Docstoc

asthma

Document Sample
asthma Powered By Docstoc
					  OREGON DHS: PUBLIC HEALTH DIVISION

        Oregon Asthma Program
             February 2009




The burden of

asthma




   in Oregon: 2008



               Independent. Healthy. Safe.
The Burden of Asthma in Oregon: 2008




                         Rodney Garland, MS

                        Oregon Asthma Program
        Health Promotion and Chronic Disease Prevention Section
             Office of Disease Prevention and Epidemiology
                          Public Health Division
                 Oregon Department of Human Services




For electronic copies and periodic updates, please visit our Web site at:
            www.oregon.gov/DHS/ph/asthma/pubs.shtml.




                      Oregon Asthma Program
                   800 N.E. Oregon Street, Suite 730
                         Portland, OR 97232
Disclaimer:
This document is in the public domain and may be used and reprinted. The
Department of Human Services appreciates citation and notification of use. This
publication was supported by Cooperative Agreement # U59/CCU017777 from
the Centers for Disease Control and Prevention (CDC). Its contents are solely the
responsibility of the authors and do not necessarily represent the official view of
the CDC.


Acknowledgements:
Katrina Hedberg, MD, MPH
Interim State Epidemiologist

Jane Moore, PhD, RD
Manager, Health Promotion and Chronic Disease Prevention Section

Jean Anderson
Chronic Disease Program Manager

Stacey Schubert, MPH
HPCDP Surveillance Team Lead,
Oregon Tobacco Prevention and Education Program

Kati Moseley, MPH
Capacity Building Coordinator, Asthma Program

Brian Ritacco, MPH
Community Partnerships and Self-Management Coordinator, Asthma Program

Charles Gallia PhD
Research Manager, Division of Medical Assistance Programs

Susan Arbor, MSW, MPA
Performance Monitoring and Utilization Coordinator,
Division of Medical Assistance Programs

Kathie Sunnarborg, MPH, CHES
Centers for Disease Control and Prevention




Suggested citation: Oregon Asthma Program. 2009. The Burden of Asthma in
Oregon: 2008. Available online at www.oregon.gov/ph/asthma/docs/burden.pdf
Table of Contents

LIST OF FIGURES .............................................................................................. iii
LIST OF TABLES .............................................................................................. viii
ChAPTER 1: Executive Summary ...................................................................... 1
ChAPTER 2: Introduction .................................................................................. 3
What is Asthma? .............................................................................................. 3
Asthma is a Public health Priority .................................................................... 3
how to Use This Report .................................................................................... 4

ChAPTER 3: Who has Asthma .......................................................................... 5
Overview........................................................................................................... 5
Data ................................................................................................................. 6
Adults with Asthma ......................................................................................... 6
Children with Asthma .................................................................................... 16

ChAPTER 4: Asthma Management and Quality of Life .................................. 20
Overview......................................................................................................... 20
Data ............................................................................................................... 21
Management .................................................................................................. 21
Quality of Life ................................................................................................. 26

ChAPTER 5: Asthma Risk Factors .................................................................... 29
Overview......................................................................................................... 29
Data ............................................................................................................... 30
Smoking ........................................................................................................ 30
Obesity ........................................................................................................... 33
Uninsured ....................................................................................................... 35

ChAPTER 6: Asthma Emergency Department or Urgent Care Visits .............. 36
Overview......................................................................................................... 36
Data ............................................................................................................... 37

ChAPTER 7: Asthma hospitalizations ............................................................. 40
Overview......................................................................................................... 40
Data ............................................................................................................... 41

ChAPTER 8: Asthma Mortality ........................................................................ 46
Overview......................................................................................................... 46
Data ............................................................................................................... 47
                                                                                                                           i
     ChAPTER 9: Asthma in the Medicaid and the State Children’s health
         Insurance Programs ............................................................................... 49
     Overview......................................................................................................... 49
     Data ............................................................................................................... 51
     Who has Asthma ............................................................................................ 51
     Emergency Department or Urgent Care Visits ............................................... 52
     Management and Quality of Life ................................................................... 53
     Risk Factors..................................................................................................... 57
     County Level – Children ................................................................................. 59
     County Level – Adults ..................................................................................... 61

     ChAPTER 10: Cost of Asthma hospitalizations .............................................. 63
     Overview......................................................................................................... 63
     Data ............................................................................................................... 64

     ChAPTER 11: Meeting healthy People 2010 Goals ........................................ 66
     Overview......................................................................................................... 66
     Data ............................................................................................................... 67

     REFEREnCES ................................................................................................... 70
     APPEnDIx A: Data Source Descriptions and Limitations ............................... 72
     APPEnDIx B: Glossary..................................................................................... 76
     ADDITIOnAL TABLE ......................................................................................... 78




ii
List of figures
  Figure 3.1 – Adults with current asthma by state, 2007...................................... 6
  Figure 3.2 – Adults with lifetime asthma ............................................................ 7
  Figure 3.3 – Adults with current asthma ............................................................. 7
  Figure 3.4 – Adults with current asthma by gender ............................................ 8
  Figure 3.5 – Adults with current asthma by age.................................................. 8
  Figure 3.6 – Adults with current asthma by race and ethnicity
               (age-standardized) 2004–2005 ........................................................ 9
  Figure 3.7 – Adults with current asthma by sexual orientation ........................... 9
  Figure 3.8 – Adults with current asthma by education level, 2007 .................... 10
  Figure 3.9 – Adults with current asthma by annual household income 2007 .... 11
  Figure 3.10 – Adults with current asthma by current type of
              health insurance ............................................................................ 12
  Figure 3.11 – Adults with current asthma by county (age-standardized)
              2002–2005 .................................................................................... 15
  Figure 3.12 – Children (0–17 years of age) with current asthma by
              adult proxy .................................................................................... 16
  Figure 3.13 – Youths (8th grade and 11th grade) with current asthma ............ 16
  Figure 3.14 – Youths (8th grade and 11th grade) with current asthma
              by gender ...................................................................................... 17
  Figure 3.15 – Youths (8th grade) with current asthma by county, 2005–2006 .. 19
  Figure 3.16 – Youths (11th grade) with current asthma by county,
              2005–2006 .................................................................................... 19
  Figure 4.1 – Adults with lifetime asthma who received asthma information
               from a doctor or health care provider, 2005 .................................. 21
  Figure 4.2 – Children (0–17 years of age) with lifetime asthma who
               received asthma information from a doctor or health care
               provider, 2005 ............................................................................... 21
  Figure 4.3 – Adults and children (0–17 years of age) with lifetime asthma who
               have ever used a prescription inhaler for their asthma and received
               asthma medication information from a doctor or health care
               provider, 2005 ............................................................................... 22
  Figure 4.4 – Adults and children (0–17 years of age) with lifetime asthma and
               have used any prescription inhaler in the last three months and
               used a spacer with any of these inhalers, 2005 ............................. 22
  Figure 4.5 – Adults with current asthma who received an influenza shot by
               current asthma status .................................................................... 23
                                                                                                                    iii
     Figure 4.6 – People with persistent asthma who filled at least one prescription
                  for a daily inhaled corticosteroid in the past year, by type of
                  insurance (age-standardized) ......................................................... 24
     Figure 4.7 – People with persistent asthma who overuse inhaled short-acting
                  beta2-agonists by receiving more than six canisters in the past year,
                  by type of insurance (age-standardized)......................................... 24
     Figure 4.8 – Asthma follow-up visit with a medical practitioner within 30 days
                  after an emergency department visit for asthma, by type of
                  insurance (age-standardized) ......................................................... 25
     Figure 4.9 – People with persistent asthma who have been seen by a health
                  professional for asthma in the past year, by type of insurance
                  (age-standardized) ......................................................................... 25
     Figure 4.10 – Adults with current asthma, by sex, who missed one or more days
                 of work, school or other daily activities because of asthma in
                 the past three months, 2005 .......................................................... 26
     Figure 4.11 – Adults with current asthma, by household income, who missed
                 one or more days of work, school or other daily activities because
                 of asthma in the past three months, 2005 ..................................... 26
     Figure 4.12 – Number of days in the past 12 months adults with current asthma
                 were unable to work or carry out their usual activities because of
                 asthma, 2005 ................................................................................. 27
     Figure 4.13 – Sleep disturbances due to asthma in the last 30 days among
                 adults with current asthma, 2005 .................................................. 27
     Figure 4.14 – Frequency of asthma symptoms in past four weeks among adults
                 with current asthma, 2005 ............................................................. 28
     Figure 4.15 – Perceived health among adults with or without
                 current asthma, 2005 ..................................................................... 28
     Figure 5.1 – Adults with current asthma by smoking status .............................. 30
     Figure 5.2 – Current smokers among adults with or without current asthma .... 30
     Figure 5.3 – Exposure to secondhand smoke in a typical week among adults with
                  or without current asthma (excluding current smokers) ................. 31
     Figure 5.4 – Adult cigarette use by county, 2002–2005 (age-standardized) ....... 32
     Figure 5.5 – Adults with current asthma by Body Mass Index, 2007 .................. 33
     Figure 5.6 –Body Mass Index among adults with or without current asthma,
                 2007 ............................................................................................... 33
     Figure 5.7 – Adult obesity by county, 2002–2005 .............................................. 34
     Figure 5.8 – People aged 64 and younger without health insurance by county,
                  2005 ............................................................................................... 35
     Figure 6.1 – Adults with current asthma with one or more emergency department
iv
                  or urgent care visits in the past 12 months .................................... 37
Figure 6.2 – Adults with current asthma by gender with one or more emergency
             department or urgent care visits in the past 12 months ................. 37
Figure 6.3 – Adults with current asthma by type of insurance with
             one or more emergency department or urgent care visits in the past
             12 months ...................................................................................... 38
Figure 6.4 – People with asthma who had one or more emergency department
             visits for asthma in the past year, by type of insurance (age-
             standardized) ................................................................................. 39
Figure 6.5 – Asthma follow-up visit with a medical practitioner by type of
             insurance within 30 days after an emergency department visit for
             asthma, by type of insurance (age-standardized) ........................... 39
Figure 7.1 – Annual age-standardized Oregon asthma hospital discharge rates
             per 10,000 residents ..................................................................... 41
Figure 7.2 – Annual unstandardized U.S. asthma hospital discharge rates per
             10,000 residents ........................................................................... 41
Figure 7.3 – Asthma hospital discharge rates per 10,000 residents
             by age groups ................................................................................ 42
Figure 7.4 – Age-adjusted asthma hospital discharge rates per
             10,000 residents by gender ............................................................ 42
Figure 7.5 – Asthma hospital discharge rates per 10,000 by gender and
             age group, 2007............................................................................. 43
Figure 7.6 – Asthma hospital discharges by month for the total
             population, 2007 .......................................................................... 43
Figure 7.7 – Asthma hospital discharge rates per 10,000 residents by county
             (age-standardized), 2002–2006 ...................................................... 45
Figure 8.1 – Annual asthma deaths in Oregon ................................................... 47
Figure 8.2 – Oregon and U.S. asthma death rates per million residents
             (age-standardized) ........................................................................ 47
Figure 8.3 – Asthma death rate per million residents by gender (age-
             standardized) ................................................................................. 48
Figure 8.4 – Asthma death rate per million residents by race/ethnicity
             (age-standardized), 1996–2005 ...................................................... 48
Figure 9.1 – Adults with current asthma among Oregon Health Plan
             recipients by gender, 2004 ............................................................. 51
Figure 9.2 – Adults with current asthma among Oregon Health Plan
             recipients by age group, 2004 ........................................................ 51
Figure 9.3 – Adults with current asthma among Oregon Health Plan
             recipients by education level, 2004 ................................................ 51
Figure 9.4 – People with asthma who had one or more emergency department
                                                                                                                   v
             visits for asthma in the past year by Oregon Health Plan recipients
             (age-standardized and age-specific) ............................................... 52
     Figure 9.5 – Follow-up visit with a medical practitioner within 30 days after an
                  emergency department visit for asthma among Oregon Health
                  Plan recipients with asthma in the past year (age-standardized and
                  age-specific) ................................................................................... 52
     Figure 9.6 – Asthma symptoms in past four weeks among adult Oregon Health
                  Plan recipients with current asthma, 2004 ..................................... 53
     Figure 9.7 – Number of days of work, school or other daily activities missed in the
                  last three months because of asthma among adult Oregon Health
                  Plan recipients with current asthma, 2004 ..................................... 53
     Figure 9.8 – Perceived health among adult Oregon Health Plan recipients with or
                  without current asthma, 2004........................................................ 54
     Figure 9.9 – Visits to a health care professional in the past 12 months for routine
                  treatment of asthma among adult Oregon Health Plan recipients
                  with current asthma, 2004 ............................................................. 55
     Figure 9.10 – Adult Oregon Health Plan recipients with asthma who
                 report receiving asthma information from their health care
                 provider, 2004 ................................................................................ 55
     Figure 9.11 – Oregon Health Plan recipients with persistent asthma who received
                 at least one inhaled corticosteroid dispensing in the past year
                 (age-standardized and age-specific) ............................................... 56
     Figure 9.12 – People with persistent asthma who overused inhaled short-acting
                 beta2-agonists by receiving more than six canisters among Oregon
                 Health Plan recipients in the past year (age-standardized
                 and age-specific) ............................................................................ 56
     Figure 9.13 – Current asthma by smoking status among adult Oregon
                 Health Plan recipients, 2004 ........................................................... 57
     Figure 9.14 – Adult Oregon Health Plan recipients who currently smoke by
                 current asthma status, 2004........................................................... 57
     Figure 9.15 – Current asthma among adult Oregon Health Plan recipients by
                 secondhand smoke exposure in a typical week (excludes current
                 smokers), 2004 ............................................................................... 58
     Figure 9.16 – Adult Oregon Health Plan recipients with secondhand smoke
                 exposure in a typical week (excludes current smokers) by current
                 asthma status, 2004 ....................................................................... 58
     Figure 9.17 – Asthma emergency department visits per 100 children (0–17 years
                 of age) with asthma on the Oregon Health Plan, 2004–2006......... 59
     Figure 9.18 – Asthma hospitalizations per 100 children (0–17 years of age) with
                 asthma on the Oregon Health Plan, 2004–2006 ............................. 59
     Figure 9.19 – Low asthma medication ratios per 100 children (0–17 years of age)
                 with persistent asthma on the Oregon Health Plan, 2004–2006 .... 60
vi   Figure 9.20 – Asthma emergency department visits per 100 adults (18 years old
                 and older) with asthma on the Oregon Health Plan, 2004–2006.... 61
Figure 9.21 – Asthma hospitalizations per 100 adults (18 years old and older)
            with asthma on the Oregon Health Plan, 2004–2006 ..................... 61
Figure 9.22 – Low asthma medication ratios per 100 adults (18 years old and
            older) with persistent asthma on the Oregon Health Plan,
            2004–2006 ..................................................................................... 62
Figure 10.1 – Total cost of asthma hospitalizations (unstandardized
            and standardized*) ......................................................................... 64
Figure 10.2 – Average cost of one asthma hospitalization (unstandardized
            and standardized*) ......................................................................... 64
Figure 10.3 – Total cost of asthma hospitalizations by gender, 2007 ................. 65
Figure 10.4 – Total cost of asthma hospitalizations by age group, 2007 ............ 65
Figure 10.5 – Total cost of asthma hospitalizations by payer, 2007.................... 65




                                                                                                                 vii
       List of tables
        Table 3.1 – Adults with current asthma percentages and 95%
                     confidence intervals (CI) by education level ....................................10
        Table 3.2 – Adults with current asthma percentages and 95%
                     confidence intervals (CI) by annual household income ...................11
        Table 3.3 – Adults with current asthma by urban and rural residence .................13
        Table 3.4 – Percentages (age-standardized and unstandardized) and
                     age-standardized 95% confidence intervals (CI) for adults
                     with current asthma by county, 2002–2005 ....................................14
        Table 3.5 – Youths (8th grade and 11th grade) with current asthma
                     by gender ........................................................................................17
        Table 3.6 – Youths (8th grade and 11th grade) with current asthma
                     by county, 2005–2006 .....................................................................18
        Table 7.1 – Asthma hospital discharge rates per 10,000 residents by county
                     (age-standardized), 2002–2006 .......................................................44
        Table 11.1 – HP2010 objective 24-1 ....................................................................67
        Table 11.2 – HP2010 objective 24-2 ....................................................................67
        Table 11.3 – HP2010 objective 24-4 ....................................................................68
        Table 11.4 – HP2010 objective 24-5 ....................................................................68
        Table 11.5 – HP2010 objective 24-6 ...................................................................68
        Table 11.6 – HP 2010 objective 24-7 ..................................................................69




viii
ChAPTER 1:
Executive Summary
Asthma is a chronic lung disease that causes      Asthma Management and
shortness of breath, coughing, and wheezing.      Quality of Life
Asthma symptoms occur when a person is
                                                  •	 Most adults and children understand how
exposed to a trigger such as tobacco smoke,
                                                     to manage their asthma. For example,
animal fur or feathers, cockroaches, mold
                                                     70.9% of the adults know what to do during
or mildew, and pollen. Asthma symptoms
                                                     an asthma attack or episode and 75.8%
are controllable with quality health care,
                                                     of children have been shown how to use
the correct medications, and good self-
                                                     their inhaler (95.6% and 94.5%). However,
management skills. By controlling their
                                                     few adults (18.6%) and even fewer children
asthma, people with asthma can live healthy
                                                     (31.9%) have an asthma action plan or have
and productive lives.
                                                     taken an asthma management course or
                                                     class (6.7% and 12.6%).
This report summarizes data from the Oregon
asthma surveillance system. The data indicate     •	 All people with asthma should get
that people without college educations, with         an annual influenza shot. In 2007,
low incomes, adult women, and groups with            approximately half of all adults with asthma
high smoking rates suffer a higher burden of         received an influenza shot.
asthma than other populations. Key findings       •	 Of Oregonians with private health
are presented below.                                 insurance, 16.6% are overusing their
                                                     inhaled rescue medications, whereas in the
Who has Asthma                                       Medicaid and SCHIP population, 33.9% are
                                                     overusing their inhaled rescue medications.
•	 In Oregon approximately 9.9% of adults
                                                  •	 More than a quarter of adults with asthma
   and 8.3% of children have asthma. This
                                                     report missing at least one day of work or
   means that more than 355,000 Oregonians
                                                     usual activities during the last 12 months
   have asthma.
                                                     due to their asthma and 30.2% report
•	 Oregon has a higher burden of asthma than         missing at least one night of sleep during
   the overall U.S. and is among the top five        the last 30 days because of their asthma.
   states with the highest percent of the adult
                                                  •	 Oregonians with asthma are more likely
   population with asthma.
                                                     to report being in fair to poor health than
•	 Adult females (12.4%) are more likely to          people without asthma.
   have asthma than adult males (7.3%).
•	 African Americans (15.5%), American            Asthma Risk Factors
   Indian/Alaskan Natives (15.2%), and
   homosexual or bisexual individuals (16.0%)     •	 Oregonians who currently smoke are more
   are especially hard hit by this disease. All      likely to have asthma (15.0%) than those
   of these groups are known to have high            who have never smoked (8.5%).
   smoking rates.                                 •	 Oregonians with asthma are exposed to
•	 Oregonians without a college education,           secondhand smoke (28.1%) about as often as
   with lower income, or are on Medicaid             those without asthma (27.7%)). People with
   or the State Children’s Health Insurance          asthma should avoid secondhand smoke.
   Program (SCHIP), are more likely to have       •	 Extremely obese people (17.8%) are twice as
   asthma than Oregonians with higher                likely to report having asthma as compared
                                                     to healthy weight individuals (8.1%).          1
   incomes and education levels and other
   forms of insurance.
    Asthma Emergency Department                              People with lower incomes are more likely
    or Urgent Care Visits                                    to live in substandard housing, smoke, and
                                                             have higher disease morbidity.2
    •	 The percentage of Oregonians with asthma
                                                          •	 Emergency department visits and overuse
       and who had an emergency department
                                                             of rescue medications are high and seem to
       visit due to asthma was approximately
                                                             show no improvement over time.
       14.1% in 2007. This is lower than the 2001
       estimate of 17.1%.
    •	 Females are more likely to have an                 Cost of Asthma hospitalizations
       emergency department visit than males.             •	 The total cost of asthma hospitalizations
    •	 People on Medicaid or SCHIP are much                  in 2007 was more than $28 million.
       more likely to have an emergency                      The total cost and the average cost of
       department visit than people not on                   an asthma hospitalization has steadily
       Medicaid or SCHIP.                                    increased over time.
    •	 Less than 40% of people who had an                 •	 Females account for 68.4% of the cost of
       emergency department visit for asthma had             asthma hospitalizations in 2007.
       a follow-up visit with a medical professional      •	 People 35 years old or older account for
       within 30 days after the emergency                    79.2% of the cost of asthma hospitalization
       department visit.                                     in 2007.
                                                          •	 The percentage of asthma hospitalization
    Asthma hospitalizations                                  costs incurred by people who are unable to
                                                             pay represents only 1.0% of the total 2007
    •	 The rate of asthma hospitalizations is stable
                                                             cost. The percentages for all payer groups
       in Oregon and is less than half the U.S. rate.
                                                             are: Medicaid (19.5%); Medicare (35.9%);
    •	 Children 0–4 years of age and females have            private insurance (33.5%); self pay (6.6%);
       the highest rates of asthma hospitalizations.         and any other payer (3.5%).
    •	 There are strong seasonal trends in asthma
       hospitalizations, with peaks in fall and spring.
                                                          Meeting healthy People
                                                          2010 Goals
    Asthma Mortality
                                                          •	 Oregon is making steady progress in
    •	 In 2005, there were 47 deaths attributed              meeting Healthy People 2010 targets.
       to asthma. Total deaths and the rate                  Oregon meets almost all of the targets
       of deaths due to asthma are steadily                  for reducing deaths and hospitalizations
       decreasing in Oregon.                                 resulting from asthma and is approaching
    •	 Females consistently have a higher asthma             the goals for persons with asthma
       death rate than males.                                receiving instructions on how to use their
    •	 African Americans die at a higher rate (24.5          prescribed inhalers.
       per million) from asthma than whites (18.2         •	 Healthy People 2010 goals on other forms
       per million) in Oregon.                               of patient education, such as formal
                                                             education, asthma management plans, and
    Asthma in Medicaid and the                               receiving assistance with assessing and
                                                             reducing exposure to risk factors at home,
    State Children’s health Insurance
                                                             school, and work, are well below Healthy
    •	 Members of the Oregon Health Plan, which              People 2010 targets.
       is composed of Medicaid and SCHIP, have
       a higher burden of asthma than the general
2      Oregon population. The Oregon Health Plan
       is intended to help ensure that medical care
       is affordable for those with low incomes.1
ChAPTER 2:
Introduction
What is Asthma?                                   Asthma is a Public health Priority
Asthma is a chronic disease that targets the      During the past 20 years, asthma has increased
tubes (airways) in the lungs and can cause        throughout the United States and ranks as
difficulty breathing. Inflammation (swelling)     one of the most common chronic diseases
and increased amounts of mucus production         with an estimated 22.2 million persons of
occur in the linings of the tubes that carry      all ages having asthma in 2005.4 Because
air to and from the lungs. In addition, the       of the seriousness of this disease the U.S.
airways become extra sensitive, and may react     Department of Health and Human Services
to things like cigarette smoke, cold air, dust,   developed guidelines to help state agencies
and pollen. When airways react, the muscles       establish asthma programs5 and included
that surround the outside of the airways start    asthma as a public health priority in the
to contract. As these muscles contract, they      Healthy People 2010 national health plan.6
tighten and the tubes leading to the lungs
become even smaller. These effects are usually             Summary of Healthy People 2010
temporary, but can cause shortness of breath,                      Asthma Goals
coughing, wheezing, and other symptoms.               •	    Reduce asthma deaths
                                                      •	    Reduce asthma hospitalizations
While we do not know what causes asthma,              •	    Reduce asthma hospital emergency
we do know that certain things called                       department visits
                                                      •	    Reduce activity limitations among
“triggers” can cause asthma symptoms to                     people with asthma
increase. Not everyone with asthma has the            •	    Reduce the number of school or
same triggers, but some common triggers                     work days missed due to asthma
include irritants such as tobacco smoke,              •	    Increase the proportion of people
exercise, and allergens (things that cause                  with asthma who receive formal
                                                            patient education
allergic reactions). 3                                •	    Increase the proportion of people
                                                            with asthma receiving appropriate
There is much about asthma that remains                     asthma care
unknown and requires further study. Asthma
cannot be cured, but it can be controlled. With
quality health care, the correct medications,     Asthma is a major burden to the quality of
and good self-management skills, people with      life of Oregonians and to Oregon’s health care
asthma can live healthy and productive lives.     system. In Oregon in 2007, 9.9% of adults and
                                                  8.3% of children had asthma, suggesting that
                                                  more than 355,000 Oregonians had asthma.
          Common Asthma Triggers
                                                  The burden of asthma is both economic and
  •	   Tobacco smoke and other smoke              personal, affecting the state of Oregon in direct
  •	   Animals with fur or feathers
  •	   Dust mites and cockroaches                 costs (e.g., hospitalizations and emergency
  •	   Strong smells and sprays                   department visits) and indirect costs (e.g.,
  •	   Mold or mildew                             missed school and work days and days of
  •	   Pollen	from	trees,	flowers,	and	plants     restricted activity) as well as an individual’s
  •	   Being physically active                    quality of life.
  •	   Breathing cold air
  •	   Illnesses that cause breathing problems

                                                                                                      3
    Starting in 1999, the Centers for Disease         with partners the Guide to Improving Asthma
    Control and Prevention (CDC) funded the           Care in Oregon: Indicators for Quality Care
    Oregon Department of Human Services               in Health Systems (the Guide). The Guide
    to address asthma from a public health            suggests population-based indicators that
    perspective. The Oregon Asthma Program            health plans and systems should collect to
    formed a broad partnership of stakeholders        monitor the quality of medical care for people
    and produced the Oregon Asthma Leadership         with asthma. The Oregon Asthma Program
    Plan: A Statewide Call for Action 2006–2011.7     publishes findings from its asthma tracking
    In this plan are the public health goals,         system in an annual Burden of Asthma
    objectives, and strategies to address the         Report. This document notes progress on the
    burden of asthma in Oregon.                       goals and objectives in the Oregon Asthma
                                                      Leadership Plan and the indicators in the
    In addition to the Oregon Asthma Leadership       Guide; and describes the burden of the disease
    Plan, the Oregon Asthma Program developed         in Oregon.




                how to Use This Report
                This report summarizes the findings of the Oregon asthma tracking
                system. It includes the most recent data available from a variety of
                sources. The intent of the information in this report is to highlight the
                burden of asthma in Oregon and to assist stakeholders, policymakers,
                and other interested parties in their efforts to reduce this burden.

                Throughout this report in both graphs and tables, confidence intervals
                are shown for both percentages and rates. Not all graphs or tables had
                the data necessary to calculate a confidence interval and therefore no
                confidence interval is displayed. A confidence interval (CI) indicates
                a measurement’s precision. See the glossary for more information on
                confidence intervals.




4
ChAPTER 3:
Who has Asthma
Overview
To understand the burden of asthma in             These questions create the two definitions of
Oregon, we need to know the prevalence of         asthma used to understand the scope of the
the disease. Prevalence is the percentage of      disease in Oregon.
a defined population with asthma at a given       1. Lifetime asthma is when the adult
time. Adult asthma prevalence is monitored           survey respondent has ever been told
primarily using the Behavioral Risk Factor           they have asthma by a doctor, nurse, or
Surveillance System (BRFSS), a national              other health professional.
survey sponsored by the CDC.                      2. Current asthma is when the adult survey
                                                     respondent has ever been told they have
The BRFSS survey uses the following questions        asthma and they have asthma at the time
to define asthma for adults:                         they are responding to the survey.
•	 Have you ever been told by a doctor,
   nurse, or other health professional that you   For most analysis presented in this report,
   have asthma?                                   current asthma is used to describe the
•	 Do you still have asthma?                      burden of asthma in Oregon. This is because
                                                  individuals with current asthma are those who
To assess asthma prevalence in Oregon children    are currently affected by their asthma and
two sources are used. The first is the BRFSS      experiencing health issues.
survey described above by adult proxy (i.e.,
answered for the child by an adult). The adult
proxy portion of the BRFSS uses the following
questions to define asthma for children:
•	 Has a doctor, nurse, or other health
   professional ever said that the child
   has asthma?
•	 Does the child still have asthma?

The other survey used to assess asthma
prevalence in Oregon children is the Oregon
Healthy Teens (OHT) survey of students in
the eighth and 11th grades. The OHT survey
uses the following questions to define asthma
for children:
•	 Has a doctor or nurse ever told you that you
   have asthma?
•	 Do you still have asthma?




                                                                                                  5
    Data
    Adults with Asthma

    Figure 3.1 – Adults with current asthma by state, 2007


                    WA
                                                                                                                                          ME
                                        MT         ND
                                                                                                                                    VT
               OR                                                 MN                   MI
                                                                                                                                      NH
                         ID
                                                                                                                                       MA
                                                   SD                            WI                                        NY
                                                                                            MI                                       CT
                                         WY                                                                                            RI
                                                                                                                     PA
                                                                                                                                     NJ
                                                   NE                  IA
                                                                                                                          MD
                    NV                                                                                OH
                                   UT                                                       IN                                 DE
                                                                                  IL
          CA                                                                                               WV        VA
                                              CO
                                                                                                 KY
                                                        KS                  MO
                                                                                                                     NC
                                                                                            TN
                                                             OK
                              AZ                                            AR
                                         NM                                                                     SC
                                                                                                                                Percent
                                                                                      MS    AL         GA
                                                                                                                                          9.4 – 10.3

                                                   TX                                                                                     8.7 – 9.3
                                                                            LA
                                                                                                                                          7.9 – 8.6
                                                                                                                FL
                                                                                                                                          6.2 – 7.8




       Key Findings – Adults
       •	 Since 2003 Oregon has ranked among the top 10 states with the highest percentage
          of adults with asthma in the nation. Ranking was determined using numbers from the
          national Behavioral Risk Factor Surveillance System (BRFSS) Web site at http://apps.nccd.
          cdc.gov/brfss/.


    Figure 3.1-Data Source: Behavioral Risk Factor Surveillance System




6
Figure 3.2 – Adults with lifetime asthma
                          20                                           Oregon            U.S.

                                                                            15.8                                15.6           16.0
                                                            14.9                               14.8
                                              13.9
                          15     13.5
Percent lifetime asthma
                                                                                  13.3                                12.8           12.9
                                                                   11.9                               12.5
                                                    11.8
                                      11.0

                          10



                            5



                            0
                                  2001         2002              2003           2004            2005             2006           2007

Figure 3.3 – Adults with current asthma
                          20
                                                                       Oregon          U.S.
Percent current asthma




                          15

                                                                          9.7            9.9             10.0            9.9
                                             8.7           9.2
                          10    8.2                                             8.1                             8.2            8.2
                                                   7.5           7.7                            7.9
                                      7.2


                           5



                           0
                                 2001         2002          2003           2004           2005               2006            2007


                          Key Findings – Adults
                          •	 In 2007, more than 450,000 Oregon adults were estimated as ever having asthma
                             (lifetime) and more than 280,000 were estimated to have asthma (current).
                          •	 Oregon has a higher percentage for both lifetime and current asthma than the overall
                             U.S. percentage in all age groups. It is currently unknown why Oregon has higher
                             percentages than the overall U.S. Further analysis is needed.
                          •	 The percentage of Oregonians with lifetime and current asthma has increased over time.


Figures 3.2 and 3.3-Data Source: Oregon Behavioral Risk Factor Surveillance System: National data from the
Behavioral Risk Factor Surveillance System
Note: National estimate excludes territories




                                                                                                                                            7
    Figure 3.4 – Adults with current asthma by gender
                             20
                                                                                    Male           Female

                             15                                                                                              12.5               12.4
                                                                                          12.1
    Percent current asthma


                                                                                                         12.4
                                                            11.1          11.4
                                          10.4

                             10                                                     7.3                                7.4                7.3
                                                                    7.0                            7.4
                                   6.0                6.2

                              5



                              0
                                     2001              2002          2003             2004          2005                2006               2007

    Figure 3.5 – Adults with current asthma by age
                             20
                                                     18-44 years old                45-64 years old                    65+ years old


                             15
    Percent current asthma




                                                        10.0                        10.1 10.4       10.6                10.1 10.6          10.0
                                               8.8                  9.7                                    9.7                                    10.0 9.6
                                         8.5                              8.8 8.6                                                   8.5
                             10    7.8                8.2     7.3                                                8.2
                                                                                             7.2



                               5



                               0
                                     2001              2002           2003                2004           2005                2006               2007



                             Key Findings – Adults
                             •	 Adult	females	are	more	likely	to	have	asthma	than	adult	males.	This	reflects	similar	
                                national trends where females report having 40% higher asthma prevalence than
                                males.4 This trend is also seen in other states.8 The reason adult women have an
                                increased risk of developing adult-onset asthma are not completely understood.
                                However, studies indicate that physiological differences such as having generally smaller
                                airways than men and different hormones as well as increased risk from obesity and
                                socio-economic differences could all attribute to the differences between women
                                and men.9,10,11
                             •	 The difference in asthma between males and females is increasing slightly.
                             •	 There is no consistent trend in differences between age groups in the percentages of
                                people with asthma.


    Figures 3.4 and 3.5-Data Source: Oregon Behavioral Risk Factor Surveillance System

8
Figure 3.6 – Adults with current asthma by race and ethnicity (age-standardized), 2004–2005
                          30


Percent current asthma
                                                         15.5                                  15.2
                          20

                                     10.2
                                                                            5.9
                          10                                                                                        5.4


                           0
                                  White, non-   African-American,      Asian/Pacific         American             Hispanic
                                   Hispanic        non-Hispanic       Islander, non-       Indian/Alaska
                                                                          Hispanic          Native, non-
                                                                                              Hispanic

                                                                    Race and ethnicity


Figure 3.7 – Adults with current asthma by sexual orientation
                                                     Homosexual/Bisexual               Heterosexual
                           30
                                      20.1
Percent current asthma




                                                                     15.7                          16.0

                           20

                                                   9.7                            9.9                             9.7
                           10


                            0
                                            2005                         2006                              2007


                         Key Findings – Adults
                         •	 Non-Hispanic African American (15.5%) and American Indian/Alaskan Native (15.2%)
                            persons report higher percentages of asthma than other racial and ethnic groups.
                            Asthma differences in non-Hispanic African American and American Indian/Alaskan
                            Native persons are also seen in national data.12 These differences may be the result of
                            economic and social disparities. In addition, in Oregon 2004-2005, 30% and 38% of
                            non-Hispanic African American and American Indian/Alaskan Native persons smoked,
                            respectively.13, 14 This is 11% and 19% higher than the general Oregon population.
                            Hispanic persons report the lowest percentage of asthma and are among the lowest
                            percentage of smokers.
                         •	 Homosexual or bisexual persons have consistently reported higher percentages of
                            asthma than heterosexual persons. Because of the small sample size of persons self-
                            reporting	as	homosexual	or	bisexual	(shown	by	the	large	confidence	intervals	in	all	
                            years reported) this information should be interpreted with caution. One study reported
                            that those in same-sex relationships are at high risk for asthma from a spectrum of
                            risk factors including higher rates of smoking, stress, and among lesbians, obesity.15 In
                            Oregon, 31% of homosexual or bisexual persons report that they smoke. This is 11%
                            higher than the overall Oregon population.16 Given the higher smoking rates, sexual
                            orientation is likely a marker for high smoking rates and is not a risk factor in itself.


Figure 3.6-Data Source: Oregon Behavioral Risk Factor Surveillance System, 2004–2005 Race-Oversample                         9
Figure 3.7-Data Source: Oregon Behavioral Risk Factor Surveillance System
     Figure 3.8 – Adults with current asthma by education level, 2007
                              20
     Percent current asthma                   9.5                 11.8
                              15
                                                                                      10.3

                              10                                                                            7.8


                                5


                                0
                                       No high school          High school      Some college           College
                                                                graduate                               graduate

                                                                    Education level




     Table 3.1 – Adults with current asthma percentages and 95% confidence intervals (CI) by
     education level
                                         No High School             High School                    Some             College
                                            Diploma                  Diploma                      College          Graduate

           Year                           %            CI          %            CI            %             CI    %         CI

        2001                             11.0       8.6–14.1       8.0        6.8–6.8         8.5      7.3–9.9    7.1     6.0–8.4

           2002                            7.8      5.8–10.4       8.8       7.6–10.3         9.8     8.4–11.4    7.8     6.6–9.1

           2003                          10.0       7.6–12.9       9.6       8.3–11.1         9.8     8.5–11.4    8.0     6.9–9.3

           2004                          12.0       9.2–15.6       8.3        7.1–9.7        11.3     9.9–12.9    8.8    7.7–10.1

           2005                          10.9       9.2–13.0      10.0       8.8–11.2        10.9     9.9–12.1    8.5     7.7–9.5

           2006                          12.6       9.0–17.3      10.3       8.6–12.2        10.4     8.9–12.2    8.6    7.4–10.0

           2007                            9.5      5.8–15.3      11.8       9.1–15.0        10.3     8.4–12.5    7.8     6.5–9.3



                              Key Findings – Adults
                              •	 College graduates are the least likely to have asthma. Trends for all other levels of
                                 education are variable.
                              •	 In Oregon, tobacco use is higher among people with lower education levels, with
                                 college graduates having the lowest percentage of smokers.17


     Figure 3.8 and Table 3.1-Data Source: Oregon Behavioral Risk Factor Surveillance System




10
Figure 3.9 – Adults with current asthma by annual household income, 2007
                          30


Percent current asthma                17.5
                          20
                                                    12.3
                                                                 10.9
                                                                                 8.7
                                                                                                 8.3
                          10



                           0
                                 < $15,000        $15,000-     $24,000-     $35,000-         > $50,000
                                                  $25,000      $35,000      $50,000

                                                           Household income



Table 3.2 – Adults with current asthma percentages and 95% confidence intervals (CI) by annual
household income

                                    < $15,000       $15,000–$25,000       $24,000–35,000         $35,000–$50,000     > $50,000

      Year                      %            CI      %          CI        %             CI        %        CI       %       CI

   2001                        12.2     9.8–15.1     8.5      6.9–10.5    10.9     8.8–13.3       6.1     4.8–7.8   6.7   5.6–7.9

      2002                     11.9     9.2–15.0     9.7      8.0–11.7     9.1     7.1–11.5       7.7     6.2–9.5   7.9   6.7–9.3

   2003                        14.0    11.4–17.1     9.9      8.1–11.9     9.6     7.7–12.0       8.0     6.5–9.8   8.3   7.1–9.6

      2004                     12.9    10.4–15.8    12.4     10.5–14.6     9.9     8.1–12.2       8.1     6.7–9.8   8.0   6.8–9.4

   2005                        14.9    12.5–17.6    12.2     10.7–13.8     8.3         7.0–9.8    8.8    7.5–10.2   8.4   7.5–9.4

      2006                     18.7    14.7–23.6    12.2     10.0–14.7     8.7     6.7–11.4       9.3    7.4–11.6   8.1   6.9–9.5

      2007                     17.5    13.8–21.9    12.3     10.0–15.0    10.9     8.6–13.7       8.7    7.1–10.6   8.3   7.3–9.4



                         Key Findings – Adults
                         •	 There is a strong correlation between asthma and income level. Oregonians from a
                            household with an income of less than $15,000 consistently report higher percentages of
                            asthma than all other income levels. Nationally, a higher percentage of people below the
                            federal poverty level report having asthma than those above the federal poverty level.18
                         •	 The percentage of smokers among people with an income of $15,000 or less is more
                            than three times higher than those making greater than $50,000.17 In addition, lower
                            income individuals may have greater exposure to asthma triggers such as mold, mildew,
                            and cockroaches, due to substandard housing.


Figure 3.9 and Table 3.2-Data Source: Oregon Behavioral Risk Factor Surveillance System
                                                                                                                                    11
     Figure 3.10 – Adults with current asthma by current type of health insurance

                                40           No health insurance                       Private or Medicare                   Oregon Health Plan
                                                                                                                                                                  27.7
     Percent current asthma

                                30                                                                                                             22.1
                                                                                                                           20.7
                                                                                                        17.1
                                                                                       15.4
                                20               14.3
                                                                    13.4
                                                                                                                                  10.3                9.7
                                     7.9                                   9.1                9.1 9.2          9.4                       9.0
                                                              8.6                8.6                                 9.2                                    8.9
                                10         7.6          6.3




                                 0
                                       2001               2002               2003               2004             2005                2006               2007



                              Key Findings – Adults
                              •	 Oregon Health Plan (OHP) members are almost twice as likely to report having asthma
                                 as people with no health insurance, or private or Medicare health insurance. This gap
                                 in the percentage of asthma by health plan continues to widen, with an absolute
                                 difference of 18% between OHP members and people with private health insurance
                                 or Medicare in 2007.
                              •	 OHP is a combination of Medicaid and the State Children’s Health Insurance Program
                                 (SCHIP), which are both funded by the federal and state governments. Adult OHP
                                 members are certain low-income individuals generally with no other health coverage,
                                 including pregnant women, other adults, seniors, and people with disabilities. Adult
                                 OHP members are more than twice as likely to smoke as people with private insurance.17
                                 In addition, the Oregon Health Plan is intended to help ensure that medical care is
                                 affordable for those with a low income.1 People with lower incomes are more likely to
                                 live in substandard housing, smoke, and have higher disease morbidity.2



     Figure 3.10-Data Source: Oregon Behavioral Risk Factor Surveillance System




12
Table 3.3 – Adults with current asthma by urban and rural residence
                      Urban                            Rural
 Year           %                CI               %            CI

 2001          7.9            7.1–8.8            9.2       7.9–10.7

 2002          8.5            7.6–9.4            9.4       8.0–11.0

 2003          9.3          8.4–10.3             9.2       7.9–10.6

 2004          9.6          8.8–10.5             9.7       8.6–11.6

2005           9.5          8.8–10.2            11.0      10.0–12.2

 2006         10.0          9.6–11.2             9.8       8.3–11.5

2007           9.8          8.8–10.8            10.4       8.9–12.0



   Key Findings – Adults
   •	 Rural and urban ZIP codes show no consistent difference in the percent of the
      population with asthma over time. For example, the 2006 percent in rural areas was
      9.8% compared to 10.0% in urban areas; whereas in 2005 the percent in rural areas
      was 11.0% compared to 9.5% in urban areas. Determination of a ZIP code as rural or
      urban used the rural-urban commuting area (RUCA) codes approximation developed by
      the U.S. Department of Agriculture.19


Table 3.3-Data Source: Oregon Behavioral Risk Factor Surveillance System




                                                                                           13
     Table 3.4 – Percentages (age-standardized and unstandardized) and age-standardized 95%
     confidence intervals (CI) for adults with current asthma by county, 2002–2005

      County             Unstandardized %        Age-standardized %        Age-standardized CI

      Baker                        9.0                      9.6                   5.5–16.1
      Benton                       8.6                      8.7                   6.9–11.0
      Clackamas                    9.6                      9.6                   8.4–10.9
      Clatsop                      9.3                      9.5                   6.7–13.4
      Columbia                     9.7                      9.7                   7.2–12.8
      Coos                         8.7                      8.4                   6.5–10.9
      Crook                        8.8                      9.2                   5.5–15.2
      Curry                        8.2                      7.8                   4.8–12.5
      Deschutes                    8.9                      8.9                   7.3–10.8
      Douglas                     11.5                     11.8                   9.6–14.5
      Grant                        8.9                     10.3                   4.4–22.3
      Harney                       6.1                      5.5                   2.5–11.5
      Hood River                   3.6                      3.6                    1.7–7.7
      Jackson                      8.4                      8.3                    7.0–9.9
      Jefferson                    6.1                      5.8                    3.4–9.8
      Josephine                   10.5                     11.2                   8.3–15.1
      Klamath                     10.6                     10.7                   8.2–13.9
      Lake                        11.6                     13.6                   6.6–25.9
      Lane                        10.5                     10.5                   9.3–11.8
      Lincoln                      9.3                      9.1                   6.5–12.6
      Linn                        11.9                     12.0                   9.9–14.4
      Malheur                      5.6                      5.7                    3.4–9.2
      Marion                       8.9                      8.9                   7.7–10.3
      Morrow                      10.5                     10.5                   5.7–18.6
      Multnomah                    8.9                      8.9                    8.1–9.8
      Polk                         7.0                      6.9                    5.2–9.3
      Tillamook                    9.6                      9.4                   5.9–14.6
      Umatilla                     7.1                      7.1                    5.4–9.3
      Union                       10.9                     11.0                   7.5–15.9
      Wallowa                      6.7                      6.9                   3.3–13.7
      Washington                   9.1                      9.1                   8.2–10.2
      Yamhill                     10.9                     10.8                   8.0–14.2
      Gilliam/Wheeler              2.8                      2.7                   0.5–14.5
      Sherman/Wasco                9.9                      9.8                   6.1–15.4
      Oregon                       9.3                      9.3                    8.9–9.6




14
Figure 3.11 – Adults with current asthma by county (age-standardized), 2002–2005




                         Co
                           lu
              Clatsop




                             m
                              bi
                                                Hood River    Gilliam/Wheeler




                                a
                        W
                         as
                             hi
                               ng        Multnomah                                          Umatilla
                                   to                                                                               Wallowa
                                     n
  Tillamook
                                                                                Morrow
                  Yamhill                                                                              Union
                                    Clackamas         Sherman/Wasco
                              Marion
                  Polk

  Lincoln                                                                                                  Baker
                                                       Jefferson
                Benton                   Linn                                            Grant
                                                                                                                         Oregon Average 9.3%
                                                                                                                              Percent
                                                                     Crook                                                              11.3 - 13.6
                            Lane
                                                     Deschutes                                                                          9.3 - 11.2

                                                                                                                                        5.9 - 9.2

                                                                                                                                        2.7 - 5.8
     Coos           Douglas                                                                                    Malheur
                                                                                         Harney
                                                                    Lake



            Josephine                            Klamath
                              Jackson
    Curry




   Key Findings – Adults
   •	 Counties with a percentage of the population with asthma higher than the Oregon
      average tend to also be counties with high smoking rates (see Figure 5.4).


Table 3.4 and Figure 3.11-Data Source: Oregon Behavioral Risk Factor Surveillance System, 2002–2005




                                                                                                                                                      15
     Children with Asthma

     Figure 3.12 – Children (0–17 years of age) with current asthma by adult proxy
                               20
     Percent current asthma




                               15


                                               8.4                  8.7                  8.3
                               10


                                5


                                0
                                              2005                  2006                 2007

     Figure 3.13 – Youths (8th grade and 11th grade) with current asthma

                              20
                                                            8th grade       11th grade
     Percent current asthma




                              15
                                       10.7   10.4       10.5   10.8                                  10.5
                                                                            10.0   9.7          9.7
                              10


                                5


                                0
                                          2004               2005              2006               2007


                              Key Findings – Children
                              •	 In 2007, approximately 75,000 Oregon children are estimated to have asthma.
                              •	 There has been little change over time in the percent of children and youths with
                                 asthma in Oregon.


     Figure 3.12-Data Source: Oregon Behavioral Risk Factor Surveillance System
     Figure 3.13-Source: Oregon Healthy Teens




16
Figure 3.14 – Youths (8th grade and 11th grade) with current asthma by gender, 2007

                         20
                                                               Male         Female
Percent current asthma
                         15                                                                  12.1

                                            9.3           10.1
                                                                                 8.9
                         10


                          5


                          0
                                                  8th grade                            11th grade




Table 3.5 – Youths (8th grade and 11th grade) with current asthma by gender
                                              8th Grade                                             11th Grade
                                     Male                     Female                         Male            Female
       Year                    %             CI           %            CI               %       CI         %      CI
      2004                    10.8      9.6–12.2       12.3       11.1–13.6            8.6     7.4–10     13.6   12.3–15.1

      2005                    10.0      8.9–11.2       12.5       11.3–13.9            8.9   7.8–10.1     13.8   12.5–15.2

      2006                    10.7      8.9–12.8       10.9        9.2–12.9            7.3    5.7–9.3     13.2   11.2–15.7

      2007                     9.3      8.2–10.4       10.1        9.0–11.3            8.9   7.6–10.4     12.1   10.7–13.7



                         Key Findings – Children
                         •	 Generally, males are less likely to report having asthma than females in both 8th and
                            11th grades. The gap between boys and girls widens in the 11th grade, which is
                            consistent with national data.18


Figure 3.14 and Table 3.5-Source: Oregon Healthy Teens




                                                                                                                             17
     Table 3.6 – Youths (8th grade and 11th grade) with current asthma by county, 2005–2006
      County                 8th Grade (%)           8th Grade CI           11th Grade (%)            11th Grade CI
      Baker                        9.8                   5.5–14.4                10.0                   6.8–14.3
      Benton                      10.8                   8.3–14.1                  8.7                    6.8–11
      Clackamas                    9.7                   8.7–10.8                10.9                   9.7–12.3
      Clatsop                     13.3                   9.8–17.9                14.5                  10.9–18.9
      Columbia                    11.9                   9.1–15.4                11.3                     8–15.6
      Coos                        12.2                10.1–14.6                  12.1                   9.6–15.1
      Crook                       12.4                   9.4–16.2                  9.3                  6.4–13.3
      Curry                       11.3                   8.3–15.1                11.2                     8–15.5
      Deschutes                    8.4                   6.7–10.4                10.2                   7.8–13.4
      Douglas                      9.9                    8.2–12                 11.8                   9.3–14.9
      Grant                       3.8*                   1.8–7.7*                  8.2                  4.7–13.9
      Harney                      10.3                   6.2–16.6                9.4*                  5.1–16.7*
      Hood River                   5.8                    4.0–8.3                  6.5                   4.5–9.5
      Jackson                     10.2                   8.9–11.6                  8.9                  7.4–10.7
      Jefferson                    7.4                   4.6–11.6                4.1*                   1.8–8.9*
      Josephine                     **                        **                   **                         **
      Klamath                      9.3                   6.8–12.7                13.4                   10.4–17
      Lake                        19.4                12.8–28.5                  8.9*                  4.6–16.5*
      Lane                        13.8                12.7–15.1                  12.2                   10.7–14
      Lincoln                       **                        **                   **                         **
      Linn                        12.6                10.7–14.7                  11.3                   9.4–13.6
      Malheur                      6.5                    4.6–9.1                  9.2                  6.7–12.6
      Marion                      10.4                   8.8–12.2                  9.6                    8–11.5
      Morrow                       9.1                   5.7–14.2                  6.6                    4–10.9
      Multnomah                    9.5                   8.6–10.5                  9.8                    8.8–11
      Polk                        13.4                10.0–17.6                  10.2                     7–14.6
      Tillamook                   11.0                   7.1–16.4                9.4*                  5.2–16.7*
      Umatilla                     7.8                    6.5–9.5                  8.1                  6.4–10.1
      Union                       10.8                   7.8–14.9                  8.1                  5.2–12.3
      Wallowa                     ***                        ***                  ***                        ***
      Washington                   9.7                   8.1–11.5                10.5                   8.8–12.4
      Yamhill                      9.3                   7.1–12.2                12.4                   9.3–16.3
      Gilliam/Wheeler             ***                        ***                  ***                        ***
      Sherman/Wasco                8.4                   6.0–11.6                11.5                     8–16.2
      Oregon                      10.2                   9.8–10.7                10.4                   9.9–10.9

     * Data may be unreliable due to small numbers   ** No data available     *** Insufficient data
18
     Table 3.6-Source: Oregon Healthy Teens, 2005–2006
Figure 3.15 – Youths (8th grade) with current asthma by county, 2005–2006




                              Co
                                 lu
                Clatsop




                                    m
                                     bi
                          W                             Hood River    Gilliam/Wheeler




                                       a
                           as
                               hi
                                   ng                                                                Umatilla
                                     to          Multnomah                                                                   Wallowa
                                         n
  Tillamook
                                                                                         Morrow
                    Yamhill                                                                                     Union
                                                  Clackamas    Sherman/Wasco
                                    Marion
                    Polk

  Lincoln                                                                                                           Baker
                                                 Linn           Jefferson                                                          Oregon Average 10.2%
                  Benton                                                                          Grant

                                                                                                                                       Percent
                                    Lane                                        Crook
                                                                                                                                                 12.1 – 20.0
                                                              Deschutes
                                                                                                                                                 10.3 – 12.0

                                                                                                                                                 9.1 – 10.2

     Coos             Douglas                                                                                           Malheur                  3.8 – 9.0
                                                                                                  Harney
                                                                               Lake                                                              Insufficient data


              Josephine                                   Klamath
                                   Jackson
    Curry




Figure 3.16 – Youths (11th grade) with current asthma by county, 2005–2006
                           Co
                               lu




                Clatsop
                                m




                                                                       Gilliam/Wheeler
                                    bi




                                                         Hood River
                                     a




                           W
                              as
                                hi               Multnomah                                           Umatilla
                                    ng                                                                                       Wallowa
                                        to
  Tillamook                                  n
                                                                                         Morrow
                    Yamhill                                                                                     Union
                                                  Clackamas    Sherman/Wasco
                   Polk             Marion

  Lincoln                                                                                                           Baker          Oregon Average 10.4%
                                                                Jefferson
                  Benton                         Linn                                              Grant


                                                                                Crook                                                  Percent
                                    Lane
                                                                                                                                                 12.1 – 20.0
                                                              Deschutes
                                                                                                                                                 10.5 – 12.0

                                                                                                                                                 9.1 – 10.4

     Coos             Douglas                                                                                           Malheur                  4.1 – 9.0
                                                                                                  Harney
                                                                               Lake                                                              Insufficient data


            Josephine                                     Klamath
                                   Jackson
    Curry




   Key Findings – Children
   •	 Only Clatsop, Lane, and Coos counties are consistently high for both 8th and 11th graders.
                                                                                                                                                                     19

Figure 3.15 and Figure 3.16-Source: Oregon Healthy Teens, 2005–2006
     ChAPTER 4:
     Asthma Management
     and Quality of Life
     Overview
     Asthma management refers primarily to                The second workgroup is the Division of
     the education, instruction, and medical or           Medical Assistance Programs (DMAP), Quality
     pharmacological care received by people              and Performance Improvement Workgroup
     with asthma. Asthma quality of life is the           (QPIWG). DMAP is a division of the Oregon
     extent people have control of their asthma           Department of Human Services that
     and asthma symptoms and can be gauged by             administers state programs providing medical
     information such as missing work or school,          coverage to eligible low-income Oregonians
     inability to carry out usual activities, and other   through the Oregon Health Plan (OHP), which
     measures that limit the quality of life of people    is a combination of Medicaid and the State
     with asthma.                                         Children’s Health Insurance Program (SCHIP).
                                                          The QPIWG is a workgroup convened by
     Both asthma management and quality of life           DMAP for all health plans that serve OHP
     are monitored primarily by the Behavioral            recipients in Oregon. Through this workgroup,
     Risk Factor Surveillance System (BRFSS)              OAP measures and reports asthma data
     through Oregon-added questions on the                consistently across all OHP managed health
     BRFSS and through the BRFSS Asthma                   plans and OHP members not in managed
     Callback Survey. The standard version of the         health plans ( fee-for-service). Almost all OHP
     BRFSS administered by all states only asks           members are in managed care or have health
     the lifetime and current asthma prevalence           services paid for on a fee-for-service basis.
     questions discussed in the Asthma Prevalence
     section. Oregon, however, has included               In 2006, data from these two workgroups
     additional questions to assess asthma control        represent almost 550,000 private and OHP
     and awareness. The BRFSS Asthma Callback             insured Oregonians aged 4–55 years who
     Survey is a follow-up survey administered to         were enrolled for at least six months in
     people who indicated on the BRFSS that they          any of the participating health plans. This
     have asthma.                                         represents approximately 15% of the total
                                                          Oregon population.
     Asthma management is also monitored
     from data provided by health plans who
     participate in two workgroups. The first
     workgroup is the Asthma Data Workgroup
     (ADWG). The ADWG is a voluntary
     partnership between the Oregon Asthma
     Program and several of Oregon’s largest
     private and Medicaid health plans.




20
Data
Management

Figure 4.1 – Adults with lifetime asthma who received asthma information from a doctor or
health care provider, 2005

                                 100
Percent receiving information




                                  80                          70.9
                                            62.2
                                  60
                                                                                                                   36.2
                                  40                                                                                                31.7
                                                                              18.6
                                  20                                                              6.7

                                   0
                                           Received           Received       Received       Taken a course       Advised to     Taught how to
                                          explanation       information     an asthma         on how to        change things    use a peak flow
                                          on how to        on what to do    action plan     manage asthma      in your home,       meter to
                                        recognize early      during an                                           school or        adjust daily
                                          signs of an     asthma episode                                           work to        medications
                                        asthma episode        or attack                                       improve asthma


Figure 4.2 – Children (0–17 years of age) with lifetime asthma who received asthma information
from a doctor or health care provider, 2005
Percent receiving information




                                 100
                                                               75.8
                                            70.4
                                  80

                                  60
                                                                                                                 36.1              35.8
                                                                             31.9
                                  40
                                                                                              12.6
                                  20

                                   0
                                          Received            Received      Received      Taken a course        Advised to     Taught how to
                                         explanation        information    an asthma        on how to         change things    use a peak flow
                                         on how to         on what to do   action plan    manage asthma       in your home,       meter to
                                       recognize early       during an                                          school or        adjust daily
                                         signs of an      asthma episode                                          work to        medications
                                       asthma episode         or attack                                      improve asthma



                                Key Findings
                                •	 The majority of people who ever had asthma have received training in recognizing
                                   early signs of an asthma episode and have received information on what to do during
                                   an asthma episode or attack. However, few people have received an asthma action
                                   plan or an asthma management class. An asthma action plan is a treatment plan and
                                   instructions provided by a health care provider. Having both an asthma action plan and
                                   completing an asthma management class are recommendations for quality care in The
                                   Guide to Improving Asthma Care in Oregon.20
                                •	 Children generally have higher training in asthma information than adults. This is
                                   especially true for those having received an asthma action plan.

                                                                                                                                                  21
Figure 4.1 and 4.2-Data Source: Oregon Behavioral Risk Factor Surveillance System, Adult and Child Asthma
Callback Surveys
     Figure 4.3 – Adults and children (0–17 years of age) with lifetime asthma who have ever used a
     prescription inhaler for their asthma and received asthma medication information from a doctor
     or health care provider, 2005

                                                                 Adult        Children

                                                 95.6         94.5
                                 100                                                             82.9
     Percent shown how to



                                                                                    81.8
       use their inhalers



                                     80

                                     60

                                     40

                                     20

                                     0
                                           Shown how to use the inhaler      Had a health professional watch
                                                                                   you use the inhaler

     Figure 4.4 – Adults and children (0–17 years of age) with lifetime asthma and have used any
     prescription inhaler in the last three months and used a spacer with any of these inhalers, 2005

                              100
     Percent using a spacer




                               80
                                                                                 54.3

                               60

                                                   31.0
                               40

                               20

                                 0
                                                   Adult                         Child



                              Key Findings
                              •	 A high proportion of adults and children who have ever used a prescription inhaler
                                 for their asthma report having received information and been watched by a health
                                 professional on how to use their inhalers.
                              •	 Children are much more likely to use a spacer with their prescription inhaler than adults.
                                 A spacer is an add-on device used to increase the effectiveness of the inhaler. Spacers add
                                 space between the mouthpiece of the inhaler and the mouth of the person with asthma.



     Figures 4.3 and 4.4-Data Source: Oregon Behavioral Risk Factor Surveillance System, Adult and Child Asthma
     Callback Surveys




22
Figure 4.5 – Adults with current asthma who received an influenza shot by current asthma status

                       100
                                     With current asthma    Without current asthma
Percent receiving an   80
   Influenza shot
                       60                                                    51.4
                             45.3                            43.4
                                              36.5                                   35.2
                       40           32.1                            30.6
                                                     25.1
                       20

                        0
                               2004             2005            2006            2007


          Key Findings
          •	 From 2004 to 2007 the number of adults with asthma and who have received an
             influenza	shot	has	been	below	or	near	50%.	Adults	with	asthma	were	
             more	likely	to	have	received	a	flu	shot	than	people	without	asthma.	Receiving	an	
             influenza	shot	is	a	recommendation	for	quality	care	in	The Guide to Improving Asthma
             Care in Oregon.20


Figure 4.5-Data Source: Oregon Behavioral Risk Factor Surveillance System




                                                                                                    23
     Figure 4.6 – People with persistent asthma who filled at least one prescription for a daily inhaled
     corticosteroid in the past year, by type of insurance (age-standardized)
                                   100                     Commercial          Oregon Health Plan
     least one prescription                                     80.1               78.9               78.6
      Percent receiving at
                                    80
                                              64.2 63.9                 64.6              65.7
                                                                                                             62.6
                                    60

                                    40

                                    20

                                        0
                                                   2003              2004               2005               2006



     Figure 4.7 – People with persistent asthma who overuse inhaled short-acting beta2-agonists by
     receiving more than six canisters in the past year, by type of insurance (age-standardized)
                                  100
     short-acting beta2-agonist
     Percent overusing inhaled




                                                           Commercial          Oregon Health Plan
                                  80

                                  60
                                                    41.5             41.3               41.2
                                  40                                                                       33.9
                                            26.9              25.8
                                                                                 18.4               16.6
                                  20

                                   0
                                              2003              2004               2005               2006


                  Key Findings
                  •	 In general, around 70-80% of people with persistent asthma with private insurance
                     receive at least one canister of inhaled corticosteroid compared to 60-66% among those
                     on	OHP.	Inhaled	corticosteroids	are	anti-inflammatory	drugs	that	prevent	asthma	attacks	
                     on an ongoing basis.
                  •	 The trend in the overuse of inhaled short-acting beta2-agonists shows a decrease
                     among people with persistent asthma with private insurance. People on the OHP are
                     almost twice as likely to overuse inhaled short-acting beta2-agonists in 2006 as people
                     with persistent asthma with private insurance. Inhaled short-acting beta2-agonists
                     quickly loosen the tightened muscles around swollen airways and are often called
                     rescue medications.
                  •	 Increased use of daily-inhaled corticosteroids and decreased overuse of short-acting
                     inhalers are recommendations for quality care in The Guide to Improving Asthma Care
                     in Oregon.20


     Figures 4.6 and 4.7-Data Source: Asthma Data Workgroup and Quality and Performance
     Improvement Workgroup


24
Figure 4.8 – Asthma follow-up visit with a medical practitioner within 30 days after an emergency
department visit for asthma, by type of insurance (age-standardized)

                         100                  Commercial         Oregon Health Plan
Percent with follow-up
    to an ED visit        80

                          60
                               43.6              42.6               43.1 43.9
                                      39.5                                            37.5 34.5
                          40                            34.3

                          20

                           0
                                 2003              2004               2005              2006


Figure 4.9 – People with persistent asthma who have been seen by a health professional for
asthma in the past year, by type of insurance (age-standardized)

                         100
                                             Commercial        Oregon Health Plan
health professional
 Percent seen by a




                         80

                               55.2 55.3        58.4               58.7
                         60                                               51.6             54.4
                                                        44.2                        47.2
                         40

                         20

                          0
                                 2003             2004               2005              2006


          Key Findings
          •	 Around 40% of people with asthma with both private insurance or on OHP visit a
             health professional for asthma within 30 days of an emergency department (ED) visit. In
             addition, generally only half of people with persistent asthma see a health professional
             for their asthma annually.
          •	 Seeing a health professional within 30 days of an emergency department visit and
             seeing a health professional annually are both recommendations for quality care in The
             Guide to Improving Asthma Care in Oregon.20


Figure 4.8-Data Source: Asthma Data Workgroup and Quality and Performance Improvement Workgroup
Figure 4.9-Data Source: Asthma Data Workgroup




                                                                                                        25
     Quality of Life

     Figure 4.10 – Adults with current asthma, by sex, who missed one or more days of work, school or
     other daily activities because of asthma in the past three months, 2005

                                    30
     Percent missing work, school
          or other activities




                                    20                     13.8
                                                                                   11.5
                                           7.5
                                    10



                                    0
                                          Male            Female                All adults


     Figure 4.11 – Adults with current asthma, by household income, who missed one or more days of
     work, school, or daily activities because of asthma in the past three months, 2005
     Percent missing work, school




                                    30
          or other activities




                                           16.9
                                    20
                                                             8.9

                                    10                                                4.4


                                     0
                                         < $35,000     $35,000–$50,000            > $50,000
                                                      Household income


                    Key Findings
                    •	 More than 11% of adults with asthma report having missed work, school, or other
                       activities due to their asthma, with females almost twice as likely to do so as males.
                       Missing work, school, or other daily activities decreases the quality of life of people
                       with asthma.
                    •	 Lower income individuals are also more likely to report missing work, school, or
                       daily	activities.	Because	of	the	large	confidence	intervals,	caution	should	be	used	in	
                       interpreting this result.



     Figures 4.10 and 4.11-Data Source: Oregon Behavioral Risk Factor Surveillance System




26
Figure 4.12 – Number of days in the past 12 months adults with current asthma were unable to
work or carry out their usual activities because of asthma, 2005


Percent unable to work or
                              100

 carry out usual activities
                                        73.7
                               80

                               60

                               40
                                                               16.9
                               20                                                       9.5

                                0
                                       None                  One to ten           Eleven or more
                                               Number of days with sleep disturbances

Figure 4.13 – Sleep disturbances due to asthma in the last 30 days among adults with current
asthma, 2005
                              80       68.8
sleep disturbances
  Percent having




                              60

                              40
                                                               20.7
                              20                                                        10.5

                               0
                                      None                  One to nine             Ten or more
                                    Number of days unable to work or carry out usual activities



             Key Findings
             •	 More than 25% of adults with asthma report missing one or more days of work or usual
                activity in the past 12 months and more than 30% report having one or more nights
                when	their	asthma	symptoms	made	it	difficult	to	stay	asleep.	


Figures 4.12 and 4.13-Data Source: Behavioral Risk Factor Surveillance System, Adult Asthma Callback Survey




                                                                                                              27
     Figure 4.14 – Frequency of asthma symptoms in past four weeks among adults with current
     asthma, 2005
                                 60
     asthma symptoms             50            39.7
       Percent having


                                 40                                    33.6
                                                                                                  26.7
                                 30
                                 20
                                 10
                                  0
                                       Less than once a week      Once to less than        Symptoms every day
                                                                 seven times a week
                                                       Number of days with asthma symptoms

     Figure 4.15 – Perceived health among adults with or without current asthma, 2007

                                 100
     Percent in each perceived
       health status group




                                  80
                                                                                  Excellent or very good
                                  60
                                                                                  Good
                                  40                                              Fair or poor

                                  20

                                   0
                                           With current         Without current
                                             asthma                 asthma
                                                      Asthma status



                 Key Findings
                 •	 More than 25% of adults with asthma report having asthma symptoms every day.
                 •	 Adults with asthma are less likely than people without asthma to report being in
                    excellent or very good health. Conversely, adults with asthma are twice as likely to
                    report being in fair or poor health than those without asthma.


     Figure 4.14-Data Source: Behavioral Risk Factor Surveillance System, Asthma Callback Survey
     Figure 4.15-Data Source: Oregon Behavioral Risk Factor Surveillance System




28
ChAPTER 5:
Asthma Risk Factors
Overview
Risk factors are external circumstances or         Risk factors for asthma were monitored
personal health behaviors that increase            through the Behavioral Risk Factor
the chance that individuals will experience        Surveillance System (BRFSS). The risk factors
asthma episodes or exacerbations. Because          analyzed in this report include smoking,
asthma is a complex disease involving many         secondhand smoke exposure, and obesity as
risk factors, no one risk factor can explain       measured by the Body Mass Index (BMI). BMI
asthma in the Oregon population. Risk              is a calculation that uses height and weight to
factors are unique to each individual and can      determine obesity. Finally, we used U.S. Census
include family history, smoking or exposure        Bureau Small Area Health Insurance Estimates
to secondhand smoke, obesity, substandard          (SAHIE) data to show the lack of health
housing that exposes an individual to irritants    insurance in Oregon. SAHIE data is available
such as mold and cockroaches, exposure to          online at www.census.gov/hhes/www/sahie/
allergens, and air quality. In addition to these   index.html.
risk factors, lack of medical insurance or
assistance makes it difficult for people with
asthma to afford the medications and care
necessary to control their disease.

Because of the complexity of risk factors
among people with asthma, it is difficult to
gather comprehensive information in an
attempt to characterize asthma risk factors in
Oregon. In this report we limit our reporting
of asthma risk factors to smoking, obesity, and
lack of medical insurance.




                                                                                                     29
     Data
     Smoking

     Figure 5.1 – Adults with current asthma by smoking status

                                20                                    2005      2007                          15.0
                                                                                        11.0
                                                                                 11.4                 12.5
                                15
     Percent current asthma




                                                             10.0 10.2
                                          9.0   8.5
                                10


                                 5


                                 0
                                         Never smoked      Former smoker       Current smoker-      Current smoker-
                                                                                 some days             every day
                                                                      Smoking status
     Figure 5.2 – Current smokers among adults with or without current asthma
                                 30                          23.6                2005       2007
                                                 22.9
     Percent current smokers




                                 20                                                       18.1
                                                                                                       15.9



                                 10




                                     0
                                                With current asthma                     Without current asthma

                                                                        Asthma status



                               Key Findings:
                               •	 Cigarette smoking among adults with asthma is associated with increased severity of
                                  asthma,	worse	asthma-specific	quality	of	life,	and	worse	mental	health	status.
                               •	 The percentage of people with asthma who are current smokers (15.0%) is almost two
                                  times higher than among people who have never smoked (8.5%).
                               •	 People with asthma (23.6%) are more likely to be smokers than those without
                                  asthma (15.9%).
30
     Figures 5.1 and 5.2-Data Source: Oregon Behavioral Risk Factor Surveillance System
Figure 5.3 – Exposure to secondhand smoke in a typical week among adults with or without
current asthma (excluding current smokers)
                     50
                                                      2005        2007
                              33.2
                     40
                                            28.1                             32.4
Percent exposed to
secondhand smoke

                                                                                           27.7
                     30


                     20


                     10


                      0
                             With current asthma                            Without current asthma

                                                      Asthma status



         Key Findings
         •	 Smoking and exposure to secondhand smoke are both critical asthma risk factors.
            Secondhand smoke exposure is also a critical risk factor among non-smokers.
         •	 People with asthma should avoid secondhand smoke. However, the percentage of
            people with asthma who are exposed to secondhand smoke is nearly identical to the
            percentage of people without asthma.


Figure 5.3-Data Source: Oregon Behavioral Risk Factor Surveillance System




                                                                                                     31
     Figure 5.4 – Adult cigarette use by county, 2002–2005 (age-standardized)




                               Co
                                 lu
                    Clatsop




                                   m
                                                                   Gilliam/Wheeler




                                       bi
                               W                      Hood River




                                        a
                                as
                                   h   in
                                         gt   Multnomah                                          Umatilla                 Wallowa
                                           on
       Tillamook
                                                                                     Morrow
                        Yamhill                                                                             Union
                                             Clackamas     Sherma n/Wasco
                        Polk
                                       Marion


       Lincoln                                                                                                  Baker
                                                            Jefferson                                                          Oregon Average 20.4%
                      Benton                Linn                                              Grant

                                                                                                                                    Percent

                                   Lane                                     Crook
                                                                                                                                              25.0 – 30.0

                                                          Deschu tes                                                                          20.4 – 24.9

                                                                                                                                              17.5 – 20.3

                                                                                                                                              9.7 – 17.4
          Coos            Dougla s                                                                                  Malheu r
                                                                                              Harney
                                                                         Lake


                  Josephine                           Klamath
                                   Jackson
          Curry




        Key Findings
        •	 In general, the coastal counties of Oregon and parts of southern Oregon have the
           highest percentages of people who smoke.


     Figure 5.4-Data Source: Oregon Tobacco Facts, 200717




32
Obesity

Figure 5.5 – Adults with current asthma by Body Mass Index, 2007
Percent current asthma    30


                                                                                                   17.8
                          20
                                                                                 12.3

                                            8.1               8.5
                          10



                            0
                                     Healthy weight     Overweight             Obese         Extremely obese
                                     (BMI 18.5-25)      (BMI 25-30)          (BMI 30-40)        (BMI>40)

                                                             Body mass index groups


Figure 5.6 –Body Mass Index among adults with or without current asthma, 2007
                            100
Percent in each body mass




                                80                                                           Obese
                                                                                             (BMI >30)
      index group




                                60                                                           Overweight
                                                                                             (BMI 25-30 )

                                40                                                           Healthy weight
                                                                                             (BMI 18.5-25)

                                20


                                 0
                                       With current asthma          Without current asthma

                                                      Asthma status


                         Key Findings
                         •	 Obesity is reported as being an important asthma risk factor.21 In Oregon extremely
                            obese people are twice as likely to have asthma as healthy weight people. More than
                            40% of people with asthma are obese, which is higher than the 28% among people
                            who do not have asthma.



Figures 5.5 and 5.6-Data Source: Oregon Behavioral Risk Factor Surveillance System

                                                                                                                  33
     Figure 5.7 – Adult obesity by county, 2002–2005




                              Co
                                lum
                   Clatsop
                                                                    Gilliam/Wheeler




                                      bi
                                                      Hood River




                                        a
                             W
                              as
                                 hi
                                   ng         Multnomah                                           Umatilla
                                       to                                                                                 Wallowa
                                         n
       Tillamook
                                                                                      Morrow
                       Yamhill                                                                               Union
                                               Clackamas    Sherman/Wasco
                                      Marion
                       Polk

       Lincoln                                                                                                   Baker
                                             Linn            Jefferson                                                              Oregon Average 22%
                     Benton                                                                    Grant

                                                                                                                                       Percent
                                                                           Crook
                                       Lane                                                                                                      26.0 – 31.0
                                                           Deschutes
                                                                                                                                                 22.0 – 25.9

                                                                                                                                                 19.0 – 21.9

          Coos           Douglas                                                                                     Malheur                     10.0 – 18.9
                                                                                               Harney
                                                                          Lake                                                                   Insufficient data



                 Josephine                             Klamath
                                   Jackson
         Curry




        Key Findings
        •	 There is no regional pattern among counties with high percentages of adult obesity.


     Figure 5.7-Data Source: Keeping Oregonians Healthy: Preventing Chronic Diseases by Reducing Tobacco Use,
     Improving Diet, and Promoting Physical Activity and Preventive Screening.22




34
Uninsured

Figure 5.8 – People aged 64 and younger without health insurance by county, 2005




                           Co
                              lu
                Clatsop




                                 m
                                                   Hood River




                                bi
                          W                                      Gilliam/Wheeler




                                  a
                           as
                               hi
                                 ng                                                            Umatilla
                                     to    Multnomah                                                                   Wallowa
                                       n
  Tillamook
                                                                                   Morrow
                    Yamhill                                                                               Union
                                             Clackamas    Sherman/Wasco
                    Polk
                                    Marion

  Lincoln                                                                                                     Baker
                                           Linn            Jefferson
                  Benton                                                                    Grant


                                                                          Crook
                                Lane
                                                                                                                                 Percent
                                                         Deschutes
                                                                                                                                           22.8 – 32.0

                                                                                                                                           20.0 – 22.8

     Coos             Douglas                                                                                     Malheur
                                                                                                                                           17.8 – 20.0
                                                                                            Harney
                                                                        Lake
                                                                                                                                           14.8 – 17.8


              Josephine                              Klamath
                                Jackson
    Curry




   Key Findings
   •	 Oregonians without health insurance may be more likely to have no access to
      medications to control their asthma or obtain asthma management training.
   •	 Northeastern Oregon counties have the highest percentage of uninsured in Oregon.


Figure 5.8-Data Source: U.S. Census Bureau Small Area Health Insurance Estimates, data available online at
www.census.gov/hhes/www/sahie/




                                                                                                                                                         35
     ChAPTER 6:
     Asthma Emergency
     Department or
     Urgent Care Visits
     Overview
     Asthma is one of the leading causes for a         The second workgroup is the Division of
     visit to an emergency department (ED) or          Medical Assistance Programs (DMAP),
     an urgent care center. Nationally, asthma is      Quality and Performance Improvement
     among the top 20 leading diagnostic reason        Workgroup (QPIWG). DMAP is a division of
     for an ED visit with approximately 1.75           the Oregon Department of Human Services
     million of the more than 110 million visits       that administers state programs providing
     with a primary diagnosis of asthma.23 In 2003,    medical coverage to low-income Oregonians
     antiasthmatic drugs were among the 20 most        through the Oregon Health Plan (OHP), which
     frequent drug classes ordered, supplied, or       is a combination of Medicaid and the State
     administered during ED visits in the U.S.23       Children’s Health Insurance Program (SCHIP).
                                                       The QPIWG is a workgroup convened by
     The percentage of Oregonians with asthma          DMAP for all health plans that serve Oregon
     who have visited an ED or an urgent               Health Plan (OHP) recipients in Oregon.
     care center for asthma in the past year is        Through this workgroup, we are able to
     assessed through the Behavioral Risk Factor       measure and report asthma data consistently
     Surveillance System (BRFSS). The question in      across all OHP managed health plans and
     the BRFSS asks:                                   OHP members not in managed health plans
     •	 During the past 12 months, how many            ( fee-for-service). Almost all OHP members
        times did you visit an emergency room or       are in managed care or have their health care
        urgent care center because of your asthma?     services paid for on a fee-for-service basis.


     ED visits are also monitored from data            In 2006, data from these two workgroups
     provided by health plans in two workgroups.       represent almost 550,000 insured Oregonians
     The first workgroup is the Asthma Data            aged 4–55 years who were enrolled for at least
     Workgroup (ADWG). The ADWG is a                   six months in any of the participating health
     voluntary partnership between the Oregon          plans. This represents approximately 15% of
     Asthma Program and several of Oregon’s            the total Oregon population.
     largest private and Medicaid health plans.
     From this collaborative, summary data is
     provided by each participating plan, including
     information on ED visits and follow up within
     one month of an ED visit by a primary care
     provider or an asthma specialist. Follow up to
     an ED visit provides a measure of people with
     asthma receiving appropriate guidance from
     a trained professional to manage their asthma
     and reduce the possibility of another ED visit.


36
Data
Figure 6.1 – Adults with current asthma with one or more emergency department or urgent care
visits in the past 12 months
                                       30
Percent with one or more ED visits




                                                         17.1
                                       20                                                          14.1
                                                                             12.9



                                       10




                                        0
                                                         2001               2003                  2007


Figure 6.2 – Adults with current asthma by gender with one or more emergency department or
urgent care visits in the past 12 months

                                       30
  Percent with one or more ED visits




                                                                         Male        Female
                                                  14.9          18.3

                                                                           10.7          14.1                15.4
                                       20                                                          11.9




                                       10




                                        0
                                                         2001                     2003                    2007


                                     Key Findings
                                     •	 Overall, the percentage of ED or urgent care visits has declined in Oregon between 2001
                                        and 2007.
                                     •	 Females with asthma are more likely than males to have an ED or urgent care visit. This
                                        trend is also seen in national data.24



Figures 6.1 and 6.2-Data Source: Oregon Behavioral Risk Factor Surveillance System
                                                                                                                                  37
     Figure 6.3 – Adults with current asthma by type of insurance with one or more emergency
     department or urgent care visits in the past 12 months

                                           60
                                                           No health insurance      Private or medicare      Oregon Health Plan
     Percent with one or more ED visits

                                                                   35.3
                                                                                                23.6
                                           40
                                                                                                              18.7
                                                    15.3                                                                    18.2

                                                            13.7                        13.1
                                           20                                                                        12.3
                                                                                  5.1



                                            0
                                                           2001                         2003                         2007


                                          Key Findings
                                          •	 In 2007, people without health insurance were more likely to report ED or urgent care
                                             visits	for	asthma	than	people	on	OHP	and	there	was	no	significant	difference	between	
                                             any of the groups.
                                          •	 In 2001, people on OHP were twice as likely to report one or more ED or urgent care
                                             visits for asthma as people with no health insurance or people on private insurance or
                                             Medicare. It is currently unknown why reported ED visits have decreased among people
                                             on OHP between 2001 and 2007.


     Figure 6.3-Data Source: Oregon Behavioral Risk Factor Surveillance System




38
Figure 6.4 – People with asthma who had one or more emergency department visits for asthma in
the past year, by type of insurance (age-standardized)
                                         30
Percent with one or more ED visits                                           Commercial        Oregon Health Plan


                                         20

                                                                                                         14.9
                                                           13.5                  13.3
                                                                                                                                12.1

                                         10         7.4
                                                                           6.5
                                                                                                 5.2                    5.2



                                          0
                                                       2003                  2004                   2005                  2006


Figure 6.5 – Asthma follow-up visit with a medical practitioner by type of insurance within 30
days after an emergency department visit for asthma, by type of insurance (age-standardized)
                                          60
Percent with follow-up to an ED visit




                                                                            Commercial        Oregon Health Plan

                                                   43.6                   42.6                   43.1      43.9
                                                           39.5
                                          40                                                                            37.5
                                                                                  34.3                                           34.5




                                          20




                                           0
                                                       2003                   2004                     2005                   2006


                                        Key Findings
                                        •	 In general, the trend among people with asthma who had an ED visit for asthma is
                                           stable in the OHP providers and decreasing in private health plan providers.
                                        •	 OHP members are twice as likely to have an ED visit as people with private health insurance.
                                        •	 Follow	up	to	an	ED	visit	has	not	changed	significantly	since	2003.	About	40%	of	people	
                                           with asthma have a follow-up visit with a primary care doctor or asthma specialist within
                                           30 days of the ED visit. Seeing a health professional within 30 days after an ED visit is a
                                           recommendation for quality care in The Guide to Improving Asthma Care in Oregon.20


Figures 6.4 and 6.5-Data Source: Asthma Data Workgroup and Quality and Performance
Improvement Workgroup
                                                                                                                                          39
     ChAPTER 7:
     Asthma hospitalizations
     Overview
     Like emergency department visits,                 financial charges, primary payer, and limited
     hospitalizations for asthma are an important      patient demographic information (e.g.,
     measure of health care use by people with         includes gender but not race/ethnicity).
     asthma. Nationally, almost 500,000 people         Expanded demographics will be collected
     were hospitalized for asthma in 2004.25 This is   starting in January 2008. Unique identifiers
     a rate of 17.0 per 10,000 U.S. residents.         are currently not available in this dataset.
                                                       Therefore, we can monitor the number of
     The rate of asthma hospitalizations per 10,000    asthma hospitalizations that occur but not
     Oregon residents is monitored through the         the number of people who are hospitalized
     Oregon Hospital Discharge Index dataset,          for asthma.
     which is provided by the Oregon Association
     of Hospitals and Health Systems. The Hospital     An asthma hospitalization is defined as having
     Discharge Index provides information              a primary diagnosis with an International
     on hospital discharges from all general           Classification Disease 9th Revision Clinical
     hospitals in Oregon except two U.S. Veterans      Modification (ICD-9-CM) code of 493. People
     Administration hospitals.                         who are not Oregon residents are excluded
                                                       from analysis. Hospitalization rates are age-
     This dataset includes information on the          adjusted to the U.S. 2000 standard population
     dates of admission and discharge, principal       where noted.
     and additional diagnosis, procedure codes,




40
Data
Figure 7.1 – Annual age-standardized Oregon asthma hospital discharge rates per 10,000 residents

                                  20
Hospital discharges per 10,000




                                  15



                                  10     7.4                                       7.3
                                                7.1    6.9     6.7      6.5                 7.0               6.8          6.5
                                                                                                      6.1            6.1

                                   5



                                   0
                                        1997    1998   1999    2000     2001       2002     2003     2004    2005   2006   2007

Figure 7.2 – Annual unstandardized U.S. asthma hospital discharge rates per 10,000 residents

                                                                                                   19.8
                                  20
                                        17.9            17.4
                                                                 16.7                    16.8               17      16.6
                                                15.5                          16
Hospital discharges per 10,000




                                                                                                                           14.9
                                  15



                                  10



                                   5



                                   0
                                        1997    1998    1999    2000      2001        2002        2003      2004    2005   2006




                                 Key Findings
                                 •	 The overall trend in Oregon’s asthma hospitalizations is stable.
                                 •	 Oregon’s hospitalization rate has been consistently half that of the nation. The reason
                                    for this difference is currently unknown and requires further analysis. National hospital
                                    discharges can be found at the National Center for Health Statistics, National Hospital
                                    Discharge and Ambulatory Surgery Data Web site at www.cdc.gov/nchs/about/major/
                                    hdasd/listpubs.htm.


Figures 7.1-Data Source: Oregon Hospital Discharge Index
Figure 7.2-Data Source: National Hospital Discharge Survey and National Survey of Ambulatory Surgery Reports



                                                                                                                                  41
          Figure 7.3 – Asthma hospital discharge rates per 10,000 residents by age groups
                                      30
                                                                                                                                                       0-4 years old
                                                                                                                                                       5-64 years old
     Hospital discharges per 10,000

                                                                                                                                                       65+ years old
                                      20




                                      10




                                       0
                                           1997         1998         1999         2000        2001        2002          2003        2004        2005        2006        2007

          Figure 7.4 – Age-adjusted asthma hospital discharge rates per 10,000 residents by gender
                                      15
     Hospital discharges per 10,000




                                                                                                    Male               Female


                                      10          8.9                                                            8.9
                                                               8.5          8.5         8.1         8.1                       8.6                     8.5
                                                                                                                                                                              7.9
                                                                                                                                          7.2                     7.5
                                            5.7          5.5          5.2         5.2                      5.5          5.2                     4.9
                                                                                              4.9                                   4.9                                 4.8
                                                                                                                                                            4.5
                                       5




                                       0
                                             1997        1998         1999         2000        2001        2002         2003        2004        2005        2006        2007




                                      Key Findings
                                      •	 The annual number of hospitalizations is highest in the 0–4 age group followed
                                         by ages 65 or older. However, Oregon is ranked second best in the nation by The
                                         Commonwealth Fund for avoidable asthma hospitalizations among children.
                                      •	 Females consistently have higher hospitalization rates than do males. As noted
                                         in Chapter 3, adult females are more likely to have asthma than adult males. The
                                         reason adult women have an increased risk of developing adult-onset asthma are not
                                         completely understood. However, physiological differences such as generally having
                                         smaller airways than men, different hormones, increased risk from obesity and socio-
                                         economic differences have all been reported.9,10,11


          Figures 7.3 and 7.4-Data Source: Oregon Hospital Discharge Index




42
Figure 7.5 – Asthma hospital discharge rates per 10,000 by gender and age group, 2007
                                    30
                                                                                  Female                Male              Total


 Hospital discharges per 10,000
                                    20




                                    10




                                     0




                                                                                                                                                                        +
                                           4

                                                 9

                                                         4

                                                                9

                                                                         4

                                                                                9

                                                                                        4

                                                                                               9

                                                                                                      4

                                                                                                              9

                                                                                                                     4

                                                                                                                            9

                                                                                                                                     4

                                                                                                                                             9

                                                                                                                                                     4

                                                                                                                                                            9

                                                                                                                                                                   4
                                         0-

                                               5-

                                                      -1




                                                                                                                                  -6
                                                             -1

                                                                      -2

                                                                             -2

                                                                                     -3

                                                                                            -3

                                                                                                   -4

                                                                                                           -4

                                                                                                                  -5

                                                                                                                         -5




                                                                                                                                          -6

                                                                                                                                                  -7

                                                                                                                                                         -7

                                                                                                                                                                -8

                                                                                                                                                                       85
                                                     10

                                                             15

                                                                    20

                                                                             25

                                                                                    30

                                                                                            35

                                                                                                   40

                                                                                                          45

                                                                                                                  50

                                                                                                                         55

                                                                                                                                60

                                                                                                                                         65

                                                                                                                                                 70

                                                                                                                                                         75

                                                                                                                                                                80
                                                                                             Age groups in years


Figure 7.6 – Asthma hospital discharges by month for the total population, 2007
                                     300
                                                          257       241
                                     250       233                                219                                                              236        231       232
                                                                                            210
Total hospitalizations




                                     200                                                                                                 160
                                                                                                    141
                                     150                                                                          123      121
                                     100
                                      50

                                         0
                                                                                                    ne




                                                                                                                                                      er
                                                                                                                              st



                                                                                                                                              r
                                                                      ch




                                                                                            ay
                                                  y




                                                                                                                  ly




                                                                                                                                                                             r
                                                                                  ril
                                                             ry




                                                                                                                                                                    r
                                                                                                                                          be




                                                                                                                                                                            be
                                                ar




                                                                                                                                                                be
                                                                                                                          gu
                                                                                                               Ju




                                                                                                                                                   ob
                                                                                                   Ju
                                                          ua




                                                                              Ap


                                                                                         M
                                                                    ar
                                               nu




                                                                                                                                     em




                                                                                                                                                                        m
                                                                                                                                                                m
                                                                  M




                                                                                                                         Au




                                                                                                                                                  ct
                                                      br




                                                                                                                                                                        ce
                                                                                                                                                              ve
                                             Ja




                                                                                                                                     pt


                                                                                                                                                 O
                                                      Fe




                                                                                                                                                                     De
                                                                                                                                                          No
                                                                                                                                  Se




                                  Key Findings
                                  •	 Asthma hospitalizations are higher for males through age 14 years. After age 14, the
                                     rate of asthma hospitalizations is higher for females. The 15-19 age group has the
                                     lowest asthma hospitalization rate, with the very young or persons aged 80 or older
                                     with the highest rates. These trends are similar to national trends.25
                                  •	 Monthly trends in asthma hospitalizations in Oregon are similar to trends reported in
                                     national studies.26 Asthma hospitalizations increase in the fall with a peak in the early
                                     spring. The period with the fewest asthma hospitalizations is summer. Large fall and
                                     spring peaks may be related to exposure to allergens, changes in temperature, and
                                     respiratory infections related to the beginning of school.26


Figures 7.5 and 7.6-Data Source: Oregon Hospital Discharge Index




                                                                                                                                                                                 43
     Table 7.1 – Asthma hospital discharge rates per 10,000 residents by county (age-standardized),
     2002–2006
                               Number of               Age-standardized
             County                                                              Age-standardized CI
                             hospitalizations                rate
      Baker                            36                         4.1                    2.7–5.5
      Benton                         112                          3.2                    2.6–3.8
      Clackamas                      852                          4.9                    4.6–5.3
      Clatsop                        156                          8.9                   7.5–10.3
      Columbia                       169                          7.4                    6.3–8.6
      Coos                           451                        13.8                  12.5–15.2
      Crook                            79                         7.2                    5.6–8.8
      Curry                          131                        10.6                    8.5–12.6
      Deschutes                      330                          5.0                    4.4–5.5
      Douglas                        607                        11.4                  10.4–12.3
      Grant                            22                         5.1                    2.9–7.3
      Harney                           69                       17.1                    13–21.2
      Hood River                       29                         2.8                    1.8–3.8
      Jackson                        816                          8.2                    7.7–8.8
      Jefferson                      103                          9.8                   7.9–11.7
      Josephine                      358                          8.3                    7.4–9.2
      Klamath                        291                          8.7                    7.7–9.7
      Lake                             42                         9.7                   6.7–12.7
      Lane                           980                          6.1                    5.7–6.5
      Lincoln                        149                          6.4                    5.4–7.5
      Linn                           425                          7.9                    7.1–8.6
      Malheur                          70                         4.3                    3.3–5.3
      Marion                         735                          5.0                    4.6–5.4
      Morrow                           30                         5.4                    3.4–7.3
      Multnomah                    2,588                          7.8                    7.5–8.1
      Polk                           131                          4.1                    3.4–4.8
      Tillamook                        84                         5.7                        4.5–7
      Umatilla                       187                          5.2                    4.4–5.9
      Union                          102                          8.3                    6.6–9.9
      Wallowa                          36                         8.4                   5.5–11.3
      Washington                   1,176                          5.0                    4.7–5.3
      Yamhill                        308                          7.1                    6.3–7.9
      Gilliam/Wheeler*                 13                         6.3                    2.7–9.9
      Sherman/Wasco                  168                        11.9                  10.1–13.7
      Oregon                      11,835                          6.6                    6.5–6.8
44
     Table 7.1-Data Source: Oregon Hospital Discharge Index, 2002–2006
     * Rate may not be reliable when there are <20 hospitalizations for asthma in a county
Figure 7.7 – Asthma hospital discharge rates per 10,000 residents by county (age-standardized),
2002–2006




                           Co
                             lu
                               m
                Clatsop




                                 bi
                                                   Hood River    Gilliam/Wheeler




                                   a
                           W
                            as
                               hi                                                              Umatilla
                                 ng        Multnomah                                                                   Wallowa
                                     to
                                       n
  Tillamook
                                                                                   Morrow
                    Yamhill                                                                               Union
                                            Clackamas    Sherman/Wasco
                    Polk            Marion


  Lincoln                                                                                                     Baker
                                           Linn
                                                          Jefferson                                                         Oregon Average 6.6%
                  Benton                                                                    Grant


                                                                                                                                 Rate per 10,000
                                                                         Crook
                                    Lane
                                                                                                                                          8.8 – 17.1
                                                        Deschutes
                                                                                                                                          6.7 – 8.7

                                                                                                                                          5.1 – 6.6

     Coos             Douglas                                                                                     Malheur                 2.8 – 5.0
                                                                                            Harney
                                                                        Lake



              Josephine                             Klamath
                                 Jackson
     Curry




   Key Findings
   •	 The highest hospitalization rates are in southern and north-central Oregon. These are
      also areas with high smoking rates as shown previously in Figure 5.4.


Figure 7.7-Data Source: Oregon Hospital Discharge Index




                                                                                                                                                       45
     ChAPTER 8:
     Asthma Mortality
     Overview
     Compared to emergency department                  underlying (principal) cause of death. When
     visits and hospitalizations, there are very       possible, the mortality rates in this chapter
     few deaths due to asthma. Even though             have been age-standardized to the U.S. 2000
     asthma is a chronic disease, with proper          standard population. For comparability, state
     management people with asthma can lead            and national rates may be obtained from the
     healthy, active lives with few limitations in     Centers for Disease Control and Prevention
     their activities and without experiencing         (CDC) WONDER (Wide-ranging Online Data
     life-threatening episodes. Unfortunately, in      for Epidemiologic Research) data system at
     2006 more than 3,500 people died as a result      http://wonder.cdc.gov.
     of asthma in the U.S.27

     Asthma mortality is monitored through
     Oregon’s Death Certificate Statistical File,
     which contains information about all deaths
     occurring in Oregon and deaths occurring out-
     of-state among Oregon residents. An asthma
     death is defined as having asthma listed as the




46
Data
Figure 8.1 – Annual asthma deaths in Oregon
                      100

                                78
                       80
                                                                         69
                                                           65
                                              60
Total deaths




                       60                                                              55
                                                                                                     49           47

                       40


                       20


                        0
                               1999         2000          2001          2002          2003          2004          2005


Figure 8.2 – Oregon and U.S. asthma death rates per million residents (age-standardized)
                       40
                             22.5
                                                                       Oregon         U.S.
                       30                                               18.9
                                                         18.0
Deaths per million




                                           16.9
                                                                                      15.0
                       20           16.9          16.1
                                                                                                    13.3
                                                                15.0           14.7          13.9                 11.8
                                                                                                           12.8          12.7

                       10


                        0
                               1999          2000         2001           2002          2003          2004           2005



                     Key Findings
                     •	 Deaths due to asthma in Oregon have consistently decreased since 1999.
                     •	 Oregon death rates have consistently been higher than the national rates. The difference
                        between the Oregon and national rate has narrowed over time and in 2005 the national
                        asthma death rate was slightly higher than Oregon’s rate.


Figure 8.1-Data Source: Oregon Death Certificates
Figure 8. 2-Data Source: Oregon Death Certificates; National Data from the CDC WONDER data system




                                                                                                                                47
     Figure 8.3 – Asthma death rate per million residents by gender (age-standardized)
                           40              29.0                               Male         Female

                                                                       23.8             23.2
                           30
     Deaths per million

                                                          18.2
                                    15.2          14.9
                                                                                                      16.8
                                                                                 13.0          12.1          13.2 13.2          13.9
                           20
                                                                 9.7                                                     10.0


                           10


                            0
                                      1999          2000          2001             2002          2003          2004        2005



     Figure 8.4 – Asthma death rate per million residents by race/ethnicity (age-standardized),
     1996–2005
                            50
                                                                          24.5

                            40
     Deaths per million




                            30                                                                        14.9
                                                  18.2
                            20


                            10


                                0
                                                  White           African-American*                 Other*

                                                                          Race

                          Key Findings
                          •	 Females are consistently more likely to die from asthma than males in Oregon. This is
                             similar to national asthma mortality trends.28
                          •	 In Oregon, African American individuals have a higher mortality rate than whites or
                             all other racial groups combined. However, because of the small number of deaths
                             among nonwhites, rates should be viewed with caution. This is true even though 10
                             years of Oregon deaths were combined. However, asthma deaths in the U.S. show
                             that African Americans have a higher death rate than whites (more than 18 per
                             1,000,000 higher in 2001).28 Nationally, African American females suffer the highest
                             death rate from asthma.28


     Figures 8.3 and 8.4-Data Source: Oregon Death Certificates
     Note: The “Other” category combines Asians, Native Hawaiians, Pacific Islanders, Native Americans and Alaskan
     Natives. Race categories include Hispanic ethnicity.
     * Rates may be unreliable due to small numbers




48
ChAPTER 9:
Asthma in the Medicaid
and the State Children’s
health Insurance Programs
Overview
The Oregon Health Plan (OHP) is the Oregon         18 or older who were enrolled in OHP for at
health care program for eligible low- income       least 137 days during the period from July 1,
residents of Oregon. It is funded by a             2003–June 30, 2004. Continuous enrollment
combination of Medicaid and State Children’s       was not required.
Health Insurance Program (SCHIP) funds,
both of which are a combination of federal         Our second source of OHP-related asthma
and state funds. OHP is made up of two             data comes from the QPIWG using claims
benefit groups, Plus and Standard. Plus is         encounters, both of which include medical
the traditional Medicaid or SCHIP coverage         visits and pharmacy dispensings. Through
offered to children and adults. Standard is        this workgroup, the Oregon Asthma Program
offered to certain low-income adults who are       (OAP) measures and reports asthma data
not eligible for traditional Medicaid coverage     consistently across all OHP managed health
and does not include coverage for children.        plans and OHP members not in managed
The Oregon Health Plan is intended to help         health plans ( fee-for-service). Almost all OHP
ensure that medical care is affordable for         members are in managed care or have health
those with a low income.1 People with lower        services paid for on a fee-for-service basis.
incomes are more likely to live in substandard     OAP measures and compares five asthma
housing, smoke, and have higher disease            indicators across all OHP clients in Oregon,
morbidity.2 In addition, OHP members are           which makes Oregon the only state to have full
more than twice as likely to smoke as people       availability to asthma data for the Medicaid
with private insurance.                            and SCHIP populations of the entire state.
                                                   The indicators are derived from medical
This section includes findings from the            and pharmacy claims for Oregonians served
Oregon Medicaid Health Risk and Health             by OHP who are between the ages of 4–55
Status Survey (HRHSS), analysis of medical         years and who have at least six months of
claims data gathered by the Division of            continuous enrollment.
Medical Assistance (DMAP) Programs-
Quality and Performance Improvement                Finally, data on children aged 0–17 and
Workgroup (QPIWG), and county level                adults aged 18 and older were provided by
information on children and adults using           DMAP for the years 2004 through 2006 to
data provided by DMAP.                             look at medical and pharmacy claims by
                                                   county. County of residence was determined
The HRHSS was conducted in 2004 by DMAP            by the home address of the OHP member
to measure the health risk and health status       and not the facility from which services
of adult OHP clients. This telephone survey        were received. Three primary measures were
was conducted in English and Spanish from          calculated at the county level: emergency
August through October 2004, and the survey        department (ED) visit rates, hospitalization
was designed to assess health risk behaviors,      rates and rates for a low medication ratio.
clinical preventive health practices, and health   These measures were chosen because each
care access, mainly related to chronic diseases.   one is indicative of asthma that is either out    49
The eligible population included adults aged       of control or not optimally controlled.
     Rates were calculated as an average rate         The denominators were created similar
     for all years combined. The numerators           to the numerator. The ED visit rates and
     for the ED visits and hospitalization rates      hospitalization rates denominators were the
     were the total number of ED visits and the       number of children or adults on OHP who had
     total number of hospitalizations for asthma      asthma. The denominator for the medication
     by children or adults with asthma. The           ratio rate was the number of children or adults
     numerators for the medication ratio rates        on OHP who had persistent asthma and had
     were the total number of OHP children or         received two or more dispensings of short-
     adult recipients in each county who had a        acting beta2-agonists.
     medication ratio less than 0.33.29, 30

     The medication ratio is a measure between
     0 and 1 and measures the extent to
     which patients with persistent asthma
     take controller medications (inhaled
     corticosteroids) compared to their total
     controller medication and rescue (inhaled
     short-acting beta2-agonists) medication use.29
     People with higher medication ratios are less
     likely to have ED visits or hospitalizations
     for asthma and are more likely to have better
     scores for asthma quality of life, asthma
     control and asthma symptom severity.29, 30




50
Data
Who has Asthma

Figure 9.1 – Adults with current asthma among Oregon Health Plan recipients by gender, 2004
                         30
Percent current asthma


                                                              21.4
                                                                                           18.8
                         20               12.8


                         10


                           0
                                          Male               Female                        Total

Figure 9.2 – Adults with current asthma among Oregon Health Plan recipients by age group, 2004
                          40
Percent current asthma




                                                                     25.2
                          30                                                                       17.2
                                            15.9
                          20

                          10

                           0
                                            18–44                   45–64                          65+
                                                            Age groups in years

Figure 9.3 – Adults with current asthma among Oregon Health Plan recipients by
education level, 2004
                          30             20.9
Percent current asthma




                                                                                    19.8
                                                           18.0
                                                                                                          11.8
                          20


                          10


                           0
                                      Less than       High school            Some college           College graduate
                                     high school    graduate or GED
                                                                  Education level



                         Key Findings
                         •	 As with the percentages for the Oregon general population shown in Chapter 3, a lower
                            percent of males and people with college degrees suffer from asthma than do females
                            and people with lower education levels.
                                                                                                                       51

Figures 9.1, 9.2 and 9.3-Data Source: Oregon Medicaid Health Risk and Health Status Survey
     Emergency Department or Urgent Care Visits

     Figure 9.4 – People with asthma who had one or more emergency department visits for asthma in
     the past year by Oregon Health Plan recipients (age-standardized and age-specific)
                                           30

                                                     Age-standardized       4–8 years old         9–16 years old     17–55 years old
     Percent with one or more ED visits




                                           20




                                           10



                                                      13.5                 13.3                     14.9                  12.1
                                            0
                                                      2003                 2004                     2005                  2006


     Figure 9.5 – Follow-up visit with a medical practitioner within 30 days after an emergency
     department visit for asthma among Oregon Health Plan recipients with asthma in the past year
     (age-standardized and age-specific)
                                            80

                                                        Age-standardized          4–8 years old     9–16 years old     17–55 years old
      Percent with one or more ED visits




                                            60




                                            40




                                            20

                                                        39.5                34.3                      43.9                    34.5
                                                0
                                                       2003                 2004                      2005                    2006




                                           Key Findings
                                           •	 OHP recipients 4-8 years of age have the highest ED use, whereas recipients 9-16 years
                                              of age have the lowest ED use.
                                           •	 Follow up to an ED visit is stable and there is little difference between age groups.
                                              Seeing a health professional within 30 days after an ED visit is a recommendation for
                                              quality care in The Guide to Improving Asthma Care in Oregon.20


     Figures 9.4 and 9.5-Data Source: Quality and Performance Improvement Workgroup



52
Management and Quality of Life

Figure 9.6 – Asthma symptoms in past four weeks among adult Oregon Health Plan recipients
with current asthma, 2004

                               60
Percent with asthma symptoms


                                                                            41.5
                                                                                                       36.1
                               40
                                                22.4


                               20



                                0
                                             Less than                  Once to less                 Symptoms
                                            once a week               than seven times               every day
                                                                           a week
                                                          Number of days with asthma symptoms

Figure 9.7 – Number of days of work, school or other daily activities missed in the last three
months because of asthma among adult Oregon Health Plan recipients with current asthma, 2004
                                100
                                                   80.4
school or other activities




                                    80
 Percent missing work,




                                    60


                                    40

                                                                              11.9
                                    20                                                                   7.7


                                     0
                                                  None                    One to ten               Eleven or more

                                                   Number of days of work, school or other activities missed



                          Key Findings
                          •	 More than 36% of OHP recipients have symptoms every day. This is almost 10%
                             greater than the general Oregon population estimate shown in Figure 4.14.
                          •	 Almost 20% of OHP recipients missed one or more days of work, school, and other
                             daily activities in the last three months. This is lower than the estimate for the general
                             Oregon population of more than 26% shown in Figure 4.12.


Figures 9.6 and 9.7-Data Source: Oregon Medicaid Health Risk and Health Status Survey
                                                                                                                          53
     Figure 9.8 – Perceived health among adult Oregon Health Plan recipients with or without current
     asthma, 2004

                                 100
                                                                                        Excellent or very good
     Percent in each perceived

                                  80                                                    Good
       health status group


                                                                                        Fair or poor
                                  60


                                  40


                                  20


                                   0
                                       With current asthma     Without current asthma
                                                      Asthma status


                 Key Findings
                 •	 Adults with asthma are almost half as likely as people without asthma to report being in
                    excellent or very good health. Conversely, adults with asthma are more likely to report
                    being in fair or poor health than those without asthma. Compared to the perceived
                    health status in Figure 4.15 in Chapter 4 of the general Oregon population, people on
                    OHP are more likely to perceive their health status as fair or poor.


     Figures 9.8,-Data Source: Oregon Medicaid Health Risk and Health Status Survey




54
Figure 9.9 – Visits to a health care professional in the past 12 months for routine treatment of
asthma among adult Oregon Health Plan recipients with current asthma, 2004
                                    100


a health professional                   80
Percent with visits to


                                                         51.8
                                        60


                                        40                                          27.5
                                                                                                                   20.7

                                        20


                                        0
                                                        None                        1–2                      3 or more
                                                                Number of visits to a health care professional
Figure 9.10 – Adult Oregon Health Plan recipients with asthma who report receiving asthma
information from their health care provider, 2004
Percent receiving information




                                 100                                                                             88.0
                                                       77.3
                                  80                                              67.1

                                  60

                                  40

                                  20

                                    0
                                               Received information       Received explanation           Received written
                                                 on how to avoid          on how to recognize             instructions on
                                               making asthma worse          early signs of an               how to take
                                                                            asthma episode               asthma medicine



                                Key Findings
                                •	 Less than half of adult OHP recipients with asthma receive routine treatment for
                                   their asthma.
                                •	 Most adults on OHP receive information on how to control their asthma.


Figures 9.9 and 9.10-Data Source: Oregon Medicaid Health Risk and Health Status Survey




                                                                                                                            55
     Figure 9.11 – Oregon Health Plan recipients with persistent asthma who received at least one
     inhaled corticosteroid dispensing in the past year (age-standardized and age-specific)
                                  100
                                        Age-standardized     4–8 years old    9–16 years old   17–55 years old

                                   80
     least one prescription
      Percent receiving at




                                   60


                                   40


                                   20
                                        63.9               64.6                 65.7                62.6
                                    0
                                        2003               2004                 2005                2006


     Figure 9.12 – People with persistent asthma who overused inhaled short-acting beta2-agonists by
     receiving more than six canisters among Oregon Health Plan recipients in the past year
     (age-standardized and age-specific)
                                  100

                                        Age-standardized      4–8 years old   9–16 years old   17–55 years old
                                  80
     short-acting beta2-agonist
     Percent overusing inhaled




                                  60


                                  40


                                  20

                                        41.5               41.3                 41.2                 33.9
                                   0
                                        2003               2004                 2005                2006




                     Key Findings
                     •	 The percent of OHP recipients who receive at least one inhaled corticosteroid in a year
                        has remained relatively stable with no difference between age groups. The percent of
                        OHP recipients who have received at least one inhaled corticosteroid is consistently lower
                        over time than the percent among people with private insurance (see Figure 4.6).
                     •	 Overuse of short-acting inhalers has been stable since 2001 except for a decrease shown
                        in 2006. Older individuals are more likely to overuse short-acting inhalers than the
                        younger age group. The percent of OHP recipients who overuse short-acting inhalers is
                        consistently higher over time than the percent among people with private insurance
                        (see Figure 4.7).
                     •	 Increased use of daily-inhaled corticosteroids and decreased overuse of short-acting
                        inhalers are recommendations for quality care in The Guide to Improving Asthma Care
                        in Oregon.20


     Figures 9.11 and 9.12-Data Source: Quality and Performance Improvement Workgroup
56   Note: For Figure 9.12 from 2003–2005 this measure examined any anti-inflammatory asthma medication. In
     2005, the measure changed to a daily inhaled corticosteroid.
Risk Factors

Figure 9.13 – Current asthma by smoking status among adult Oregon Health Plan recipients, 2004
                          30                                              21.8
                                                                                                     20.4
Percent current asthma



                                              16.0
                          20




                          10




                           0
                                         Never smoked                Former smoker              Current smoker
                                                                     Smoking status

Figure 9.14 – Adult Oregon Health Plan recipients who currently smoke by current asthma status,
2004
                          60

                                                        37.9
Percent current smoker




                          40                                                                  34.5




                          20




                           0
                                               With current asthma                    Without current asthma
                                                                      Asthma status



                         Key Findings
                         •	 The percentage of people with asthma is higher in both former and current smokers
                            than among people who have never smoked.
                         •	 The percentage of current smokers who have asthma is slightly higher than the percent
                            of current smokers without asthma, similar to the general Oregon population as shown
                            in Figure 5.2.


Figures 9.13 and 9.14-Data Source: Oregon Medicaid Health Risk and Health Status Survey
                                                                                                                    57
     Figure 9.15 – Current asthma among adult Oregon Health Plan recipients by secondhand smoke
     exposure in a typical week (excludes current smokers), 2004
                               30                                                                 20.9
     Percent current asthma

                                                           17.2
                               20




                               10




                                 0
                                                        No exposure                           Some exposure
                                                                      Smoke exposure status

     Figure 9.16 – Adult Oregon Health Plan recipients with secondhand smoke exposure in a typical
     week (excludes current smokers) by current asthma status, 2004

                                     50                     36.1

                                     40                                                          30.9
     Percent exposted to
     secondhand smoke




                                     30


                                     20


                                     10


                                      0
                                                     With current asthma               Without current asthma
                                                                           Asthma status



                              Key Findings
                              •	 The percent of non-smoking people with asthma who were exposed to secondhand
                                 smoke is higher than those with no exposure to secondhand smoke.
                              •	 Non-smoking people with asthma are exposed to secondhand smoke at a higher rate
                                 among OHP recipients than among people without asthma. This result is similar to the
                                 general Oregon population as shown in Figure 5.3. People with asthma should avoid
                                 secondhand smoke.


     Figures 9.15 and 9.16-Data Source: Oregon Medicaid Health Risk and Health Status Survey

58
County Level – Children

Figure 9.17 – Asthma emergency department visits per 100 children (0–17 years of age) with
asthma on the Oregon Health Plan, 2004–2006




                           Co
                              lu
                Clatsop



                                 m
                                                                     Gilliam/Wheeler



                                  bi
                          W                        Hood River



                                    a
                           as
                              hi
                                ng                                                                        Umatilla
                                    to     Multnomah                                                                                   Wallowa
                                      n
  Tillamook
                                                                                          Morrow
                    Yamhill                                                                                             Union
                                            Clackamas      Sherman/Wasco
                                   Marion
                    Polk

  Lincoln                                                                                                                     Baker         Oregon Average 17.8%
                                                            Jefferson
                                          Linn
                  Benton                                                                            Grant

                                                                                                                                                     Rate per 100
                           Lane                                              Crook
                                                                                                                                                                21.3 – 25.1
                                                         Deschutes
                                                                                                                                                                17.8 – 21.2

                                                                                                                                                                12.1 – 17.7

     Coos                Douglas                                                                                                Malheur                         9.5 – 12.0
                                                                                                   Harney
                                                                            Lake



              Josephine                               Klamath
                                Jackson
    Curry




Figure 9.18 – Asthma hospitalizations per 100 children (0–17 years of age) with asthma on the
Oregon Health Plan, 2004–2006


               Clatsop
                           Columbia                                   Gilliam/Wheeler
                                                   Hood River
                                                                                                    Umatilla
                      Washington                                                                                                  Wallowa
                                          Multnomah
 Tillamook
                                                                                        Morrow
                                                                                                                     Union
                    Yamhill               Clackamas     Sherman/Wasco

                   Polk
                                Marion
 Lincoln                                                                                                                 Baker              Oregon Average 3.2%
                                                         Jefferson
                                          Linn                                                   Grant
                  Benton

                                                                           Crook
                           Lane                                                                                                                  Rate per 100
                                                        Deschutes
                                                                                                                                                          4.2 – 6.1

                                                                                                                                                          3.2 – 4.1

     Coos            Douglas                                                                                                 Malheur                      2.4 – 3.1
                                                                                                 Harney
                                                                          Lake                                                                            1.1 – 2.3

                                                                                                                                                          Insufficient data
                                                  Klamath
             Josephine        Jackson
                                                                                                                                                                              59
   Curry
     Figure 9.19 – Low asthma medication ratios per 100 children (0–17 years of age) with persistent
     asthma on the Oregon Health Plan, 2004–2006




                               Co
                                 lu
                    Clatsop




                                   m
                                                                    Gilliam/Wheeler




                                       bi
                                                     Hood River




                                          a
                              W
                                as
                                  hi                                                              Umatilla
                                     ng        Multnomah                                                                  Wallowa
                                        to
       Tillamook                          n
                                                                                      Morrow
                       Yamhill                 Clackamas                                                     Union
                                                            Sherman/Wasco
                        Polk           Marion


       Lincoln                                                                                                   Baker         Oregon Average 51.4%
                                              Linn           Jefferson
                      Benton                                                                   Grant

                                                                                                                                    Rate per 100
                                                                            Crook
                                  Lane
                                                                                                                                             58.0 – 78.9
                                                           Deschutes
                                                                                                                                             51.4 – 57.9

                                                                                                                                             44.1 – 51.3

          Coos               Douglas                                                                                 Malheur                 31.1 – 44.0
                                                                                               Harney
                                                                          Lake                                                               Insufficient data



                 Josephine                             Klamath
                                     Jackson
         Curry




        Key Findings
        •	 On all maps, darker shading indicates poor asthma control.
        •	 It	is	difficult	to	generalize	the	trends	in	Figures	9.17-9.19.	There	seemed	to	be	a	strong	
           grouping of counties with poor medication ratios in eastern Oregon, whereas there
           seemed to be a grouping of counties with high hospitalization rates in southwest
           Oregon. Overall, only Clatsop County has poor rates in all measures.
        •	 The	reasons	for	the	patterns	seen	in	these	graphs	are	difficult	to	determine.	The	rural	
           setting and access to care may play a key role. However, several rural counties do not
           exhibit asthma control problems. Therefore, other factors are likely contributing factors
           such as, but not limited to, smoking, secondhand smoke exposure, and
           cultural differences.


     Figure 9.17, 9.18 and 9.19-Data Source: Division of Medical Assistance Programs




60
County Level – Adults

Figure 9.20 – Asthma emergency department visits per 100 adults (18 years old and older) with
asthma on the Oregon Health Plan, 2004–2006




                             Co
                               lu
                Clatsop



                                 m
                                                                               Gilliam/Wheeler



                                      bi
                                                            Hood River



                                         a
                            W
                              as
                                 hi
                                    ng         Multnomah                                                             Umatilla                   Wallowa
                                       to
                                           n
  Tillamook
                                                                                                    Morrow
                     Yamhill                    Clackamas                                                                       Union
                                                                     Sherman/Wasco
                     Polk             Marion


  Lincoln
                                               Linn
                                                                                                                                        Baker         Oregon Average 12.0%
                                                                     Jefferson
                  Benton                                                                                        Grant

                                                                                                                                                              Rate per 100
                                                                                         Crook
                                   Lane                                                                                                                                  14.5 – 17.8
                                                                   Deschutes
                                                                                                                                                                         12.0 – 14.4

                                                                                                                                                                         10.0 – 11.9

                          Douglas                                                                                                        Malheur                         7.5 – 9.9
       Coos
                                                                                                               Harney
                                                                                     Lake



              Josephine                                     Klamath
                                   Jackson
     Curry




Figure 9.21 – Asthma hospitalizations per 100 adults (18 years old and older) with asthma on the
Oregon Health Plan, 2004–2006
                           Co
                             lu




               Clatso p
                                m
                                   bi




                          W                           Hood River         Gilliam/Wheeler
                                      a




                           as
                              hi
                                 ng            Multnomah                                                       Umati lla
                                    to                                                                                                   Wallowa
                                       n
  Tillamook
                                                                                                 Morro w                   Union
                    Yamhill                    Clacka mas
                                                               Sherman/Wasco
                   Polk            Marion


  Lincol n                                                                                                                      Baker              Oregon Average 2.9%
                                             Linn                  Jefferson
                 Benton                                                                                     Grant

                                                                                                                                                          Rate per 100
                                                                                   Crook
                                Lane
                                                                                                                                                                   3.7 – 5.6
                                                              Desch utes
                                                                                                                                                                   2.9 – 3.6

                                                                                                                                                                   2.4 – 2.8

      Coos           Dougl as                                                                                                      Malhe ur                        1.1 – 2.3
                                                                                                           Harne y
                                                                                  Lake                                                                             Insufficient data


             Josephine                                    Klama th
                                Jackson
    Curry
                                                                                                                                                                                       61
     Figure 9.22 – Low asthma medication ratios per 100 adults (18 years old and older) with
     persistent asthma on the Oregon Health Plan, 2004–2006




                               Co
                                   lu
                    Clatsop




                                     m
                                                      Hood River   Gilliam/Wheeler




                                      bi
                                        a
                               W
                                as
                                   hi
                                      ng       Multnomah                                         Umatilla                Wallowa
                                        to
                                           n
       Tillamook
                                                                                     Morrow
                        Yamhill                                                                             Union
                                               Clackamas     Sherman/Wasco
                        Polk            Marion

       Lincoln                                                                                                  Baker         Oregon Average 54.7%
                                               Linn          Jefferson
                      Benton                                                                  Grant


                                                                             Crook                                                 Rate per 100
                                        Lane
                                                                                                                                            56.7 – 67.5
                                                           Deschutes
                                                                                                                                            54.7 – 56.6

                                                                                                                                            52.0 – 54.6

          Coos            Douglas                                                                                   Malheur
                                                                                                                                            43.5 – 51.9
                                                                                              Harney
                                                                          Lake


                  Josephine                            Klamath
                                     Jackson
          Curry




        Key Findings
        •	 As in the childhood asthma maps, darker shading indicates poor asthma control.
        •	 Also,	as	in	the	childhood	asthma	maps,	it	is	difficult	to	generalize	the	trends	in	each	of	
           Figures 9.20-9.22. In these maps, there seemed to be a strong grouping of counties
           with poor medication ratios in eastern Oregon and a grouping of counties with high
           hospitalization rates in southwest Oregon.


     Figure 9.20, 9.21 and 9.22-Data Source: Oregon Division of Medical Assistance Programs




62
ChAPTER 10: Cost of
Asthma hospitalizations
Overview
Asthma has a significant economic burden at        To measure the cost of asthma in Oregon, the
the national, state and community level. The       Oregon Asthma Program used the total costs
Asthma and Allergy Foundation of America           of hospitalizations in the Oregon Hospital
(AAFA) estimated total national asthma             Discharge Index with a primary diagnosis
costs in 1998 at more than 10 billion dollars.31   of asthma. Cost data does not include
In Oregon, AAFA estimated the total of the         information from one managed care hospital
direct and indirect costs of asthma in 1998        in Oregon. Other direct costs of asthma can
at more than 125 million dollars, of which         include, but are not limited to, outpatient
71 million was in direct costs (direct costs       visits, ED visits, and medications. However,
include hospitalizations, doctors’ visits and      this information is currently not available.
medications) and 54 million in indirect costs
(indirect costs include the value of time lost
from school and work).31




                                                                                                  63
     Data
     Figure 10.1 – Total cost of asthma hospitalizations (unstandardized and standardized*)
                               30

                                                 Unstandardized
                               25                Standardized


                               20
     Total cost (millions)




                               15


                               10


                                5


                                0
                                       1997    1998      1999        2000     2001     2002     2003     2004      2005      2006   2007

     Figure 10.2 – Average cost of one asthma hospitalization (unstandardized and standardized*)
                                $14,000
                                                      Unstandardized
                                $12,000               Standardized
       Total cost (millions)




                                $10,000


                                    $8,000


                                    $6,000


                                    $4,000


                                    $2,000


                                       $0
                                              1997    1998      1999        2000     2001     2002     2003     2004      2005   2006   2007



                               Key Findings
                               •	 The standardized costs show what past costs would be if adjusted to current monetary
                                  value. The total standardized and unstandardized cost for asthma hospitalizations has
                                  steadily increased since 1997. Even when costs are standardized, the total cost for all
                                  asthma hospitalizations is increasing compared to past years.
                               •	 In addition to the total cost, the average cost of a hospital visit for asthma has steadily
                                  increased and now costs almost $12,000 per visit. Like total costs for all hospitalizations,
                                  the standardized cost shows that the average cost of an asthma hospitalization is
                                  increasing	faster	than	inflation.


64   Figures 10.1 and 10.2-Data Source: Oregon Hospital Discharge Index
     * Cost standardized using the 2007 Consumer Price Index for medical care in the urban west
Figure 10.3 – Total cost of asthma hospitalizations by gender, 2007

                                                                  Male
                                                                  $8,970,093



                   Female
                   $19,451,461




Figure 10.4 – Total cost of asthma hospitalizations by age group, 2007
                                               Ages 0–4
                                               $1,886,920
                                                             Ages 5–14
                                                             $1,531,172

                    Ages 65+                                     Ages 15–34
                    $9,678,295                                   $2,489,569




                                                              Ages 35–64
                                                              $12,835,598

Figure 10.5 – Total cost of asthma hospitalizations by payer, 2007
                                  Self pay
                                  $1,891,890             Medicaid/OHP
                                                         $5,536,457


                                                                 Unable to pay
                 Private/HMO                                     $284,670
                 $9,513,442




                           Other                            Medicare
                           $1,005,747                       $10,189,349



   Key Findings
   •	 Females account for 68.4% of the total cost of asthma hospitalizations.
   •	 The bulk (78.2%) of the cost of asthma hospitalizations is for people 35 years of age or
      older. Children 14 years of age and younger represent only 12.0% of the cost of
      asthma hospitalizations.
   •	 Medicare is the primary payer for more than 10 million dollars (35.9%) of the total cost
      of asthma hospitalizations. People unable to pay for their hospitalizations make up only
      a small proportion of the costs.
                                                                                                 65

Figures 10.3, 10.4 and 10.5-Data Source: Oregon Hospital Discharge Index
     ChAPTER 11:
     Meeting healthy People
     2010 Goals
     Overview
     The Healthy People 2010 initiative is a             Healthy People 2010 is guided by the goals of
     framework for national health objectives            increasing the quality and years of healthy life
     designed to identify preventable threats to the     and eliminating health disparities. Supporting
     health of the nation and to establish goals to      these goals are 28 focus areas with objectives
     reduce these threats. It builds on initiatives      to be achieved by 2010. Asthma has eight
     starting from the Surgeon General’s 1979            objectives for reducing the burden and
     health report and Healthy People 2000 and           increasing the management of the disease.
     sets public health priorities and goals (targets)   For more information about Healthy People
     that can be used by communities and states to       2010 see the Web site www.healthypeople.gov/
     gauge their progress toward these goals.            default.htm.




66
Data
Table 11.1 – HP2010 objective 24-1
Reduce asthma deaths: Numbers represent deaths due to asthma per 1,000,000 people.
                            U.S.               Oregon        Oregon          Healthy People
 Age Group
                            2005              1999–2001     2003–2005          2010 Goal
 0–4                         2.0                  0.0           1.5                1.0

 5–14                        2.4                  0.7           0.0                1.0

 15–34                       4.1                  2.5           2.7                2.0

 36–64                       12.7                 14.0         13.4                9.0

 65 and older                52.3                104.9         62.3               60.0



Table 11.2 – HP2010 objective 24-2
Reduce hospitalizations for asthma: Numbers represent the hospitalizations for asthma per
10,000 people.
                            U.S.                Oregon        Oregon         Healthy People
 Age Group
                            1998                 1998          2006            2010 Goal
 0–4                         45.6                 19.8         14.8               25.0

 5–64                        12.5                 5.3           4.5                7.7

 65 and older                17.7                 11.8         11.7               11.0



   Key Findings
   •	 Deaths due to asthma are decreasing in Oregon and are approaching or exceeding
      the Healthy People 2010 targets. However, Oregon is generally still higher than the
      U.S. rates.
   •	 Oregon meets all Healthy People 2010 targets for hospitalizations except for the age
      group of 65 and older.



Table 11.1-Data Source: Oregon Death Certificates
Table 11.2-Data Source: Oregon Hospital Discharge Index




                                                                                              67
     Table 11.3 – HP2010 objective 24-4
     Reduce activity limitations among persons with asthma
                                   Oregon 2005 (%)                     Healthy People 2010 Goal (%)

      Children 0–17                         53                                        20

      Adult 18 or older                     67                                        20



     Table 11.4 – HP2010 objective 24-5
     Reduce the number of school or work days missed by persons with asthma due to asthma
                            Oregon 2005 (Average Number                  Healthy People 2010 Goal
                                  of Days Missed)                                 (Days)
      Children 0–17                        2.7                                        2.0

      Adult 18 or older                    10.8                                       2.0



     Table 11.5 – HP2010 objective 24-6
     Increase the proportion of persons with asthma who receive formal patient education, including
     information about community and self-help resources, as an essential part of the management of
     their condition (current asthma)
                                Oregon            Healthy People
                               2005 (%)           2010 Goal (%)
      Children 0–17                14                    30

      Adult 18 or older             9                    30

     Tables 11.3 and 11.4 and 11.5-Data Source: Behavioral Risk Factors Surveillance System, Asthma Callback Survey
     Note: Oregon data for persons with asthma


        Key Findings
        •	 Activities limitations among children and adults are still much higher than the Healthy
           People 2010 objectives.
        •	 Oregon children are close to the Healthy People 2010 goal of only 2.0 days of school
           days missed by a person with asthma due to asthma. However, adults report more than
           10 days on average that they were unable to work or carry out usual activities because
           of asthma. Because the survey question used to measure this objective included “usual
           activities” it is likely that the number of days is overstated.
        •	 Neither children nor adults met the Healthy People 2010 goal of receiving formal
           education on how to manage their condition (asthma management class).




68
Table 11.6 – HP 2010 objective 24-7
Increase the proportion of persons with asthma who receive appropriate asthma care according to
the National Asthma Education and Prevention Program guidelines
                               Oregon 2005 (%)                Healthy People 2010 Goal (%)

 24-7a: Persons with asthma who receive written asthma management plans from their
 health care provider (current asthma)

 Children 0–17                         33                                    38

 Adult 18 or older                     24                                    38


 24-7b: Persons with asthma with prescribed inhalers who receive instructions on how to use
 them properly (current asthma)

 Children 0–17                        92.4                                  98.8

 Adult 18 or older                    96.6                                  98.8


 24-7f: Persons with asthma who receive assistance with assessing and reducing exposure to
 environmental risk factors in their home, school, and work environment (current asthma)

 Children 0–17                         39                                    50

 Adult 18 or older                     43                                    50




   Key Findings
   •	 The original Healthy People 2010 objectives did not include targets for objective 24-7.
      However, targets were added in the midcourse review of Healthy People 2010. As of
      2005, Oregon met none of the targets for these objectives.



Table 11.6-Data Source: Behavioral Risk Factors Surveillance System, Asthma Callback Survey
Note: Oregon data for persons who ever reported having asthma




                                                                                                  69
     References
     1.   Oregon Department of Human Services.          9.    Caracta, C.F. 2003. Gender Differences
          The Oregon Health Plan: An Historical               in Pulmonary Disease. The Mount Sinai
          Overview. Salem: Office of Medical                  Journal of Medicine: 70:215-224.
          Assistance Programs. Available online at      10.   Carey, M.A., Card, J.W., Voltz, J.W., Arbes,
          www.oregon.gov/DHS/healthplan/data_                 S.J. Germolec, D.R., Korach, K.S. and
          pubs/ohpoverview0706.pdf. Accessed                  Zeldin, D.C. 2007. It’s All about Sex:
          December 2008.                                      Gender, Lung Development, and Lung
     2.   Adler, N.E. and Newman, K. 2002.                    Disease. Trends in Endocrinology and
          Socioeconomic Disparities in Health:                Metabolism: 18:308-313.
          Pathways and Policies. Health Affairs:        11.   Melgert, B.N., Ray, A., Hylkema, M.N.,
          21:60-76.                                           Timens, W. and Postma, D.S. 2007. Are
     3.   National Heart Lung and Blood Institute.            There Reasons Why Adult Asthma Is
          Diseases and Conditions Index: Asthma.              More Common in Females? Current
          Available online at www.nhlbi.nih.gov/              Allergy and Asthma Reports: 7:143-150.
          health/dci/Diseases/Asthma/Asthma_            12.   Centers for Disease Control and
          WhatIs.html. Accessed August 2008.                  Prevention. 2004. Asthma Prevalence
     4.   Centers for Disease Control and                     and Control Characteristics by Race/
          Prevention. Asthma Prevalence, Health               Ethnicity: United States, 2002. Morbidity
          Care Use and Mortality: United States,              and Mortality Weekly Report: 53:145-148.
          2003–2005. Available online at www.cdc.       13.   Oregon Tobacco Prevention and
          gov/nchs/products/pubs/pubd/hestats/                Education Program. African American
          ashtma03-05/asthma03-05.htm. Accessed               Data Report – 2007. Available online
          August 2008.                                        at www.oregon.gov/DHS/ph/tobacco/
     5.   Centers for Disease Control and                     docs/07factsheets/aafact.pdf. Accessed
          Prevention. Guide for State Health                  August 2008.
          Agencies in the Development of Asthma         14.   Oregon Tobacco Prevention and
          Programs. Available online at www.cdc.              Education Program. American Indian/
          gov/asthma/pdfs/asthma_guide.pdf.                   Alaska Native Data Report – 2007.
          Accessed August 2008.                               Available online at www.oregon.gov/DHS/
     6.   U.S. Department of Health and Human                 ph/tobacco/docs/07factsheets/aianfact.
          Services. Healthy People 2010: Respiratory          pdf. Accessed August 2008.
          Diseases. Available online at www.            15.   Heck, J.E. and Jacobson, J.S. 2006. Asthma
          healthypeople.gov/Document/HTML/                    Diagnosis among Individuals in Same-Sex
          Volume2/24Respiratory.htm. Accessed                 Relationships. Journal of Asthma: 43:579-
          August 2008.                                        584.
     7.   Oregon Department of Human Services.          16.   Oregon Tobacco Prevention and
          Oregon Asthma Leadership Plan: A                    Education Program. Lesbian, Gay and
          Statewide Call for Action 2006–2011.                Bisexual (LGB) Data Report – 2007.
          Available online at www.oregon.gov/DHS/             Available online at www.oregon.gov/DHS/
          ph/asthma/plan/alplan.pdf. Accessed                 ph/tobacco/2007_Pop_Fact_Sheets/
          August 2008.                                        LGBOregs.pdf. Accessed August 2008.
     8.   Rhodes, L. Moorman, J.E. and Redd,            17.   Oregon Tobacco Prevention and
          S.C. 2007. Sex Differences in Asthma                Education Program. Oregon Tobacco
          Prevalence and Other Disease                        Facts: 2007. Available online at www.
70        Characteristics in Eight States. Journal of         oregon.gov/DHS/ph/tobacco/docs/
          Asthma: 42:777-782.                                 facts07.pdf. Accessed August 2008.
18. Moorman, J.E., Rudd, R, Johnson, C.A.,          26. Weiss, K.B. 1990. Seasonal Trends in U.S.
    King, M., Minor, P., Bailey, C., Scalia,            Asthma Hospitalizations and Mortality.
    M.R. and Akinbami, L.J. 2007. National              Journal of the American Medical
    Surveillance for Asthma – United States,            Association: 263:2323-2328.
    1980–2004. Morbidity and Mortality              27. Heron, M.P., Hoyert, D.L., Xu, J.; Scott, C.,
    Weekly Report: 56:18-54.                            and Tejada-Vera, B. 2008. National Vital
19. Hall, S.A., Kaufman, J.S., and Ricketts, T.C.       Statistics Reports: Deaths: Preliminary
    2006. Defining Urban and Rural Areas                Data for 2006: 56(16). Available online at
    in U.S. Epidemiologic Studies. Journal of           www.cdc.gov/nchs/data/nvsr/nvsr56/
    Urban Health: Bulletin of the New York              nvsr56_16.pdf. Accessed November 2008.
    Academy of Medicine: 83:162-175.                28. Getahun, D., Demissie, K. and Rhoads,
20. Oregon Asthma Program. 2005. The Guide              G.G. 2005. Recent Trends in Asthma
    to Improving Asthma Care in Oregon.                 Hospitalization and Mortality in the United
    Available online at www.oregon.gov/                 States. Journal of Asthma: 42:373-378.
    DHS/ph/asthma/guideor.shtml. Accessed           29. Schatz, M., Nakahiro, R., Crawford, W.,
    October 2008.                                       Mendoza, G., Mosen, D. and Stibolt, T.B.
21. Huovinen, E., Kaprio, J. and Koskenvuo, M.          2005. Asthma Quality-of-Care Markers
    2003. Factors Associated to Lifestyle and           Using Administrative Data. Chest:
    Risk of Adult Onset Asthma. Respiratory             128:1968-1973.
    Medicine: 97:273-280.                           30. Schatz, M., Zeiger, R.S., Vollmer, W.M.,
22. Oregon Department of Human Services.                Mosen, D., Mendoza, G., Apter, A.J.,
    2007. Keeping Oregonians Healthy:                   Stibolt, T.B., Leong, A., Johnson, M.S. and
    Preventing Chronic Diseases by                      Cook, E.F. 2006. The Controller-to-Total
    Reducing Tobacco Use, Improving Diet,               Asthma Medication Ratio is Associated
    and Promoting Physical Activity and                 with Patient-Centered as Well as
    Preventive Screenings. Available online at          Utilization Outcomes. Chest: 130:43-50.
    www.oregon.gov/DHS/ph/hpcdp/docs/               31. Asthma and Allergy Foundation of
    healthor.pdf. Accessed October 2008.                America. 2000. The Costs of Asthma:
23. McCraig, L.F. and Burt, C.W. 2005. National         Asthma and Allergy Foundation 1992
    Hospital Ambulatory Medical Care Survey:            and 1998 Study, 2000 Update. Available
    2003 Emergency Department Summary.                  online at www.aafa.org/display.
    Advanced Data from Vital and Health                 cfm?id=6&sub=63&cont=252. Accessed
    Statistics: 358:1-37. Available online at           October 2008.
    www.cdc.gov/nchs/data/ad/ad358.pdf.
    Accessed November 2008.
24. U.S. Department of Health and Human
    Services, Public Health Service. 2008.
    Healthy People 2010 Progress Review:
    Respiratory Diseases. Available online at
    www.healthypeople.gov/data/2010prog/
    focus24/default.htm. Accessed
    September 2008.
25. DeFrances, C.J. and Podgornik, M.N. 2006.
    Advance Data from Vital and Health
    Statistics of the National Center for
    Health Statistics: 371:1-20.
                                                                                                        71
     APPEnDIx A:
     Data Source Descriptions
     and Limitations
     The data sources used in this report are listed   Behavioral Risk Factor
     below. Each data source is described, and the     Surveillance System (BRFSS)
     limitations for each source are also provided.
                                                       - Annual Survey
                                                       - Race/Ethnicity Oversample
     Asthma Data Workgroup (ADWG)                      - County Combined Dataset
     Description:                                      Description:
     The ADWG is a collaboration between the           The BRFSS is a random-digit dialed telephone
       Oregon Asthma Program (OAP) and                    survey that is conducted year-round
       Oregon’s private and Medicaid health               among Oregon adults aged 18 years or
       plans and health systems. ADWG has                 older. Asthma prevalence questions are
       developed methods to measure and                   included every year, and Oregon-specific
       report asthma data consistently across             supplemental asthma questions are
       plans. Currently, health plans report data         included most years. Child prevalence is
       in summary form to the OAP each year.              obtained by adult proxy to the six-question
       The OAP analyzes the data and reports              random child selection module and the two-
       the aggregate results back to the ADWG;            question child prevalence module, which
       results are also reported via presentations        have been asked every year since 2002.
       and publications. The data are derived
       from the medical and pharmacy claims            Every few years, Oregon conducts additional
       records of insured Oregonians who are              BRFSS surveys among under-represented
       4–55 years old and have at least six               races and ethnicities. The results of these
       months of continuous enrollment in a               surveys are combined with statewide
       participating health plan. In 2005, more           BRFSS data to provide more stable
       than 550,000 insured Oregonians met                estimates for asthma prevalence, other
       these criteria.                                    chronic diseases, and related risk factors
                                                          among these groups of Oregonians. The
     Limitations:                                         most recent race/ethnicity oversamples
     The data are limited by age (4–55 years), by         were conducted in 2004–2005. In addition,
        the number of health plans that participate       BRFSS surveys from 2002–2005 were
        (e.g., 14 health plans in 2005), and by           aggregated to produce more reliable
        insurance status (insured people with six         county-level asthma prevalence estimates.
        months or more of continuous coverage).
        As such, the data are not necessarily          Limitations:
        representative of all Oregonians or of all
                                                       BRFSS estimates pertain only to the adult
        insured Oregonians.
                                                         population aged 18 years or older, living
                                                         in households. Respondents are identified
                                                         through telephone-based methods;
                                                         however, according to the 2000 census,
                                                         1.6% of Oregon households do not
                                                         have telephones. No direct method of
72
                                                         compensating for non-telephone coverage
                                                         is employed by the BRFSS; however, post-
   stratification weights are used, and these     Oregon death certificates and
   are expected to partially correct for any      national CDC WOnDER data
   bias caused by non-telephone coverage.
   These weights adjust for differences in        Description:
   probability of selection and non-response,     Asthma mortality is monitored through
   as well as non-telephone coverage, and            Oregon’s Death Certificate Statistical File,
   must be used for deriving representative          which contains information about all deaths
   population-based estimates of prevalences.        occurring in Oregon and deaths occurring
                                                     out-of-state among Oregon residents.
Results obtained through BRFSS surveys are
   also limited in that they represent self-      Asthma must be listed as the underlying
   reported responses. Some, but not all,            (principal) cause of death in order to
   questions have been validated.                    be considered an asthma death. When
                                                     appropriate, mortality rates presented
                                                     in this report have been age-adjusted to
BRFSS Asthma Callback                                the U.S. 2000 standard population. For
                                                     comparability, state and national age-
Description:                                         adjusted rates may be obtained from the
Oregon was one of three states to implement          Centers for Disease Control and Prevention
   the BRFSS asthma callback in 2005. The            (CDC) WONDER (Wide-ranging Online
   callback is a follow-up survey administered       Data for Epidemiologic Research) data
   to people who indicated on the BRFSS that         system at http://wonder.cdc.gov.
   they currently have asthma or had asthma
   in their lifetime. Through the callback, the   Limitations:
   Oregon Asthma Program collects detailed
                                                  One limitation to this dataset is the relatively
   information on topics such as health
                                                    small number of asthma deaths that occur
   care utilization, knowledge of asthma,
                                                    in Oregon each year (about 50–70 deaths
   asthma management, asthma medications,
                                                    annually). Given these small numbers, the
   environmental factors, costs of asthma
                                                    mortality rate for any given year may not
   care, work-related asthma, comorbid
                                                    provide a stable estimate.
   conditions, and complementary and
   alternative medicines.
                                                  A second limitation is that the accuracy
                                                     of these data naturally depends on
Limitations:                                         the accuracy with which the provider
The BRFSS asthma callback has many of the            completes the death certificate.
  same limitations described above for the
  telephone-based BRFSS. In addition, not
  all people with asthma from the standard
  BRFSS are reached; hence, the attrition
  may lead to differences between the
  original BRFSS respondents and those
  respondents who also complete the
  asthma callback.




                                                                                                     73
     Division of Medical Assistance                   hospital Discharge Index
     Programs-Quality and                             Description:
     Performance Improvement                          The Hospital Discharge Index provides
     Workgroup (DMAP-QPIWG)                              information on hospital discharges from all
     Description:                                        acute care hospitals in Oregon except the
                                                         two Veterans Administration hospitals. The
     Our unique relationship with the DMAP-
                                                         dataset includes admit and discharge dates,
       QPIWG enables the Oregon Asthma
                                                         diagnosis and procedural codes, financial
       Program to measure five asthma indicators
                                                         charges, primary payer, and limited patient
       for all Medicaid/SCHIP clients in the
                                                         demographic information (e.g., gender).
       state, which makes Oregon the only state
                                                         Unique identifiers are not available.
       to have access to asthma data for the
       entire state Medicaid/SCHIP population.
       The indicators are the same as those           Limitations:
       measured by the ADWG and are calculated        In this dataset, an asthma hospitalization
       using medical and pharmacy claims for              is defined as having a primary diagnosis
       Oregonians served by Medicaid/SCHIP                with an International Classification
       who are 4–55 years old and have at least six       Disease 9th Revision Clinical Modification
       months of continuous enrollment.                   (ICD-9-CM) code of 493. When possible,
                                                          hospitalization rates presented for this
     Limitations:                                         dataset have been age-adjusted to the U.S.
                                                          2000 standard population.
     The data are limited to Medicaid/SCHIP
        members only and are further limited by
                                                      The Hospital Discharge Index does not include
        age (4-55 years) and by insurance status
                                                         identifying information that would allow
        (insured people with at least six months
                                                         us to ascertain when a single person
        of continuous coverage). All health plans
                                                         has multiple hospitalizations; therefore,
        providing Medicaid/SCHIP services started
                                                         the calculated rate is the number of
        providing data in 2003. Prior to 2003 only
                                                         hospitalizations per capita rather than
        volunteer plans provided data.
                                                         number of different people hospitalized per
                                                         capita. In addition, the dataset does not
                                                         include information on race or ethnicity.




74
Oregon Medicaid health Risk and                  Oregon healthy Teens (OhT) Survey
health Status Survey (hRhSS)                     Description:
Description:                                     Since 2000, the Youth Risk Behavior Survey
The HRHSS was conducted in 2004 by the              (developed by the CDC) and the Oregon
   Oregon Department of Human Services              Public School Drug Use Survey have been
   Division of Medical Assistance Programs to       combined for Oregon into a single annual
   measure the health risk and health status        survey called Oregon Healthy Teens
   of adult Oregon Health Plan (OHP) clients.       (OHT). The sample size varies between
   This telephone survey was conducted in           1,600 to 32,000 per year, and the final
   English and Spanish from August–October          data are weighted to more accurately
   2004, and the survey was designed to assess      represent Oregon eighth and 11th graders.
   health-risk behaviors, clinical preventive       In addition to assessing other topics
   health practices and health care access,         such as tobacco and alcohol use, HIV
   mainly related to chronic diseases. The          knowledge and attitudes, eating behaviors,
   eligible population included adults aged 18      nutrition, and exercise, the questionnaire
   or older who were enrolled in the Oregon         also provides an estimate of lifetime and
   Health Plan (OHP) for at least 137 days          current asthma prevalence among Oregon
   during the period of July 1, 2003–June 30,       students in eighth or 11th grade. The
   2004. Continuous enrollment was not              OHT may also assess frequency of asthma
   required. The sample was random and              symptoms, asthma episodes, or missing
   stratified by six race/ethnicity categories      school due to asthma.
   (white, African American, Hispanic, Native
   American, Asian and other). A total of        Limitations:
   11,921 adult enrollees were eligible to be
                                                 One limitation is that participation by school
   surveyed and 2,995 completed the survey.
                                                   systems in the OHT is voluntary. However,
                                                   participation rates have been high thus far
Limitations:                                       and recent sample sizes have been ~25,000
As a random sample, these results should be        per year.
   interpreted as estimates of behaviors and
   practices with inherent variability rather    Another limitation is that the OHT
   than as precise prevalence percentages.         questionnaire is not currently available in
   In addition, the HRHSS has many of the          non-English versions except for a Spanish
   same limitations described above for the        booklet that can be used as a reference when
   telephone-based BRFSS.                          filling out the English version of the survey.

                                                 A third limitation is that 3% of surveys
                                                    were eliminated due to combinations of
                                                    “dubious” answers and another 5% were
                                                    eliminated because the student did not fill
                                                    out the grade or gender information




                                                                                                    75
     APPEnDIx B:
     Glossary
     Age-standardization – A method to                      That means that differences between two rates
     standardize populations with different age             may be statistically significant even though the
     distributions. Age-standardization enables             confidence intervals for those two rates overlap.
     the comparison of different areas and
     times regardless of changes in the overall             Cost standardized – A method to standardize
     population age structure from place-to-place           economic costs using the Consumer Price
     and time-to-time.                                      Index (CPI). CPI is a measure of the average
                                                            change in prices over time. For this report we
     Asthma (as defined from claims data, such              used a CPI specific for medical costs.
     as from the Oregon Health Plan) – People
     are identified as having asthma if they met            Current asthma – When a survey respondent
     any of the following criteria during the period        reports that they have ever been told they
     January 1 through December 31 of each year:            have asthma by a doctor, nurse or other health
     (1) hospitalization for asthma; (2) ED visit for       professional and they currently have asthma.
     asthma; (3) three or more asthma medication
     dispensings (as long as not all dispensings are        Disease burden – The burden of a disease
     for leukotriene modifiers); or (4) two or more         is the effect of a health problem in an area
     outpatient visits (admitted to a hospital or           measured by financial cost, mortality,
     clinic for treatment that does not require an          morbidity, or other indicators.
     overnight stay) with asthma listed as any of
     the diagnoses.                                         Extremely obese – Weight category where
                                                            BMI is 40 and greater.
     Body Mass Index (BMI) – BMI is a
     mathematical method to determine obesity by            Healthy weight – Weight category where BMI
     dividing a person’s metric weight by the square        is between 18.5 and 25.
     of the person’s metric height.
                                                            Hospital discharge – A patient who stays
     Confidence interval (CI) – An indication               overnight at a hospital and then either returns
     of a measurement’s precision with a narrow             home or is transferred to another facility is
     confidence interval indicating high precision          referred to as a discharge.
     and a wide confidence interval indicating
     low precision. For example, a CI can be                Inhaled corticosteroid – Inhaled
     used to describe how reliable survey results           corticosteroids are anti-inflammatory drugs
     are. Confidence intervals can also be used             taken on a daily, ongoing basis to prevent
     to determine if the difference between                 asthma attacks.
     two percentages or rates are statistically
     significantly different from each other. If the        Inhaled short-acting beta2-agonist – Inhaled
     confidence intervals between two populations           short-acting beta2-agonists are medications
     overlap then it is likely that they are not            that quickly loosen the tightened muscles
     significantly different from each other. If they       around swollen airways and are often called
     do not overlap, they are likely to be significantly    rescue medications.
     different from each other. Caution should be
     used when interpreting statistical significance
76   in this way because using confidence intervals
     is a conservative test for statistical significance.
Lifetime asthma – When a survey respondent
reports that he or she has ever been told he
or she has asthma by a doctor, nurse or other
health professional.

Obese – Weight category where BMI is
between 30 and 40.

Outpatient – An outpatient visit is one in
which a person visits a hospital, clinic, or
other facility for diagnosis or treatment but is
not hospitalized.

Overweight – Weight category where BMI is
between 25 and 30.

Persistent asthma (as defined from claims
data, such as from the Oregon Health Plan)
– People are identified as having persistent
asthma during the period January 1 through
December 31 of each year: (1) hospitalization
for asthma; (2) ED visit for asthma; (3) four
or more asthma medication dispensings (as
long as not all dispensings are for leukotriene
modifiers); or (4) four or more outpatient visits
with asthma listed as any of the diagnoses.

Prevalence – The percentage of a defined
population with a disease at a given time.

Rate – Rates are a fraction calculated by
dividing the number of people affected by
a problem by the number of people at risk
of experiencing the problem. Rates are
generally expressed in relation to a specific
time period and multiplied so that the rate is
not expressed as a fraction. For example, the
fraction 0.08 would be expressed as 80 per
1,000 people.




                                                    77
     ADDITIOnAL TABLE

     Annual asthma hospital discharges
           Year     Count

           1997     2411
           1998     2318
           1999     2306
           2000     2291
           2001     2262
           2002     2541
           2003     2463
           2004     2149
           2005     2446
           2006     2221
           2007     2404




78
   Oregon Asthma Program
800 N.E. Oregon Street, Suite 730
      Portland, OR 97232

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:206
posted:8/11/2011
language:English
pages:92