Claim: Malta’s asthma rate is amongst the highest in the world.

Verdict: There is little agreement on asthma rates, with figures varying from one study to the next. But most studies suggest that Malta’s rate is higher than average, although not quite as dire as several other countries.

Outgoing medical union boss Martin Balzan issued a stark warning over respiratory health in Malta last week, saying that Malta has among the highest rates of asthma in the world.

“We’re in the champions’ league in that regard,” Balzan, a respiratory expert, quipped, pointing to traffic congestion as a leading cause

The statement raised alarm amongst viewers, with several writing to Times of Malta to express their concern.

But data about asthma rates paints a slightly more complex picture, suggesting that while Malta’s asthma rates remain high, several other European countries are in a fairly similar situation.

How many asthma cases does Malta have?

Data about asthma is surprisingly scarce, with most publicly available information dating back several years.

A landmark study throughout the 1990s and early 2000s, known as ISAAC, found that Maltese children were increasingly prone to wheezing and other symptoms linked to asthma. 

But a response to a parliamentary question filed by PN MP Albert Buttigieg in 2023 sheds some light on the sheer number of people admitted to hospital due to asthma over the past decade.

In 2022, the last full year reported in the reply, 473 people had a stint in hospital because of asthma, more than any year since 2019.

Unsurprisingly, numbers dipped in 2020 and 2021, as pandemic lockdowns kept people indoors and slashed air pollution levels.

But before that, asthma-related hospital admissions frequently topped 500, with older adults invariably being the hardest hit.

Meanwhile, EU data shows that asthma was the cause of death for six people in Malta in 2022, with deaths fluctuating between a low of 4 in 2015 to a high of 14 just three years later.

How does this compare to other countries?

This is where things get a little more complicated.

EU-wide data shows that asthma affected 5.7% of the EU population in 2019, a slight rise from the 5.4% five years earlier in 2014, with asthma rates varying from one European country to the next.

Malta ranks somewhat mid-table, with its 6% prevalence rate marginally above average, but far lower than the continent’s high-fliers.

But this data looks at how many people reported having asthma, opening the door to the suspicions of under-reporting amongst some of Europe’s more marginalised communities skewing the rankings.

And, with some of Europe’s poorest nations (such as Bulgaria and Romania) propping up the table, and some of the wealthiest (Iceland, Finland, Germany, Norway) leading it, this prospect appears to be at least partially possible.

Perhaps a better measure would be to compare the standardised death rate, which looks at how many people died of asthma in each country per 100,000 inhabitants.

The most recent figures show that in 2021 there were 1.44 deaths in Malta caused by asthma per 100,000 people. Again, this is higher than the EU average (1.11 deaths) but well behind several other countries.

And Malta’s ranking compared to other countries tends to shift from mid-table in some years (2015, 2021) to amongst the upper echelons in others (2014, 2018, 2019), making it difficult to establish a pattern.

Meanwhile, an index by the Institute for Health Metrics and Evaluation, a research institute at the University of Washington, presents similar figures to the EU when looking at the prevalence of asthma.

Asthma affects 6.7% of people in Malta, the index says.

This is higher than most European countries, although not quite as high as some of worst culprits (Portugal, UK and Poland), all of which exceed 9%, with Malta also ranking behind several other countries across the world (including the USA and Australia).

Maltese worry about asthma

Regardless of the exact figures, what is clear is that worries about asthma loom large on the minds of many Maltese.

A 2021 European Commission report on the state of health in the EU found that while hospital admission rates for asthma and pulmonary disease (as well as several other diseases such as heart failure and diabetes) are higher than the EU average, many of these admissions could be avoided.

Despite the above-average prevalence of these diseases, the report says. “many hospital admissions could be avoided through stronger primary and outpatient care interventions and more effective care coordination between ambulatory and inpatient care settings.

And another, more recent study, found that people in Malta are the most likely to Google the term “asthma” in all of Europe, “although it has a disease prevalence of approximately 6%, which is not as high as in other examined countries”.

“One reason for this may be the high number of tourists, particularly from English-speaking countries, visiting Malta each year,” the study says.

Verdict

There is relatively little recent data comparing the prevalence of asthma in Malta to that in other countries.

EU data indicates that asthma affected 6% of Malta’s population in 2019, slightly higher than the 5.7% EU-wide average, but lower than several other European countries. More recent comparative data is not available.

And asthma was responsible for the death of 1.44 people per 100,000 inhabitants in Malta in 2021. Again, this is higher than the EU average, but stops short of the rates recorded by several other countries.

Further afield, a US index suggests that Malta’s asthma prevalence of 6.7% is high, but lags behind several others in Europe and across the world.

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