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Epidemiology of Asthma

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					Epidemiology of Asthma
Among Children in the U.S.

       Joän Patterson, Ph.D.
 Maternal and Child Health Program
      University of Minnesota
Definition of Asthma
   Chronic inflammatory disease of the
    lungs
   Airways are constricted from
    inflammation and hyper-responsiveness
    to asthma “triggers”
Potential Asthma Triggers
   Allergens
   Infections
   Exercise
   Abrupt changes in the weather
   Exposure to airway irritants, such as
    tobacco smoke
Asthma Exacerbations
   Recurrent asthma episodes, involving
       Shortness of breath
       Coughing
       Wheezing
       Chest pain or tightness
   Range in severity from
       Mild intermittent
       Severe persistent
Epidemiology of Asthma
   Asthma is the most common chronic
    disease among children
   It has increased at epidemic rates since
    the early 1980s
       From 37 of every 1000 children in 1980
       To 69 of every 1000 children in 1995
        Asthma Prevalence in U.S.
        1980-1996
        90
        80
        70
        60
                                                       All children
        50                                             0-4 yrs
        40                                             5-10 yrs
        30                                             11-17 yrs
        20
        10
         0
               1980-81   1985-86   1990-91   1995-96
Source: MMWR
      Asthma Attack Prevalence in U.S.
      1997-2000
      90
      80
      70
      60                                   All children
      50                                   0-4 yrs
      40
                                           5-10 yrs
                                           11-17 yrs
      30
      20
      10
       0
               1997   1998   1999   2000
Source: MMWR
Variability in Asthma Prevalence
   By gender
       Males 0 – 17 years are more likely than
        girls to have asthma or experience an
        asthma attack
   By race/ethnicity
       Higher for Black non-Hispanic children
       Higher for Hispanic children
   Asthma Prevalence by
   Race/Ethnicity 1980 - 1996
      90
      80
      70                                           White, non-
      60                                           Hispanic
      50                                           Black, non-
                                                   Hispanic
      40
                                                   Hispanic
      30
      20
      10
       0
           1980-81   1985-86   1990-91   1995-96

Source: MMWR
What Accounts for this Epidemic?
   Etiology of asthma is due to the interaction of
    environmental and genetic factors
       Atopy, the genetically inherited susceptibility to
        asthma, cannot account for epidemic
   Probably NOT due to outdoor air quality
   Indoor air contaminants may be a factor
       Tighter construction trapping contaminants
       Children spending more time indoors
Burden of Asthma
   Increases risk for early death
   Compromises child’s quality of life
   Affects family’s quality of life
   Increased costs associated with
    increased utilization of health care
        Asthma Deaths by Race/Ethnicity per
        1,000,000 Children 1980 - 1998
           12

           10

            8
                                                                    1980
            6
                                                                    1990
            4                                                       1998

            2

            0
                 Overall       White, non- Black, non-   Hispanic
                 mortality      Hispanic    Hispanic

Source: National Vital Statistics System, NCHS, CDC
        Asthma Deaths by Age per 1,000,000
        Children 1980 - 1998
       4.5
         4
       3.5
         3
                                                              1980
       2.5
                                                              1990
         2
                                                              1998
       1.5
         1
       0.5
         0
               0-4 years       5-10 years       11-17 years

Source: National Vital Statistics System, NCHS, CDC
Asthma and Quality of Life
   Most common cause of school absence
       An average of 9.7 days per year for asthma
   Most prevalent cause of childhood disability
    (long-term reduction in ability to do normal activities)
   In 1994-95, 1.4% of U.S. children
    experienced some disability due to asthma
       This is 21% of all children with asthma
   SES disadvantage doubles rate of disability
   Children with asthma have higher rates of
    social and emotional problems
Healthcare Costs and Utilization
   For all individuals with asthma in 1998,
    estimated costs were:
       $7.5 billion for direct costs
       $3.8 billion for indirect costs – lost work days and
        lifetime earnings lost due to mortality from asthma
   Overuse of emergency care by some groups,
    increasing costs
   Greater use of doctor’s office visits and
    adherence to a written asthma action plan
    would reduce mortality, improve quality of
    life, and reduce costs

				
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posted:1/31/2013
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