral infections, environmental triggers such as environmental tobacco smoke, secondary smoking at home, traffic-related air pollution, moulds at home, dust-mite allergens, food allergens and inhalant allergens are causal risk factors for asthma readmissions among young children.

The same study/data was used to identify risk factors for these asthma readmissions (ref 3).

This second publication reported: (ref 3)

• 22% were readmitted within a year: 18% of these readmitted within 30 days (early readmission) and 82% readmitted after 30 days (late readmission)
• Most readmitted children were aged between 2 and 4 (77% of early readmissions, 81.5% of late readmissions)

Risk factors for early readmissions:(ref 3)

• children’s age 2–4 years (adjusted Relative Risk (adjusted risk ratio 1.71)
• No older siblings (1.26)
• Length of stay ≥ 2 days (1.42)
• Intensive care unit admission (2.27)
• Underlying chronic comorbidities and/or congenital anomalies (1.27)
• Admissions related to allergies or eczema (1.54)

Risk factors for late readmissions:(ref 3)

• Children’s age 2–4 years (1.93) – nearly twice as likely!
• No older siblings (1.09)
• Residence in the most socio‐economically disadvantaged areas (1.16)
• Residence in major cities (1.20)
• Index admission during spring (1.16) or summer (1.10)
• Length of stay ≥ 2 days (1.21)
• Admissions related to allergies or eczema (1.40)

VIC (ref 2)

A smaller study was conducted in VIC across 3 hospitals for 767 children 3-18 years hospitalised for asthma between 2017 and 2018. The study found that 34.3% of children were radmitted within 12 months, 69% of them being aged 3-5 yo.(ref 2)

note: the NSW data is stronger evidence as it is a population-based large study in NSW and included longer follow-up.

Asthma hospitalisations 2023 – 2024 (AIHW)
In 2023 – 2024, there were 31,994 hospitalisations with asthma as principal diagnosis.(ref 1)
This is very small increase compared to the previous year (31,107 hospitalisations in 2022-2023), a substantial increase compared to years affected by COVID-19 restrictions (e.g. about 25,500 in 2021-22) but remains below pre-pandemic level (about 37,000 in 2018-19).(ref 2)

Children under 15 accounted for 43% of all asthma hospitalisations.(ref 1)

In 2023-2024, 90% of asthma hospitalisations were potentially preventable.(ref1, 3)

*PPH: Potentially Preventable Hospitalisations (hospitalisations for asthma in people 4 years and over).

According to AIHW asthma webpage (ref 4), in 2023-24 there were:

• 32,000 hospitalisations with a principal diagnosis of asthma, representing 0.3% of all hospitalisations in Australia, and 119 hospitalisations per 100,000 population. Children 0-14 yo made up 43% of these hospitalisations (about 13,600 admissions)
• 65% of asthma hospitalisations were overnight stays, with an average length of 2.6 days
• the median age for asthma hospitalisations was 23
• When counting asthma hospitalisations as principal or additional diagnosis (any diagnosis), there were about 47,200 hospitalisations (0.4% of all hospitalisations)
• First Nations: 2,3000 hospitalisations due to asthma in First nations people, a rate of 220 per 100,000, which after adjustement for age, was 1.8 times higher than non-Indigenous Australians

Hospitalisation rates (ref 4):

• 119 per 100,000 (all ages, principal diagnosis)
• Highest among children aged 5-9 (around 405 per 100,000)
• boys aged 0–4, 5–9, and 10–14 had higher rates of hospitalisation than girls of the same age. For example, boys aged 0–4 were 1.8 times as likely as girls of the same age to be admitted to hospital

In 2023-2024, there were 28,778 potentially preventable hospitalisations (PPH) due to asthma. (ref 1).

This is similar to the year before with 28,238 PPH in 2022-2023, compared to 22,985 in 2021-2022 (a year with pandemic measures), and 32,558 in 2018-2019 before the COVID pandemic. (ref 2)

Note: Asthma PPH are all hospitalisations with asthma as principal diagnosis in people aged 4 and over.

Asthma PPH by jurisdiction (2023-24)

Asthma PPH rate (per 1,000 people) by Indigenous status and state or territory of residence, 2023-2024 (ref 3)

(c) Includes other territories, overseas residents and unknown state of residence.

Data collected from AIHW:

• Ref 1 – asthma hospitalisations: AIHW Principal diagnosis data cubes [Internet]. Separation statistics by principle diagnosis. https://www.aihw.gov.au/reports/hospitals/principal-diagnosis-data-cubes/contents/data-cubes => open data cube Separation statistics by principal diagnosis for each year; navigate to tab 5-char PDx counts summary and add Sum of Separations for J45 and J46, tab 5-char PDx counts Data for age-specific hospitalisation counts)
• Ref 2 – asthma potentially preventable hospitalisations (PPH): AIHW. Admitted patients. https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients#more-data => Download data table, chapter 8, Admitted patient care 2020–21 or 2021-22, 8 Safety and quality of the health systems, Tab S8.2. https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients#more-data
• Note: PPH are all hospitalisations with asthma as principle diagnosis in people aged 4 and over. Ref: AIHW. METEOR. National Healthcare Agreement: PI 18–Selected potentially preventable hospitalisations, 2021. (https://meteor.aihw.gov.au/content/725793)

Hospitalisations (ref 1), PPH (ref 2) and Hosp. rate (ref 3) 2016-2017 to 2020-23:

* Hospitalisation counts potentially affected by Covid pandemic measures

Hospitalisation rates 2011-12 to 2021-22 (age standardised, principal diagnosis, per 100,000 population) – ref 3, Fig 15

A population-based study in WA analysing hospital admissions in Perth in 2015-2017 and smoke exposure using a model tracking PM2.5 levels during 1700 bushfires and burn offs found that following exposure to high PM2.5 (12.60 mcg/m3 or higher) there was:
– 16% (RR 1.16, 95% CI 1.00 to 1.35) increase in hospital admissions on the same day as exposure
– 93% increase in asthma hospitalisations the next day (lag of 1 day) for children
– 52% increase in asthma hospitalisations on a lag of 3 days in low socio-economic groups.

Asthma hospitalisations 2022 – 2023 (AIHW)
In 2022 – 2023, there were 31,107 hospitalisations with asthma as principal diagnosis.(ref 1)
This is an increase compared to years affected by COVID-19 restrictions (e.g. about 25,500 in 2021-22) but remains below pre-pandemic level (about 37,000 in 2018-19).(ref 2)

Children under 15 accounted for 43% of all asthma hospitalisations.(ref 1)

*PPH: Potentially Preventable Hospitalisations, defined as hospitalisations with asthma as principal diagnosis in people aged 4 years and over.

In 2022-23, there were 28,238 potentially preventable hospitalisations (PPH) due to asthma. (ref 1) This represents 91% of all hospitalisations with asthma as principal diagnosis in 2022-23. (ref 1 and 2)

This compares to 22,985 the year before (2021/22, year with pandemic measures), and 32,558 in 2018/19 before the COVID pandemic. (ref 3)

Note: Asthma PPH are all hospitalisations with asthma as principal diagnosis in people aged 4 and over.

According to AIHW asthma report 2024 (ref 1), the peaks for asthma hospitalisations generally occur for children:

• in late summer (February): the peak in February is related to respiratory infections spreading with return to school and childcare after the summer break, and possibly a lower use of preventer medicines during the summer break
• in autumn (May)
• One-off natural events occurring on a seasonal basis like bushfires and thunderstorms can also impact asthma hospitalisations

2020 was an exception to this general trend, with a large decrease in hospitalisations in April and May for all age groups, due to COVID measures and lockdowns.

Figure 16: Monthly variation in hospitalisations due to asthma, by age group, 2017 to 2021 (ref 1)

Refer to Fig 16 on AIHW website to obtain exact hospitalisation rates per months and age groups.

Letter to the Editor, emphasising latest data/findings on childhood asthma in Australia including:
Facts:
– High prevalence (8.5% for children 0-14)
– Leading cause of burden of disease
– Hospital admissions have decreased in the last decade
– About 1 in 10 children dispensed SABA (e.g. Ventolin) through the PBS (as opposed as over the counter) have poor asthma control
– Only one in three (29%) children that have been dispensed a preventer used it regularly
– Overreliance on SABAs (reliever) and underuse of ICS are an enduring problem in childhood asthma, as these indicators have not improved in the last 5 years
– 1 in 3 hospitalised children is readmitted within 12 months for asthma (compared to 1 in 5 a decade ago) — Note: this is from a study looking at children admitted in 2017-18
– only 16.2% of children admitted to the hospital due to asthma were prescribed ICS before admission, and of those who were not on a preventer at the time of admission only 12.2% were commenced during the admission
– only 25.6% of children admitted to the hospital with asthma received asthma education and only one‐third of children had an assessment of their inhaler technique during their admission
– several studies from across Australia highlight guideline‐ discordant care across many settings (including pediatricians), which is a known risk factor for hospital readmission

Barriers:
A lack of standardized management and asthma action plans, inadequate systems to allow for timely follow‐up with GPs, inadequate asthma education for parents/carers, and lack of integrated asthma care between GPs and hospitals7 are some of the barriers to optimal asthma management in Australian children.

What is needed:
Multidimensional interventions have been shown to improve asthma control and reduce hospitalization, including asthma self‐management education, home environmental assessment regarding potential asthma triggers and supporting families to deliver asthma care at home, care coordination between primary and tertiary care, and school involvement to support the administration of asthma medications.

Note: The term potentially preventable hospitalisation (PPH) does not mean that a patient admitted for that condition did not need to be hospitalised at the time of admission. Rather the hospitalisation could have potentially been prevented through the provision of appropriate preventative health interventions and early disease management in primary care and community-based care settings (including by general practitioners, medical specialists, dentists, nurses and allied health professionals). PPH rates are indicators of the effectiveness of non-hospital care.

PPH are available to download from AIHW’s Admitted Patient Care,  chapter 8, Tab S8.2 for each corresponding year.

In 2020, Australia ranked 4th OECD country (out of 29 countries) with the highest rate of asthma hospitalisations in people aged 15+ (42 per 100,000), decreased from 71 per 100,000 in 2011. The average asthma hospitalisation rate was just 23 per 100,000.

To compare the rates of asthma hospitalisations between OECD countries (2018 and prior), download the primary care table and g to tabs AA1.1 and AA1.2. The data is from the National Hospital Morbidity Database

Age-standardised asthma hospitalisation rate in 2021-2022 in First Nations people vs other Australians, by jurisdictions:
– for Aboriginal and Torres Strait Islander people: 1.6 per 1,000 in NSW; 1.3 in VIC; 2.1 in QLD; 2.2 in WA; 2.0 in SA; 0.7 in TAS; 2.1 in ACT; 3.4 in NT, Nationally 2.0 per 1,000 (Table 10A.71)
– for other Australians (incl when indigenous status is not stated): 0.8 per 1,000 in NSW; 0.9 in VIC; 1.1 in QLD; 0.5 in WA; 1.0 in SA; 1.3 in TAS; 0.6 in ACT; 0.2 in NT, Nationally 0.9 per 1,000 (Table 10A.71)

In 2019, Australia ranked 9th OECD country with the highest age-standardised rate of asthma hospital admissions in adults (people aged 15+), with 63 admissions per 100,000 population.

(Note: the OECD page has been removed)

* The age-standardised rate of asthma hospitalisations for children aged 0–14 decreased overall, falling from 491 per 100,000 population in 2011–2012 to 225 per 100,000 population in 2021–2022

* The age-standardised rate of asthma hospitalisations for those aged 15 and over was relatively stable, fluctuating between 93 per 100,000 in 2011–2012 and 70 per 100,000 population in 2021–2022, peaking at 112 separations per 100,000 in 2016–2017 (after adjusting for age structure).

* the rate of hospitalisations has been affected by the Covid pandemic over the past few years.

Note: to obtain hospitalisation counts or rates for specific years, refer to Fig 15 and 16 in AIHW webreport and scroll over the dots on the graph, the actual values will appear.

AIHW report providing summary of epidemiological data in First Nations peoples with asthma (prevalence, risk factors, quality of life, burden of disease, mortality, hospitalisations, ED). This report provides a nice summary and a single reference.

Prevalence (2018-2019 National Aboriginal and Torres Strait Islander Health survey (NATSIHS):
– Around 128,000 First Nations people reported having asthma (16%), down from 18% in 2012-13, making asthma the third most prevalent long-term condition reported in 2018-19.
– higher in females (18%) compared to males (13%)
– increased with age, from 12% in children aged 0–14 to 26% in those aged 55 and over
– 1.6 times as high for boys compared with girls (aged 0–14) (14% and 8.6%, respectively)
– 2.1 times as high for females compared with males aged 55 and over (34% and 16%, respectively)
– 1.6 times higher in First Nations people compared to non-Indigenous Australians after adjusting for age structure (18% and 11% age-standardised prevalence respectively)
– Prevalence decreased with increasing remoteness: 19% in Major Cities, 12% in Remote areas and 7% in Very remote areas
– Prevalence by states: 25% in ACT, 23% in SA, 22% in TAS, 19% in NSW, 18% in VIC, 14% in QLD, 13% in WA, 6% in NT

Hospitalisation rates (2021-2022):
– 1,800 hospitalisations with asthma as principal diagnosis in 2021-22 (Covid pandemic year), an hospitalisation rate of 200 per 100,000; a decrease by 30% compared to 2018-19 (non Covid-pandemic year; 290 per 100,000)
– highest for females aged 45–54 (469 per 100,000) and higher for females overall compared to males (250 vs 155 per 100,000)
– 1.8 times higher for boys compared to girls aged 0-14 (318 vs 173 per 100,000)
– 2.1 times higher in First Nations people compared to non-Indigenous Australians after adjusting for age structure (205 vs 100 per 100,000, age-adjusted)

Emergency Departments visits (2021-2022 Non-admitted Patient Emergency Department Care database):
– 5,400 ED presentations for asthma in 2021-22 (605 per 100,000 population, decreased by 14% compared to 700 per 100,000 in 2018-19)
– Highest for females 35-44 (1,063 per 100,000) then females 45-54 (1,014 per 100,000) then boys 0-14 (883 per 100,000)
– 1.6 times higher in boys vs gilrs aged 0-14 (883 vs 558 per 100,000)
– 1.4 times higher in females vs males overall (about 710 vs 500 per 100,000)
– 2.6 times higher in First Nations people compared to non-Indigenous Australians after adjusting for age structure (about 600 vs 230 per 100,000; age-standardised)

Mortality (2017-2021):
– 65 deaths over the 5 years, corresponding to a mortality rate of 1.7 deaths per 100,000 population (decreasing from 2.1 per 100,000 in 2015-2019)
– Mortality rate increases with age and is 1.6 times higher in females
– Mortality rates adjusted for age structure are 1.9 times higher in First Nations people compared to non-Indigenous Australians

Burden of Disease (Australian Burden of Disease Study 2018):
– 7th leading cause of disease burden in First Nations people, contributing 3.4% to the total burden
– Burden of asthma is greater in females (4.3%) compared to males (2.5%)
– 4th leading cause of non-fatal disease burden (5.7% of total non-fatal burden)

Risk factors for First Nations people with asthma compared to those without asthma (2018–2019 NATSIHS):
– Similar likelihood to be a current daily smoker (43% vs 40%)
– More likely to be insufficiently active (93% vs 87%)
– 1.3 times more likely to live with obesity (55% vs 43%)

Quality of life (2018–2019 NATSIHS) for adult First nations people with asthma compared to those without asthma:
– 2.5 times more likely to have poor health (18% vs 7.2%)
– 1.5 times more likely to experience high or very high levels of psychological distress (42% vs 28%)
– 62% had at least one other chronic condition – the top 3 comorbidities were arthritis (51%), mental and behavioural conditions (46%), and back problems (37%)

Asthma Management in First Nations people with asthma (2018–2019 NATSIHS):
– 56% reported using asthma medication within the last 2 weeks
– 32% had a written asthma action plan (32% of those in non-remote areas vs 27% of those in remote areas)

In 2021-2022, a year affected by Covid-129 pandemic measures, there were:
– 1,800 hospitalisations with asthma as principal diagnosis in First Nations people, an hospitalisation rate of 200 per 100,000 population; a decrease by 30% compared to 2018-2019 (non Covid-pandemic year; 290 per 100,000)
– highest asthma hospitalisation rates for females aged 45–54 (469 per 100,000) and higher for females overall compared to males (250 vs 155 per 100,000)
– 1.8 times higher asthma hospitalisation rates for boys compared to girls aged 0-14 (318 vs 173 per 100,000)
– 2.1 times higher hospitalisation rates in First Nations people compared to non-Indigenous Australians after adjusting for age structure (205 vs 100 per 100,000, age-standardised)

COVID measures: lockdowns and travel restrictions until end of 2021, returning to normal in early 2022, all compulsory public health restrictions ceased by September 2022

Hospitalisations (in public hospitals) in 2021/22- pandemic year:
* In 2021/2022, there were over 25,000 hospitalisations for asthma (in public and private hospitals), of which more than 10,000 (42%) were in children aged under 15.(ref 1)
*90% of asthma hospitalisations were considered potentially preventable.(ref 1, 2) — scroll down to PPH by states and territory table

* there were about 25,500 hospitalisations with asthma as principal diagnosis in 2021-22 (hospitalisation rate of 99 per 100,000 population, or 101.5 per 100,000 when age-standardised), representing 0.2% of all hospitalisations in Australia (ref 3)

By age groups: (see graph below)
* most of asthma hospitalisations were in children aged 0-9 (ref 3)
* children aged 0–14 had a markedly higher hospitalisation rate than people aged 15 and over (225 vs 70 per 100,000 population) (ref 3)
* boys aged 0–14 were 1.6 times as likely as girls of the same age to be admitted to hospital for asthma (ref 3)
*in people aged 15 and over, females were 2.4 times as likely as males to be admitted to hospital for asthma (ref 3)

For potentially preventable hospitalisations by states, see: AIHW. Admitted patient care 2021-22. Table S8.2. https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients

For potentially preventable hospitalisations counts, rates and average length of stay at the National, PHN and SA3 level, download data table from https://www.aihw.gov.au/reports/primary-health-care/potentially-preventable-hospitalisations-2020-22/data (ref 4)

Graph available at https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma (Ref 3, accessed 8 Oct 2024):

Note: first entry on 13/07/2023; last update on 8/10/2024

Between 2017 and 2019, Aboriginal and Torres Strait Islander people were 80% more likelly to be hospitalised for asthma than other Australians, with an age standardised asthma hospitalisation rate of 2.7 per 1,000 people, and an asthma hospitalisation rate ratio of 1.8 (rate difference 1.2 per 1,000) compared to non-Indigenous Australians.
Specifically, the age standardised asthma hospitalisation rates and rate ratios were:
– for males: 1.9 hospitalisations per 1,000 population (rate ratio 1.4 so 40% higher compared to non-Indigenous Australians)
– for females: 3.5 hospitalisations per 1,000 population (rate ratio 2.2 so 120% higher compared to non-Indigenous Australians)

By age groups, the asthma hospitalisation rates for 2017-2019 were:
– under 1 yo: 0.3 per 1,000 (vs 0.2 per 1,000 in non-Indigenous, rate ratio 1.7) – 70% higher
– 1-4 yo: 7.1 per 1,000 (vs 6.2 per 1,000 in non-Indigenous, rate ratio 1.2) – 20% higher
– 5-14 yo: 3.0 per 1,000 (vs 2.8 per 1,000 in non-Indigenous, rate ratio 1.2) – 10% higher
– 15-24 yo: 1.6 per 1,000 (vs 0.9 per 1,000 in non-Indigenous, rate ratio 1.8) – 80% higher
– 25-34: 2.1 per 1,000 (vs 0.7 per 1,000 in non-Indigenous, rate ratio 3.1) – 310% higher
– 35-44 yo: 2.9 per 1,000 (vs 0.9 per 1,000 in non-Indigenous, rate ratio 3.1) – 310% higher
– 45-54 yo: 3.1 per 1,000 (vs 1.0 per 1,000 in non-Indigenous, rate ratio 3.1) – 310% higher
– 55-64 yo: 2.6 per 1,000 (vs 1.0 per 1,000 in non-Indigenous, rate ratio 2.5) – 250% higher
– 65 and over: 2.2 per 1,000 (vs 1.5 per 1,000 in non-Indigenous, rate ratio 1.5) – 150% higher

The age-standardised hospitalisation rate for asthma fluctuated during the last 11 years, with the highest rate at 183 per 100,000 population in 2009–2010 and the lowest at 130 per 100,000 population in 2019-2020.

Note: 2019-2020 was a COVID pandemic year, with restrictions starting on 28 March 2020.

Multicentre cohort study by the Murdoch Children’s Research Institute following-up for 12 months 767 children aged 3–18 years admitted to hospital for asthma in Victoria in 2017-2018.
Results:
– About one third (34.3 %) were readmitted to hospital for asthma, (those aged 3-5 years accounting for 69.2 per cent): 20.6 % were readmitted once and 13.7 % had two or more readmissions in 12 months.
– children were 57% more likely to be readmitted when their general practitioners did not adhere to recommended asthma management guidelines
– almost 75% were discharged without a preventer and more than 80% did not have a follow-up appointment at the hospital
– Over a third hadn’t had a review of inhaler technique
Conclusion: Hospital readmissions among Australian children with asthma are increasing (compared to a decade ago when about 1 in 5 were readmitted), and the study highlights the gaps in children’s asthma care throughout their care journey such as reviewing their baseline asthma control, inhaler technique and asthma medication, lack of booked follow-up arrangements before discharge, and guideline discordant care.

see MCRI website: https://www.mcri.edu.au/news-stories/hospital-readmissions-for-asthma-on-the-rise-among-children

The bushfires that swept across Australia in 2019–2020 resulted in 33 deaths, destruction of over 3,000 houses and millions of hectares. Bushfire smoke exposure was significantly associated with an increased risk of respiratory morbidity. Nationally, hospitalisation rates increased for asthma and COPD coinciding with increased bushfire activity during the 2019–20 bushfire season. For asthma, the highest increase was 36% in the week beginning 12 January 2020 (2.4 per 100,000 persons) compared to the previous 5-year average (1.7 per 100,000 persons).
For Emergency Department presentations, asthma saw the highest increase of 44% in the week beginning 12 January 2020 (4.7 per 100,000 persons compared to the previous bushfire season (3.3 per 100,000 persons).

Extract from AIHW Chronic respiratory conditions report:

COVID‑19 impact on chronic respiratory conditions

The COVID‑19 pandemic had substantial impacts on hospital activity generally. The range of social, economic, business and travel restrictions, including restrictions on, or suspension of, some hospital services, and associated measures in other healthcare services to support physical distancing in Australia, resulted in an overall decrease in hospital activity between 2019–20 and 2020–21. As a result, the hospitalisation rates for asthma and COPD in these years were the lowest recorded in the last 10 years (AIHW 2022a).

For more information on how the pandemic has affected the population’s health in the context of longer-term trends, see ‘Changes in the health of Australians during the COVID‑19 period’ in Australia’s health 2022: data insights.

Emergency department presentations for asthma and COPD were also affected by the pandemic, decreasing from March (when the national lockdown started) to May 2020 (from 26 to 11 and 39 to 28 presentations per 100,000 population, respectively).

In June 2020, emergency department presentations increased again as restrictions began to ease across the country (to 19 presentations per 100,000 population for asthma and to 33 presentations per 100,000 population for COPD) (Figure 9).

During the COVID‑19 pandemic (as at 31 October 2022), chronic respiratory conditions were certified as a pre-existing condition in 18% of the deaths with a chronic condition mentioned, the third highest of all chronic conditions (ABS 2022)

Death rates due to all respiratory diseases combined also showed a substantial fall in 2020, with rates particularly low for females and during the winter months compared with previous years, though rates have increased since (Figure 10).

While the long-term impact of COVID‑19 on the respiratory system is still being assessed, evidence shows that COVID‑19 does not directly impact the risk of increasing asthma severity and vice versa (Lee et al. 2020; Lieberman-Cribbin et al. 2020; Mather et al. 2021). However, there is increasing evidence showing that COPD patients with COVID‑19 have greater risk of mortality, severity of infection and higher likelihood of requiring Intensive Care Unit (ICU) support than those without COPD (Cazzola et al. 2021; Clark et al. 2021; Wells 2021).

For more information, see ‘The impact of a new disease: COVID‑19 from 2020, 2021 and into 2022’ in Australia’s health 2022: data insights.

* In 2020/2021, there were nearly 25,000 hospitalisations for asthma (in public and private hospitals), of which more than 10,000 (43%) were in children aged under 15.(ref 1, 5)
Nearly 90% of asthma hospitalisations (89.3%) were considered potentially preventable.(ref 1, 2)

* The age-standardised hospitalisation rate for asthma for all ages combined was 100 per 100,000 population. It was markedly higher in chidren 0-14 (225 per 100,000) compared to people aged 15 and over (68 per 100,000). (ref 5)

* For age-specific hospitalisation rates, SEE FIGURE 14 from reference 5
Boys aged 0-14 were 1.6x as likely as girls to be hospitalised for asthma, while females 15 and over were 2.3x as likely as males to be hospitalised for asthma. (ref 5)

* Note that for hospitalisations due to all causes, following steady annual growth of 3.3% between 2014–15 and 2018–19, and a dip of 2.8% in 2019–20, hospitalisations increased by 6.3% nationally in 2020–21. This saw hospitalisations returning the trend to pre-pandemic years, and can be largely attributed to the easing of restrictions following the first waves of the COVID pandemic. (ref 3)

* A study conducted in two major hospital in Sydney also reported a 50-70% decrease in paediatric asthma hospitalisations during lockdown periods in 2020-21, stating potential explanations may be a reduction in respiratory infections, better outdoor air quality combined with less outdoor activities, and patients opting for telehealth appointments rather than hospital visits by fear of contracting COVID. (ref 4)

*For hospitalisations by PHN, see indicator 9, AIHW. Asthma. Data. Data tables: Asthma 2023. Table 9.1. https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma/data (ref 6)

First entry date: 19/07/2022; last update 13/02/2024

PHIDU dataset of potentially preventable hospitalisations from 2012/13 – 2016/17 by Public Health Areas:

http://phidu.torrens.edu.au/social-health-atlases/topic-atlas/pph#potentially-preventable-hospitalisations-atlas-data

Note: data for prior releases, including NHS asthma prevalence data, is available at: https://phidu.torrens.edu.au/social-health-atlases/data-archive/data-archive-social-health-atlases-of-australia

In 2017-2018 there were nearly 39,000 hospitalisations for asthma. The rate of hospitalisations for asthma was 158 per 100,000 population.

Nearly half (44%) of these were for children aged 0-14 years old, giving asthma an age profile of hospitalisation much younger compared to hospitalisations for all causes.

The age-standardised rate of hospitalistions for asthma in children aged 0-14years old has decreased overall during the last decade, falling from 542 per 100,000 population in 2009–2010 to 363 per 100,000 population in 2017–2018.

In 2017-2018 more than 80% of these were potentially preventable through the provision of appropriate preventive health interventions and early disease management in primary care settings. (ref 1 and 2)
(note that there were 32,720 PPH (ref 1) out of 38,792 hospitalisations for asthma (ref 2), therefore 84% of hospitalisations were potentially preventable/avoidable)

PPH for asthma (and other chronic conditions) between 2012-2013 and 2017-2018 by:
– National, state/territory, PHN and SA3
– Gender
– Age group and life stage
– Indigenous/non Indigenous
– Seasons
– SES area and remoteness

PPH per 100,000 included (crude rate).

Download the Excel table at https://www.aihw.gov.au/reports/primary-health-care/disparities-in-potentially-preventable-hospitalisa/data-1 and then sort/filter according to your area of interest.

PPH rate (National)

PPH by Indigenous status

PPH by season

PPH 2017/2018 by age group, socio-economic status and remoteness:

In May 2016 there were hazard reductions burns conducted around Sydney causing smoky conditions and high PM2.5 concentrations for several days. This study assessed the impact of smoke-related PM2.5 on all-cause mortality and hospitalisations for cardiovascular and respiratory conditions in Sydney. Six days were identified as being clearly smoky. It was estimated that 14 premature deaths and 58 respiratory hospitalisations were attributable to these smoky days. This highlights the potential scale of the public health impacts when smoke affects a population of nearly 5 million people for several days.

In 2015-2016, there were 31,245 Potentially Preventable Hospitalisations (PPH) for asthma, costing 89,365,433$ or an average 2,860$ per PPH.

Each ED presentation for asthma costs $443 on average, an uncomplicated hospital admission costs approximately $2,591 (approximately 1.5 hospital days) and a complicated admission costs $5,393 (approximately three hospital days).

The below table is a collation of multiple year file downloads from the morbidity database. Note: this is raw data not standardised to the population.

AA commissioned the PHIDU team to create an Asthma Atlas with prevalence, AAP ownership, hospitalisations, and deaths. It breaks the data down by Commonwealth Electorate Divisions (CED), Population Health Areas (PHAs) and Statistical Area 3 (SA3).
The link to the left takes you to an online atlas.

The data is modelled using 2016/17 hospitalisation data which is not the most updated national or state/territory level data we have. However, this is very useful if you need data broken down by a local level.

Note (Feb 2024): this link is not accessible anymore, and PHIDU has updated their Social Health Atlas maps with the following asthma-specific data: Census 2021 data (for prevalence), asthma hospital admissions 2020/21; asthma potentially preventable hospitalisations 2020/21.

Previous releases of the PHIDU including NHS 2017/2018 prevalence data (2021 release) can be accessed at: https://phidu.torrens.edu.au/social-health-atlases/data-archive/data-archive-social-health-atlases-of-australia