Asthma in US children Update

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Asthma in US childrenUpdate

• Seymour Williams, M.D.Medical Epidemiologist,
• Air Pollution and Respiratory Health Branch
• National Center for Environmental Health
• sjw9_at_cdc.gov
• www.cdc.gov/nceh/asthma/

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Pediatric Asthma, US

• Why care?
• What is asthma?
• How big is the problem?
• What is being done
• What can you do?

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Why care about asthma?

• Rising prevalence
• Rising measures of burden (stabilizing?)
• Disparities improvement opportunities

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Costs of AsthmaUnited States, 19801998
Source Weiss, et al. 1992 Weiss, et al.
2001
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What is asthma?

• A chronic disease marked by reversible
  narrowing of the airways it produces recurring
  episodes of breathing problems (wheezing, chest
  tightness, shortness of breath)

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How big is the asthma problem in children?

• 9.0 M affected
• Most common chronic disease
• 4 million had asthma attack in past 12 months
• Over 14 million missed school days/year
• 24 with activity limitation due to asthma
• Disparity black compared to white children
• 2-6 x more likely to be hospitalized
• 4 x more likely to die
• Worse disability/functional outcome not
  completely explained by SES

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Asthma Prevalence by Age US, 1980-1996
Rate per 1000 Population
5-17 yr
18-34 yr
35-64 yr
65 yr up
0-4 yr
Source National Health Interview Survey
12-month prevalence
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Asthma prevalence, 1980-96, lifetime diagnosis,
current and asthma attack prevalence,
1997-2002 NHIS, children 0-17 years
Asthma lifetime diagnosis
Current asthma prevalence
Asthma prevalence (4.3 per yr ?)
Asthma attack prevalence
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Adult and child asthma emergency department
rates, United States 19922001
Children
Adults
Source National Hospital Ambulatory Care Survey
National Center for Health Statistics
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Asthma hospitalizations for children 0-17 years,
1980-2002 NHDS
NHDS National Hospital Discharge Survey
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Deaths Due to Asthma, United States, 1979-2001
ICD-10
Source Compressed Mortality Files
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Race/ethnic disparities in asthma attack
prevalence, (1997-2001), NHIS
Non-Hispanic black
Non-Hispanic black children had 30 higher asthma
attack prevalence than NH white children
Non-Hispanic white
Hispanic
NHIS National Health Interview survey
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Racial disparities in asthma emergency room
visits (2000-2002 annual average), NHAMCS
Black
Black children had 270 higher ER visit rate than
white children
White
NHAMCS National Hospital Ambulatory Medical Care
Survey
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Racial disparities in asthma hospitalizations
(2000-2002 annual average), NHDS
Black
Black children had 240 higher hospitalization
rate than white children
White
NHDS National Hospital Discharge survey
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Race/ethnic disparities in mortality (1999-2001
annual average), NVSS
Non-Hispanic black
Non-Hispanic black children had 350 higher
asthma death rate than NH white children
Non-Hispanic white
Hispanic
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Summary trends in childhood asthma

• Prevalence, health care use, and mortality
  increased through mid 1990s
• Since mid 1990s, prevalence, ambulatory health
  care use, hospitalization and death rates have
  plateaued
• Minority children bear a higher asthma burden
• Racial disparities most pronounced for
  preventable outcomes, such as ER visits,
  hospitalization and death

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What is being done?

• Medication
• Education
• Collaboration

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Asthma Medication
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Non Medical Asthma Control
X
X
X
Infections
X
X
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Asthma Action Plan
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CDCs asthma program

• Surveillance
• Implement scientifically proven interventions
• Partnership / Training

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Key Clinical Activities for Quality Asthma Care
Recommendations of the National Asthma Education
and Prevention Program
MMWR Recommendations and Reports, Volume 52,
Number RR-6,. Adobe PDF format
http//www.cdc.gov/mmwr/PDF/rr/rr5206.pdf HTML
(web) format http//www.cdc.gov/mmwr/preview/mmwr
html/rr5206a1.htm
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Elements of Quality Asthma Care

• Establish asthma diagnosis
• Classify the severity of an individuals asthma
• Schedule routine follow-up asthma care
• Assess individuals with asthma for possible
  referral to specialty care
• Recommend measures to control and avoid asthma
  triggers
• Treat/prevent all other medical conditions that
  could exacerbate the individuals asthma
• Prescribe medications according to the severity
  of the individuals asthma
• Monitor the use of beta agonist drugs
• Develop a written asthma management plan for the
  individual
• Provide routine education on self-management of
  asthma

http//www.cdc.gov/mmwr/preview/mmwrhtml/rr5206a1.
htm
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What You Can Do?

• Designate the workplace as a no smoking area
• Support smoking cessation programs
• Promote and participate in community asthma
  activities

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What You Can Do?

• Purchasers- Assure quality care
• HEDIS measure- only a start
• Disease management -?
• Providers/Health planners- Work to improve care

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What works

• Practice Redesign
• Patient Education
• Asthma Expert support
• Clinical Information Support

Wagner ED. et. al. Milbank Quarterly, 1996
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Conclusions

• Asthma is an important problem- disparate
  outcomes and cost
• Opportunities for improvement

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Asthma Resources

• www.cdc.gov/nceh/airpollution/asthma
• www.nhlbi.nih.gov/about/naepp
• www.aanma.org
• www.cdc.gov/nceh/airpollution/links.htm
• www.aafa.org
• www.aaaai.org
• www.nationaljewish.org