Asthma Prevalence and Health Care Resource Utilization Estimates,
Asthma Prevalence and Health Care Resource Utilization Estimates, United States, 2001-2017 National Center for Environmental Health Division of Environmental Health Science and Practice CDCs National Asthma Control Program (NACP) was created in 1999 to help the millions of people with asthma in the United States gain control over their disease. The NACP conducts national asthma surveillance and funds states to help improve asthma surveillance and to focus efforts and resources where needed. Introduction Asthma: is a chronic disease of the lungs affects adults and children of all ages is characterized by repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing Introduction In most cases, we dont know the exact causes of asthma and we dont know how to cure it. Most people with asthma can control their symptoms by: o avoiding things that trigger an asthma attack and o receiving appropriate medical care Without proper management, asthma can result in frequent
emergency department (ED) visits, hospitalizations, and premature deaths. Introduction Asthma: affects 25 million people, including 6.0 million children under 18; is a significant health and economic burden to patients, their families, and society: In 2016, 1.8 million people visited an ED for asthma-related care and in 2016, 189,000 people were hospitalized because of asthma Introduction Asthma prevalence is an estimate of the percentage of the U.S. population with asthma. Prevalence estimates help us understand the burden of asthma on the nation. Asthma period prevalence is the percentage of the U.S. population that had asthma in the previous 12 months. Current asthma prevalence is the percentage of the U.S. population who had been diagnosed with asthma and had asthma at the time of the survey. Asthma period prevalence was the original prevalence measure (1980-1996). The survey was redesigned in 1997 and this measure was replaced by lifetime prevalence (not presented in slides) and asthma episode or attack in the past 12
months. In 2001, another measure was added to assess current asthma prevalence. Adult Self-Reported Current Asthma Prevalence (%) by State or Territory, 2017 Current asthma prevalence among adults varies in states and Puerto Rico, ranging from 7.3% in Texas to 13.2% in New Hampshire. The median across all states and Puerto Rico was 9.4% with current asthma. Asthma Period Prevalence and Current Asthma Prevalence: United States, 1980-2017 10 Percent Current asthma prevalence, 2001-2017 8 Asthma period prevalence, 1980-1996 6 4 2 0 81 19 83 19 85 19 87 19
The percentage of the U.S. population with asthma increased over time. Current asthma increased from 7.3% in 2001 to 7.9% in 2017. 11 20 13 20 15 20 17 20 T o ta l n u m b er o f p erso n s in m illio n s Current Asthma Prevalence: United States, 2001-2017 Total number of persons Percent 10 26 24 9 22 8 20 7
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year About 25 million (8% of the U.S. population) had asthma in 2017, an increase from 20 million, or 7.3% who had asthma in 2001. Current Asthma Prevalence by Race and Ethnicity: United States, 2001-2017 14 White Black Hispanic Percent 12 10 8 6 4 2 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year Blacks are more likely to have asthma than both whites and Hispanics. Percent of current asthma increased for whites, blacks, and Hispanics from 2001 to 2017. Females, blacks, and Puerto Ricans are more likely to have asthma.
People with lower annual household income were more likely to have asthma. Asthma did not differ by age group, region, or Metropolitan Statistical Area (MSA). Not in MSA Small MSA Large MSA West South Midwest Northeast 450% poverty 250-<450% poverty 100-<250% poverty <100% poverty Mexican Puerto Rican Total Hispanic Black White Female
Male Adults 20 18 16 14 12 10 8 6 4 2 0 Children Percent Current Asthma Prevalence by Age Group, Sex, Race and Ethnicity, Poverty Status, Geographic Region, and Place of Residence: United States, 2017 Percent Child and Adult Current Asthma Prevalence by Age and Sex: United States, 2017 Male Female 12 10 8 6 4
2 0 0-4 5-14 15-19 20-24 25-34 35-64 65+ Age group Males and females aged 5-24 years had no difference in percent of current asthma. Among children 0-4 years, males had a higher percent of asthma and among adults 25 years and older, was higher for women than men. Asthma Attack Prevalence among Children and Adults with Current Asthma: United States, 2001-2017 Percent 80 60 40 Children aged 0-17 years Adults aged 18 and over
20 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year From 2001 to 2017, percent of children and adults with current asthma who had at least one asthma attack in the previous 12 months declined. For children, asthma attacks declined from 61.7% of children with asthma in 2001 to 51.6% in 2017. For adults, asthma attacks declined from 53.8% of adults with asthma in 2001 to 43.6% in 2017. Asthma Attack Prevalence among Persons with Current Asthma by Age Group, Sex, Race and Ethnicity, Poverty Status, and Geographic Region: Unites States, 2017 60 50 40 30 20 10 In 2017, asthma attacks occurred more often in children and females. Asthma attack prevalence did not differ by race or ethnicity, poverty level, or census region. West South Midwest Northeast 450% poverty
250-<450% poverty 100-<250% poverty <100% poverty Mexican Puerto Rican Hispanic Black White Female Male Adults 0 Children Percent 70 20 Rate per 10,000 population 18
Total number of visits 16 500 450 400 14 350 12 300 10 250 8 200 6 150 4 100 2 50
T o t a l n u m b e r o f v isit s in m illio n s Asthma Physician Office Visits: United States, 20012016 0 Year The rate of asthma-related physician office visits declined from 409.7 per 10,000 population in 2001 to 307.8 per 10,000 population in 2016. 2,200 Rate per 10,000 population Total number of visits 2,000 80 70 1,800 1,600 60 1,400 50 1,200 40
1,000 800 30 600 20 400 10 200 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year The rate of asthma-related emergency department visits did not significantly change from 2001 to 2016. 0 Rate T o t a l n u m b e r o f v isit s in t h o u sa n d s Asthma Emergency Department Visits: United States, 20012016 800 700 600 500 20
18 Total number of hospitalizatio ns 16 Rate per 10,000 population 14 12 *Trend data unavailable for 2015 due to transition from ICD-9-CM to ICD-10CM in October 2015 400 Rate T o t a l n u m b e r o f p e r s o n s in t h o u s a n d s Asthma Hospitalizations: United States, 2010-2016 10 8 300 6 200 4 100
0 2 * 2010 2011 2012 2013 2014 2015 2016 0 Year The rate of asthma-related hospitalization was 13.0 per 10,000 population in 2010 and 10.7 per 10,000 population in 2014. After the ICD-CM coding scheme transition, the rate dropped to 5.9 per 10,000 in 2016. *Asthma hospitalization data in 2015 is not available because in 2015, the first three quarters of year were coded using ICD-9-CM (493) and last quarter of year was coded using ICD-10-CM code for asthma (J45). 6 5 4 Rate per million population
16 14 Total number of deaths 12 10 3 8 6 2 4 1 0 2 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 The rate of asthma deaths declined from 15.0 per million population in 2001 to 11.2 deaths per million population in 2008. Rates gradually peaked between 2011 and 2014 but not significant. 0 R ate T o t a l n u m b e r o f d e a t h s in t h o u s a n d s Asthma Deaths:
United States, 20012017 Technical Notes Trends across years were evaluated using Joinpoint regression software version 22.214.171.124. Annual Percent Change (APC) and corresponding p-value were calculated for jointpoint segments. Differences between subgroups were assessed using z-scores calculated from estimates and their standard errors Asthma Period Prevalence and Current Asthma Prevalence: Estimates of asthma prevalence indicate the percentage of the population with asthma at a given point in time and represent the burden on the U.S. population. Asthma prevalence data are self-reported by respondents to the National Health Interview Survey (NHIS). Asthma period prevalence was the original measure (1980-1996) of U.S. asthma prevalence and estimated the percentage of the population that had asthma in the previous 12 months. From 1997-2000, a redesign of the NHIS questions resulted in a break in the trend data as the new questions were not fully comparable to the previous questions. Beginning in 2001, current asthma prevalence (measured by the question, Do you still have asthma? for those with an asthma diagnosis) was introduced to identify all persons with asthma. Current asthma prevalence estimates from 2001 onward are point prevalence (previous 12 months) estimates and therefore are not directly comparable with asthma period prevalence estimates from 1980 to 1996. Behavioral Risk Factor Surveillance System (BRFSS): State asthma prevalence rates on the map come from the BRFSS. The BRFSS is a state-based, randomdigit-dialed telephone survey of the noninstitutionalized civilian population 18 years of age and older. It monitors the prevalence of the major behavioral risks among adults associated with premature illness and death. Information from the survey is used to improve the health of the American people. More information about BRFSS can be found at: http://www.cdc.gov/brfss/. Sources CDC National Center for Health Statistics, National Health Interview Survey (NHIS). National Surveillance of Asthma: United States, 2001-2017 Moorman JE, Akinbami LJ, Bailey CM, et al. National Surveillance of Asthma: United States, 2001 2010. National Center for Health Statistics. Vital Health Stat 3 (35). 2012. Asthma Period Prevalence (1980-1996) and Current Asthma Prevalence (2001-2010): United
States o Percentages were adjusted by age using the 2000 U.S. Census standard population Asthma Attack Prevalence (2001-2010): United States NHIS Asthma Data Tables: https://www.cdc.gov/asthma/nhis/default.htm Current Asthma and Asthma Attack Prevalence (2011-2017): United States Notes: represents 95% confidence interval Race categories white and black include only those with a single race. Persons of Hispanic origin may be of any race CDC Behavioral Risk Factor Surveillance System (BRFSS) Adult Current Asthma Prevalence by State or US Territory, 2017. Sources (continued) National Ambulatory Medical Care Survey (NAMCS) Total number and rate (per 10,000 population) of physician office visits, 2001-2016. o Rates for years 2001-2010 are adjusted by age using the 2000 U.S. Census standard population National Hospital Ambulatory Medical Care Survey (NHAMCS) Total number and rate (per 10,000 population) of asthma emergency department (ED) visits, 2001-2016. o Rates for years 2001-2010 are adjusted by age using the 2000 U.S. Census standard population NHAMCS does not provide data for hospital office visits and hospital inpatient short stays since 2010. Healthcare Cost and Utilization Project (HCUP)
HCUP data are used for hospital inpatient short stays because NCHS NHAMCS does not provide related data since 2010. Total number and rate (per 10,000 population) of asthma hospitalizations (hospital discharges), 2010-2016 (note: trend data not available for 2015 due to transition from ICD-9-CM to ICD10CM in October 2015) Source is HCUPnet, Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality, Rockville, MD. https://hcupnet.ahrq.govExternal/. For more information about HCUP data see http:// www.hcup-us.ahrq.gov/External. National Vital Statistics System (NVSS) CDC Wonder Website: https://wonder.cdc.gov/ Number and crude asthma mortality rate (per million), 2001-2017: United States Mortality rates were calculated using records for which asthma was coded as the underlying causes of death, using ICD-10 codes J45 and J46. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Environmental Health Division of Environmental Health Science and Practice
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