National surveillance for asthma - United States, 1980-2004. MMWR Surveill Summ

Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC, Atlanta, Georgia 30333, USA.
MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries / CDC 11/2007; 56(8):1-54.
Source: PubMed


Asthma, a chronic respiratory disease with episodic symptoms, increased in prevalence during 1980-1996 in the United States. Asthma has been the focus of numerous provider interventions (e.g., improving adherence to asthma guidelines) and public health interventions during recent years. Although the etiology of asthma is unknown, adherence to medical treatment regimen and environmental management should reduce the occurrence of exacerbations and lessen the hardship of this disease. CDC has outlined a public health approach to asthma that includes comprehensive analyses of national surveillance data on prevalence, health-care use and mortality, and a strategy to improve the timeliness and geographic specificity of asthma surveillance data.
This report presents national data on asthma for self-reported prevalence (1980-1996 and 2001-2004); self-reported attacks (1997-2004); visits to physicians' offices (1980-2004), hospital outpatient departments (1992-2004), and emergency departments (1992-2004); hospitalizations (1980-2004); and deaths (1980-2004).
The National Health Interview Survey includes questions about asthma prevalence and asthma attacks. Physicians' office visit data are collected in the National Ambulatory Medical Care Survey, emergency department and hospital outpatient data in the National Hospital Ambulatory Medical Care Survey, hospitalization data in the National Hospital Discharge Survey, and death data in the Mortality component of the National Vital Statistics System.
From 1980 to 1996, 12-month asthma prevalence increased both in counts and rates, but no discernable change was identified in asthma attack estimates since 1997 or in current asthma prevalence from 2001 to 2004. During the period of increasing prevalence, patient encounters (office visits, emergency department visits, outpatient visits, and hospitalizations) for asthma increased. However, rates for these encounters, when based on the population with asthma, did not increase. Although the rate of asthma deaths increased during 1980-1995, the rate of deaths has decreased each year since 2000. During 2001-2003, current asthma prevalence was higher in children (8.5%) compared with adults (6.7%), females (8.1%) compared with males (6.2%), blacks (9.2%) compared with whites (6.9%), those of Puerto Rican descent (14.5%) compared with those of Mexican descent (3.9%), those below the federal poverty level (10.3%) compared with those at or above the federal poverty level (6.4% to 7.9%), and those residing in the Northeast (8.1%) compared with those residing in other regions (6.7% to 7.5%). Among persons with current asthma, whites and blacks were equally likely to report an attack during the preceding 12 months. Women with current asthma were more likely to report asthma attacks than men, and children were more likely than adults. The rate for asthma health-care encounters, regardless of place (physician office, emergency department, outpatient department, or hospital), when based on the population with asthma, did not differ by race. However, whites with current asthma had higher rates for physician offices, and blacks had higher rates for hospital-based sites (e.g., outpatient clinics and emergency departments).
The findings in this report suggest that from 1980 through the mid-1990s, increases in asthma prevalence played a substantial role in the increases in patient encounter measures used in asthma surveillance. Because no primary strategies for preventing asthma have been identified, efforts to control asthma exacerbations through interventions that promote adhering to proper medical regimens and reducing exposures to causes of asthma exacerbations should continue to be pursued.

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    • "In the past, asthma was considered mainly as a childhood disease; however, recent epidemiologic studies have indicated that asthma is highly frequent in the elderly population with its prevalence ranging from 4.5% to 12.7% [2-15]. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life [15-20]. Nevertheless, asthma in the elderly (AIE) is still been underdiagnosed and undertreated [5,21-23]. "
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    ABSTRACT: In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients.
    Full-text · Article · May 2014 · World Allergy Organization Journal
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    • "Although racial disparities for hospitalization associated with acute respiratory illness including influenza have been reported,26,27 it is likely that other data we collected in our study, including household income and the presence of specific chronic medical conditions, accounted for any greater risk of influenza hospitalization among select racial/ethnic groups. For example, other studies have found that black children have higher asthma prevalence,28 black and Hispanic women have lower maternal age at first parity29 and blacks and Hispanics have highest US poverty rates.30 It also should be noted that our sample size of non-Caucasian children was small, and therefore it is unlikely that this study was powered to detect small differences in risk, especially after controlling for the factors mentioned above. "
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    ABSTRACT: Young children are at increased risk of severe outcomes from influenza illness, including hospitalization. We conducted a case-control study to identify risk factors for influenza-associated hospitalizations among children in U.S. Emerging Infections Program sites. Cases were children 6-59 months of age hospitalized for laboratory-confirmed influenza infections during 2005-08. Age- and zip-code-matched controls were enrolled. Data on child, caregiver, and household characteristics were collected from parents and medical records. Conditional logistic regression was used to identify independent risk factors for hospitalization. We enrolled 290 (64%) of 454 eligible cases and 1,089 (49%) of 2,204 eligible controls. Risk for influenza hospitalization increased with maternal age <26 years (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1-2.9); household income below the poverty threshold (OR 2.2, CI 1.4-3.6); smoking by >50% of household members (OR 2.9, CI 1.4-6.6); lack of household influenza vaccination (OR 1.8, CI 1.2-2.5); and presence of chronic illnesses, including hematologic/oncologic (OR 11.8, CI 4.5-31.0), pulmonary (OR 2.9, CI 1.9-4.4), and neurologic (OR 3.8, CI 1.6-9.2) conditions. Full influenza immunization decreased the risk among children aged 6-23 months (OR 0.5, CI 0.3-0.9) but not among those 24-59 months of age (OR 1.5, CI 0.8-3.0; p-value for difference = 0.01). Chronic illnesses, young maternal age, poverty, household smoking, and lack of household influenza vaccination increased the risk of influenza hospitalization. These characteristics may help providers to identify young children who are at greatest risk for severe outcomes from influenza illness.
    Full-text · Article · Mar 2014 · The Pediatric Infectious Disease Journal
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    • "Estimates of current asthma prevalence from both the national- (NHIS) and the state-based (BRFSS) surveys show that current asthma prevalence among adults is increasing [1,2,4-6] and continuing to vary by certain sociodemographic, behavioral, and geographic factors [7-12]. More specifically, asthma prevalence can vary by certain modifiable (e.g., weight and smoking status) [13-25] and non-modifiable (e.g., age and race status) risk factors [7-11,26-30]; however, the extent to which these risk factors contribute to increasing prevalence at the state level over time has not been analyzed or determined. Identifying state-specific changes in asthma prevalence and determining how known risk factors for asthma contribute to changes in prevalence over time are important for public health planning and for generating hypotheses for asthma prevention and control. "
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    ABSTRACT: Current asthma prevalence among adults in the United States has reached historically high levels. Although national-level estimates indicate that asthma prevalence among adults increased by 33% from 2000 to 2009, state-specific temporal trends of current asthma prevalence and their contributing risk factors have not been explored. We used 2000--2009 Behavioral Risk Factor Surveillance System data from all 50 states and the District of Columbia (D.C.) to estimate state-specific current asthma prevalence by 2-year periods (2000--2001, 2002--2003, 2004--2005, 2006--2007, 2008--2009). We fitted a series of four logistic-regression models for each state to evaluate whether there was a statistically significant linear change in the current asthma prevalence over time, accounting for sociodemographic factors, smoking status, and weight status (using body mass index as the indicator). During 2000--2009, current asthma prevalence increased in all 50 states and D.C., with significant increases in 46/50 (92%) states and D.C. After accounting for weight status in the model series with sociodemographic factors, and smoking status, 10 states (AR, AZ, IA, IL, KS, ME, MT, UT, WV, and WY) that had previously shown a significant increase did not show a significant increase in current asthma prevalence. There was a significant increasing trend in state-specific current asthma prevalence among adults from 2000 to 2009 in most states in the United States. Obesity prevalence appears to contribute to increased current asthma prevalence in some states.
    Full-text · Article · Dec 2013 · BMC Public Health
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