Jeanne E. Moorman

Status of Childhood Asthma in the United States, 1980–2007

Centers for Disease Control and Prevention data were used to describe 1980–2007 trends among children 0 to 17 years of age and recent patterns according to gender, race, and age. Asthma period prevalence increased by 4.6% per year from 1980 to 1996. New measures introduced in 1997 show a plateau at historically high levels; 9.1% of US children (6.7 million) currently had asthma in 2007. Ambulatory care visit rates fluctuated during the 1990s, whereas emergency department visits and hospitalization rates decreased slightly. Asthma-related death rates increased through the middle 1990s but decreased after 1999. Recent data showed higher prevalence among older children (11–17 years), but the highest rates of asthma-related health care use were among the youngest children (0–4 years). After controlling for racial differences in prevalence, disparities in adverse outcomes remained; among children with asthma, non-Hispanic black children had greater risks for emergency department visits and death, compared with non-Hispanic white children. For hospitalizations, for which Hispanic ethnicity data were not available, black children had greater risk than white children. However, nonemergency ambulatory care use was lower for non-Hispanic black children. Although the large increases in childhood asthma prevalence have abated, the burden remains large. Potentially avoidable adverse outcomes and racial disparities continue to present challenges. These findings suggest the need for sustained asthma prevention and control efforts for children.

Racial and ethnic disparities in asthma medication usage and health-care utilization: data from the National Asthma Survey.

BACKGROUND Despite the availability of effective treatment, minority children continue to experience disproportionate morbidity from asthma. Our objective was to identify and characterize racial and ethnic disparities in health-care utilization and medication usage among US children with asthma in a large multistate asthma survey. METHODS We analyzed questions from the 2003-2004 four-state sample of the National Asthma Survey to assess symptom control, medication use, and health-care utilization among white, black, and Hispanic children < 18 years old with current asthma who were residing in Alabama, California, Illinois, or Texas. RESULTS Of the 1,485 children surveyed, 55% were white, 25% were Hispanic, and 20% were black. Twice as many black children had asthma-related ED visits (39% vs 18%, respectively; p < 0.001) and hospitalizations (12% vs 5%, respectively; p = 0.02) compared with white children. Significantly fewer black and Hispanic children reported using inhaled corticosteroids (ICSs) in the past 3 months (21% and 22%, respectively) compared to white children (33%; p = 0.001). Additionally, 26% of black children and 19% of Hispanic children reported receiving a daily dose of a short-acting beta-agonist compared with 12% of white children (p = 0.001). ED visits were positively correlated with short-acting beta-agonist use and were negatively correlated with ICS use when stratified by race/ethnicity. CONCLUSIONS Children with asthma in this large, multistate survey showed a dramatic underuse of ICSs. Black and Hispanic children compared with white children had more indicators of poorly controlled asthma, including increased emergency health-care utilization, more daily rescue medication use, and lower use of ICSs, regardless of symptom control.

Increasing U.S. asthma mortality rates : Who is really dying?

Asthma mortality rates have been increasing since 1979, but rates of change among different demographic subgroups have not been examined in detail. This analysis identifies the demographic subgroups that are most responsible for the increase in asthma mortality rates in the United States between 1979 and 1996. The analysis is limited to those death certificates that specified asthma as the underlying cause of death. Blacks, females, and people aged 65 and older had the largest increases in age-adjusted asthma mortality rates between 1979 and 1996. When all three demographic variables are considered simultaneously, black females aged 65 years and older had the highest crude asthma mortality rates in 1996 and the largest increase in rates since 1979. However, white females aged 65 years and older contributed the most to the increase in age-adjusted rates between 1979 and 1996 because of their relatively larger population size. Overall, the increase in asthma mortality rates between 1979 and 1996 was due primarily to increased mortality rates in the population subgroup aged 65 years and older. Even though the rapid increase in asthma mortality rates in those aged 65 years and older shows evidence of a slight reversal after 1989, efforts to develop strategies to reduce overall mortality from asthma should concentrate on middle-aged and elderly women.

Asthma Incidence among Children and Adults: Findings from the Behavioral Risk Factor Surveillance System Asthma Call-back Survey—United States, 2006–2008

Background. Asthma, a chronic respiratory condition affecting 8.2% of the US population (2009), causes significant societal and economic burden, resulting in missed school/work days, activity limitations, and increased healthcare utilization. Annual asthma prevalence estimates are available from national surveys, but these surveys have not routinely collected asthma incidence data that are important for identifying risk factors and trends in rates of disease onset. The Asthma Call-back Survey (ACBS), implemented in 2006, provides detailed asthma data that supplement Behavioral Risk Factor Surveillance System (BRFSS) data. We analyzed BRFSS and ACBS data to estimate annual asthma incidence and to determine whether these rates differed by age group, sex, and race/ethnicity. Methods. BRFSS and ACBS data from the participating states during 2006–2008 (24 states and District of Columbia [DC] in 2006; 34 states and DC in 2007 and 2008) were analyzed to calculate 12-month incidence rates. Incident cases of asthma were defined as people diagnosed with asthma by a healthcare provider within 12 months prior to survey participation. Results. Estimated asthma incidence among at-risk adults was 3.8/1000, whereas that among at-risk children was 12.5/1000. Incidence among children aged 0–4 years was 23.4/1000, more than five times greater than that among youth aged 12–17 years (4.4/1000). Adult females had 1.8 times greater asthma incidence than adult males (4.9/1000 vs. 2.8/1000, respectively). Incidence among non-Hispanic (NH) White adults was 3.9/1000, among NH non-White adults was 3.2/1000, and among Hispanic adults was 4.0/1000. Conclusions. This is the first successful application of the BRFSS–ACBS during 2006–2008 to estimate asthma incidence rates from participating states and DC. As with known patterns in asthma prevalence, we found that asthma incidence was higher in children than adults, higher in younger children than older children and adolescents, and higher in adult females than adult males. However, we were unable to identify statistically significant differences in asthma incidence among most race/ethnic groups. As additional data on asthma incidence become available from the ACBS, these rates, coupled with ACBS data on symptoms, asthma self-management practices, and healthcare utilization, may help asthma control programs identify risk factors for disease development and target asthma prevention and control measures to populations most affected.

Asthma incidence: data from the National Health Interview Survey, 1980-1996.

Objective. To obtain historical estimates of US asthma incidence from 17 years of health survey data. Methods. The 1980 through 1996 National Health Interview Survey contained a question asking about the time of asthma onset in persons with asthma. Annual past year incidence estimates were calculated from self-reports of asthma status. Results. Incidence increased from 2.5 per 1,000 (SE 0.37) in 1980 to 6.0 per 1,000 (SE 0.75) in 1996. Incidence increased faster in children than in adults and increased in females but not in males during this time. Conclusion. These findings suggest that increasing asthma incidence contributed to the increasing prevalence during this time.

Sex Differences in Asthma Prevalence and Other Disease Characteristics in Eight States

Objectives. We assessed the sex differences in asthma prevalence and asthma-control characteristics within eight states. Methods. We analyzed data from the 2001 Behavioral Risk Factor Surveillance System survey. Results. Lifetime and current asthma prevalence were higher for females in each of the eight states compared to males. Adult onset of asthma was reported more often by females with current asthma, and childhood onset was reported more often by males. Sex differences were identified for the eight asthma-control characteristics. Conclusions. Females in eight states presented higher asthma risk and poorer asthma profiles than males. State surveillance data can be used to identify disparities and to develop appropriate public health interventions.

Work-related asthma, financial barriers to asthma care, and adverse asthma outcomes: asthma call-back survey, 37 states and District of Columbia, 2006 to 2008.

Background:Proper asthma management and control depend on patients having affordable access to healthcare yet financial barriers to asthma care are common. Objective:To examine associations of work-related asthma (WRA) with financial barriers to asthma care and adverse asthma outcomes. Research Design:Cross-sectional, random-digit-dial survey conducted in 37 states and District of Columbia. Subjects:A total of 27,927 ever-employed adults aged ≥18 years with current asthma. Measures:Prevalence ratios (PR) for the associations of WRA with financial barriers to asthma care and of WRA with adverse asthma outcomes stratified by financial barriers. Results:Persons with WRA were significantly more likely than those with non-WRA to have at least 1 financial barrier to asthma care [PR, 1.66; 95% confidence interval (CI), 1.43–1.92]. Individuals with WRA were more likely to experience adverse asthma outcomes such as asthma attack (PR, 1.31; 95% CI, 1.22–1.40), urgent treatment for worsening asthma (PR, 1.57; 95% CI, 1.39–1.78), asthma-related emergency room visit (PR, 1.69; 95% CI, 1.41–2.03), and very poorly controlled asthma (PR, 1.54; 95% CI: 1.36–1.75). After stratifying for financial barriers to asthma care, the associations did not change. Conclusions:Financial barriers to asthma care should be considered in asthma management, and individuals with WRA are more likely to experience financial barriers. However, individuals with WRA are more likely to experience adverse asthma outcomes than individuals with non-WRA, regardless of financial barriers. Additional studies are needed to identify medical, behavioral, occupational, or environmental factors associated with adverse asthma outcomes among individuals with WRA.

Assessing asthma control and associated risk factors among persons with current asthma - findings from the child and adult Asthma Call-back Survey.

Abstract Introduction: Monitoring the level of asthma control is important in determining the effectiveness of current treatment which may decrease the frequency and intensity of symptoms and functional limitations. Uncontrolled asthma has been associated with decreased quality of life and increased health care use. The objectives of this study were to assess the level of asthma control and identify related risk factors among persons with current asthma. Methods: Using the 2006 to 2010 BRFSS child and adult Asthma Call-back Survey, asthma control was classified as well-controlled or uncontrolled (not-well-controlled or very-poorly-controlled) using three impairment measures: daytime symptoms, night-time symptoms, and taking short-acting β2-agonists for symptom control. Multivariate logistic regression identified predictors of asthma control. Results: Fifty percent of adults and 38.4% of children with current asthma had uncontrolled asthma. About 63% of children and 53% of adults with uncontrolled asthma were on long-term asthma control medications. Among children, uncontrolled asthma was significantly associated with being younger than 5 years, having annual household income <

Predictors of Asthma Self-Management Education among Children and Adults—2006–2007 Behavioral Risk Factor Surveillance System Asthma Call-back Survey

15 000, and reporting cost as barriers to medical care. Among adults, it was significantly associated with being 45 years or older, having annual household income of <

A National Survey of Adult Asthma Prevalence by Urban-Rural Residence U.S. 2005

25 000, being “other” race, having less than a 4-year college degree, being a current or former smoker, reporting cost as barriers, being obese, and having chronic obstructive pulmonary disease or depression. Conclusion: Identifying and targeting modifiable predictors of uncontrolled asthma (low educational attainment, low income, cigarette smoking, and co-morbid conditions including obesity and depression) could improve asthma control.