The high burden of asthma acute care in singapore in the next 20 years

SESSION TITLE: Asthma and Allergy SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2023 08:30 am - 09:30 am PURPOSE: Currently, there is limited population-based evidence on current and future healthcare burden of asthma in Singapore. This study examined the trends of asthma admissions, emergency department (ED) attendances and mortality in Singapore in the past 25 years, and predicted future burdens up to 2040. METHODS: We obtained annual rates of asthma admissions and mortality (1994-2020), and ED attendance rates (2005-2020) from the Singapore Ministry of Health Clinical and National Disease Registry. Generalised linear models with Poisson distribution and the change points were performed to estimate the annual rate of asthma-related health services use and identify periods with distinct trends. Inference of regression coefficients were obtained via bootstrapping with 1,000 iterations. Next, we projected the future burdens of asthma-related health services use using a probabilistic model which combined the rate estimate from the latest stable trend of the change-point model with the Singaporean population growth projections. RESULTS: Singapore’s asthma admission rates had hovered between 70‒80 episodes per 100,000 persons between 2003 and 2019. Despite temporal fluctuation due to the COVID-19 pandemic, asthma admissions are expected to increase by 1.7% (95% CI: 0.7% to 5.0%) per year. As such, between 2023-2040, the total asthma admissions in Singapore will amount to an estimated 163,633 total episodes, corresponding to a total of USD$92,307,917 (2022 USD$1=SGD$1.33) based on average asthma-related hospitalisation costs in Singapore. In 2019, the rate of asthma-related ED attendances in Singapore was 390 per 100,000, which is expected to decrease by 3.4% (95% CI: -5.8% to 0.0%) per year. Between 2023-2040, the estimated total number of asthma-related ED attendances in Singapore is 209,502 episodes, which amounts to USD$15,146,355 ED costs. On the other hand, asthma mortality rates in Singapore reached a low of 0.57 per 100,000 in 2019 and are expected to decline by 1.3% (95% CI: -11.0% to 4.3%) per year. Total asthma-related deaths in Singapore between 2023-2040 is approximately 638 episodes. CONCLUSIONS: Current rates of asthma-related hospitalisations and ED attendances in Singapore are relatively high, roughly twice of the average of OECD countries. While asthma-related ED visits and mortality have stabilised, asthma admissions will increase persistently over the next 20 years in Singapore. CLINICAL IMPLICATIONS: The relatively higher asthma admission rates in Singapore may indicate excess resource use and lower threshold of inpatient care for asthma, partially due to gaps in primary care which resulted in underuse of inhaled corticosteroids and irregular follow-ups. Thus, there is an urgent need to reinforce asthma primary care in Singapore to bend the preventable cost curves. DISCLOSURES: No relevant relationships by Joseph Amegadzie No relevant relationships by Wenjia Chen No relevant relationships by Laura Huey Mien Lim No relevant relationships by Hui Fang Lim No relevant relationships by Mohsen Sadatsafavi