View
214
Download
1
Category
Preview:
DESCRIPTION
Asthma prevalence
Citation preview
Trends in childhood asthma: NCHS data on prevalence,
health care use and mortalitySusan Lukacs, DO, MSPH
Lara Akinbami, MD
Infant, Child and Women’s Health Studies Branch, NCHS, CDC
Asthma data available from NCHS data systems
Prevalence Health care utilization
Ambulatory health care Hospitalizations
Mortality
Asthma prevalence
National Health Interview Survey (NHIS)
Continuous multipurpose survey on health conditions, status and behavior
Representative sample of the noninstitutionalized civilian US population
Interviews in >40,000 households – no review of medical records
Parent or responsible adult answers in proxy for children under 18 years of age
Redesigned in 1997 – affected asthma estimates
1980-1996 Redesigned 1997-present
Additional question
2001-presentScreener question:
(None) Has a doctor or other healthprofessional EVER told you that your child had asthma?
Prevalence questions:
During the past 12 mos, did anyone in the family have asthma?
IF YES to “EVER?”: During the past 12 mo, has your child had an episode of asthma or an asthma attack?
IF YES to “EVER?”: Does your child still have asthma?
NHIS original and redesigned asthma questions
Asthma prevalence, 1980-96, asthma lifetime diagnosis, current and asthma attack prevalence, 1997-2002:
NHIS, children 0-17 years
0
20
40
60
80
100
120
140
1980 1985 1990 1995 2000
Pre
vale
nce
per
1,00
0 ch
ildre
n
Asthma prevalence (4.3% per yr )
Asthma lifetime diagnosis
Asthma attack prevalence
Current asthma prevalence
Other asthma indicators available from the NHIS
• 2002 asthma module– School days missed (trend established prior
to 1997)– Preventive medications– Given asthma management plan by doctor– Advised by doctor to change home
environment• 1999 asthma module (different questions)
– Wheezing severity– Use of OTC and prescription medications
Average number school days a child with asthma missed per year, ages 5-17 years:
NHIS 1980-2002
4.94.4 4.7
3.74.5
0.0
2.0
4.0
6.0
8.0
1980-82 1985-87 1990-92 1994-96 2002
Num
ber o
f day
s
NHIS redesign
*
•Per child with asthma having > one asthma attack per year
Indicators of asthma control among children with current asthma, 2002 NHIS
asthma module
Ever taken preventive medication
65%
Given management plan by MD
40%
Advised to change environment by MD
48%
Asthma hospitalizations
Asthma hospitalizations for children 0-17 years, 1980-2002 National Hospital
Discharge Survey (NHDS)
05
10152025303540
1980 1985 1990 1995 2000
Per 1
0,00
0 ch
ildre
n
Asthma mortality
Mortality component of National Vital Statistics System (NVSS)
Death certificate data received by NCHS from 50 States and DC can obtain State-level data
Coding system changed in 1999 from ICD-9 to ICD-10
Asthma deaths, children 0-17 years, 1980-2000, NVSS
0
1
2
3
4
5
1980 1985 1990 1995 2000
Per 1
,000
,000
chi
ldre
n
ICD-9
ICD-10
ICD-9
Race/ethnic disparities in the burden of childhood asthma
Healthy People 2010 overarching goal Examining disparities in asthma can guide
policy and program decisions However, issues in categorizing by race
New OMB guidelines: single vs. multiple race Ethnicity not consistently available in data
systems that rely on abstraction from medical records
Race/ethnic disparities in asthma attack prevalence, (1997-2001 annual average),
NHIS
0
2
4
6
8
10
12
14
Perc
ent c
hild
ren
Non-Hispanic
white
Non-Hispanic
black
Hispanic
Non-Hispanic black children
had 30% higher asthma attack
prevalence than NH white
children
Race/ethnic disparities in asthma attack prevalence, (1997-2001 annual average),
NHIS
0
2
4
6
8
10
12
14
Perc
ent c
hild
ren
Non-Hispanic
white
Non-Hispanic
black
Hispanic
Puerto Rican
Mexican
Racial disparities in asthma hospitalizations (2000-2002 annual
average), NHDS
0
10
20
30
40
50
60
70
Per 1
0,00
0 ch
ildre
n
White
Black
Black children had 240%
higher hospitalization rate than white
children
Race/ethnic disparities in mortality (1999-2001 annual average), NVSS
0
2
4
6
8
10
12
Per 1
,000
,000
chi
ldre
n Non-Hispanic black children
had 350% higher asthma death rate than
NH white children
Non-Hispanic
white
Non-Hispanic
black
Hispanic
Summary on trends in childhood asthma
Prevalence, health care use, and mortality increased through the mid 1990s
Since the mid 1990s, prevalence, ambulatory health care use, hospitalization and death rates have plateaued
Minority children bear a higher asthma burden Racial disparities are most pronounced for
preventable outcomes, such as ER visits, hospitalization and death
For additional information on asthma from the CDC
NCHS home page: http://www.cdc.gov/nchs/ Asthma Health E stat: asthma prevalence, health care
use and mortality for all ages in 2002 Summary statistics from the NHIS for children, 2002
National Center for Environmental Health: http://www.cdc.gov/nceh/airpollution/asthma/ Behavioral Risk Factor Surveillance Survey: state level
asthma prevalence for adults Links to asthma-related reports in the Morbidity and
Mortality Weekly Report, including the Asthma Surveillance Summary, 1980-1999
Recommended