# Presentation: 605980

## Focus Area 24Respiratory DiseasesProgress Review

**Focus Area 24****Respiratory Diseases****Progress Review**

**Edward J. Sondik****National Center for Health Statistics**
**May 22, 2008**

## Respiratory Diseases

**Respiratory Diseases**

**Asthma Facts**

- Prevalence (2006)
- Children -- 9.4%
- Adults -- 7.3%
- Asthma was responsible for (2005):
- 12,823,000 physician office visits
- 1,770,000 emergency department visits
- 489,000 hospitalizations
- 3,884 deaths

- COPD is under-diagnosed
- Diagnosed prevalence -- 12 million U.S. adults (2006)
- NHANES III data estimated that 24 million U.S. adults had evidence of impaired lung function (1988-94)
- COPD was responsible for (2006):
- 17,528,000 physician and hospital outpatient visits
- 1,998,000 emergency department visits
- 661,000 hospitalizations
- Fourth leading cause of death -- 122,000 deaths (2004)

**Chronic Obstructive Pulmonary Disease (COPD) Facts**

## Highlighted Objectives

- *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant.

**Highlighted Objectives**

_**Asthma**_
**24-1 a-e  Deaths from asthma**
**24-2 a-c  Hospitalizations for asthma**
**24-3 a-c  Hospital emergency department visits for asthma**
**24-6        Patient education—among persons with asthma**
**24-7 a-f  Appropriate asthma care**
_**Chronic Obstructive Pulmonary Disease**_
**24-10      Deaths from chronic obstructive pulmonary disease**

## Asthma Mortality

**Obj. 24-1 a-e**

- I = 95% confidence interval. Note: Data are for ICD-10 codes J45-J46.
- SOURCE:  National Vital Statistics System, CDC, NCHS.

- Death rate per million population

**2005**

**1999**

**2010**
**Targets**

**Under 5 years**

**5-14 years**

**15-34 years**

**35-64 years**

**65 years and over**

| Year | 1999 | 2005 |
| --- | --- | --- |
| Number of asthma deaths | 4,657 | 3,884 |
| % change 1999-2005 | -16.6% |  |

## Asthma Mortality,

- Note:  Data are for ICD-10 codes J45-J46. The categories black and white exclude persons of Hispanic origin. Asian includes other Pacific Islander. Persons of Hispanic origin may be any race. Only one race could be recorded prior to 2003. For 2003 and later years, one or more races could be recorded. Data by single race categories are for persons for whom only one racial group was recorded.
- SOURCE:  National Vital Statistics System, CDC, NCHS

**Asthma Mortality,**
**Adults 65 Years and Over**

**Obj. 24-1 e**

**0**

**40**

**80**

**120**

**1999**

**2000**

**2001**

**2002**

**2003**

**2004**

**2005**

**Black**

**White**

**Hispanic**

**Asian**

**2010 Target: 47.0**

- Death rate per million population

## Asthma Hospitalizations

**Asthma Hospitalizations**

**Obj. 24-2 a-c**

- I = 95% confidence interval.** **Note: Hospital discharges with a principal diagnosis of asthma (ICD-9-CM code 493).  Data for 24-2 b & c are age adjusted to the 2000 standard population.
- SOURCE:  National Hospital Discharge Survey, CDC, NCHS

- Hospitalizations  per 10,000 population

**2006**

**1998**

**65 years and over**

**Under 5 years**

**5-64 years**

**2010**
**Targets**

**Asthma Hospitalizations, 2006**

## Asthma Hospitalizations,

**Children Under 5 Years**

**Obj. 24-2 a**

- I = 95% confidence interval. Note: Hospital discharges with a principal diagnosis of asthma (ICD-9-CM code 493). The race categories black and white include persons of Hispanic or non-Hispanic origin. Only one race category could be recorded prior to 1999. For 1999 and later years, one or more races could be recorded. The categories black and white include persons for whom only one racial group was recorded. SOURCE:  National Hospital Discharge Survey, CDC, NCHS

-  Hospitalizations per 10,000 population

**Total**

**Black**

**White**

**Male**

**Female**

**2006**

**1998**

**2010 Target: 25.0**

## Asthma Hospitalizations, 

**Asthma Hospitalizations, **
**Adults 65 Years and Over**

**Obj. 24-2 c**

- I = 95% confidence interval.** **Note: Hospital discharges with a principal diagnosis of asthma (ICD-9-CM code 493). Data are age adjusted to the 2000 standard population. The race categories black and white include persons of Hispanic or non-Hispanic origin. Only one race category could be recorded prior to 1999. For 1999 and later years, one or more races could be recorded. The categories black and white include persons for whom only one racial group was recorded. SOURCE:  National Hospital Discharge Survey, CDC, NCHS

-  Hospitalizations per 10,000 population

**Total**

**Black**

**White**

**Male**

**Female**

**2006**

**1998**

**2010 Target: 11.0**

## Asthma Emergency Department Visits

**Obj. 24-3 a-c**

- I = 95% confidence interval.** **Note: Visits to an emergency department with a first-listed diagnosis of asthma (ICD-9-CM code 493).
- SOURCE:  National Hospital Ambulatory Medical Care Survey, CDC, NCHS

- Visits per 10,000 population

**2004-06**

**1995-97**

**65 years and over**

**Under 5 years**

**5-64 years**

**2010**
**Targets**

## Asthma Emergency Department Visits, 

**Ages 5-64 years**

**Obj. 24-3 b**

- I = 95% confidence interval.** **Note: Visits to an emergency department with a first-listed diagnosis of asthma (ICD-9-CM code 493).** **The race categories black and white include persons of Hispanic or non-Hispanic origin. Only one race category could be recorded prior to 1999. For 1999 and later years, one or more races could be recorded. The categories black and white include persons for whom only one racial group was recorded. SOURCE:  National Hospital Ambulatory Medical Care Survey, CDC, NCHS

**2004-06**

**1995-97**

**White**

**Total**

**Black**

**Female**

**Male**

**2010 Target: 50.0**

- Visits per 10,000 population

## Asthma Patient Education

- *Have you ever taken a course or class on how to manage your asthma yourself?

**Obj. 24-6**

- I = 95% confidence interval. Note: Data are for persons aged 18 years and older.  Data are age adjusted to the 2000 standard population. Poor is below the Federal poverty level.  Near poor is 100-199% of the Federal poverty level.  Middle/high income is 200% or more of the Federal poverty level. SOURCE:  National Health Interview Survey, CDC, NCHS

- Percent

**2003**

**1998**

**Total**

**2010 Target: 30.0**

**Poor**

**Near Poor**

**Middle/ High Income**

## Appropriate Asthma Care, 2003

**Obj. 24-7 a-f**

- I = 95% confidence interval. *People who take medicine everyday to protect their lungs and keep them from having attacks (includes both oral medicine and inhalers and NOT inhalers for quick relief). **Persons who report having been advised to change things at home, school, or work to improve their asthma. Note: Data are age adjusted to the 2000 standard population. SOURCE:  National Health Interview Survey, CDC, NCHS

**Percent**

**Increase desired**

**Preventive medication regimens* (24-7d)**

**Long term management care after hospitalization due to asthma (24-7e)**

**Proper-use instructions with prescribed inhalers (24-7b)**

**Education on early signs, symptoms, and responses to asthma episodes (24-7c)**

**Advice to reduce exposure to environmental risk factors** (24-7f)**

**Written asthma plan from health care provider (24-7a)**

**2010**
**Targets**

- 2002

- 2002

## Advice to Reduce Exposure

** ****to Environmental Risk Factors***

**Obj. 24-7 f**

- I = 95% confidence interval.** ***Persons who report having been advised to change things at home, school, or work to improve their asthma. Note: Data are age adjusted to the 2000 standard population.  The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. Poor is below the Federal poverty level.  Near poor is 100-199% of the Federal poverty level.  Middle/high income is 200% or more of the Federal poverty level.  SOURCE:  National Health Interview Survey, CDC, NCHS

**White**

**Total**

**Black**

**Female**

**Male**

**Hispanic**

**2003**

**2002**

**2010 Target: 50**

**Poor**

**Near poor**

**Middle/ High**

**Percent**

**Increase desired**

## COPD Mortality

**Obj. 24-10**

- Note: COPD data are for ICD-10 codes J40-J44.  Current smokers are those who ever smoked 100 cigarettes in lifetime and now smoke everyday or some days.  Data are age adjusted to the 2000 standard population.
- SOURCE:  National Vital Statistics Survey, CDC, NCHS

## COPD Mortality, 

**Adults 45 Years and Over**

**Obj. 24-10**

- I = 95% confidence interval. Note: Data are for ICD-10 codes J40-J44. Data are age adjusted to the 2000 standard population.  American Indian includes Alaska Native. Asian includes other Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Only one race could be recorded prior to 2003. For 2003 and later years, one or more races could be recorded. Data by single race categories are for persons for whom only one racial group was recorded. SOURCE:  National Vital Statistics Survey, CDC, NCHS

- Death rate per 100,000 population

**2005**

**1999**

**White**

**Total**

**Black**

**American Indian**

**Hispanic**

**2010 Target: 62.3**

**Asian**

## Chronic Obstructive Pulmonary Disease

**Death Rates, 2003-2005**

- Note: Data are for ICD-10 codes J40-J44.  Data are for ages 45 year and older and are age-adjusted to the 2000 standard population. Legend represents quintiles of the rates. Rates are calculated by health service area.** **Rates are per 100,000 population.
- SOURCE: National Vital Statistics System—Mortality, CDC, NCHS.

**Obj. 24-10**

- Rates are unreliable

**2010 Target: 62.3**

**Rates per 100,000 population**

- 46.7 – 104.6

- 104.7 – 123.7

- 123.8 – 137.6

- 137.7 – 157.3

- 157.4 – 250.9

## Chronic Obstructive Pulmonary Disease

**Death Rates, 2003-2005**

- Note: Data are for ICD-10 codes J40-J44.  Data are for ages 45 year and older and are age-adjusted to the 2000 standard population. Legend represents quintiles of the rates. Rates are calculated by health service area.** **Rates are per 100,000 population.
- SOURCE: National Vital Statistics System—Mortality, CDC, NCHS.

**Obj. 24-10**

- 46.7 – 104.6

- 104.7 – 123.7

- 123.8 – 137.6

- 137.7 – 157.3

- 157.4 – 250.9

- Rates are unreliable

**2010 Target: 62.3**

**Rates per 100,000 population**

## Adults With Sleep Apnea Symptoms† who 

**Seek Medical Care, 2005-2006**

- I = 95% confidence interval. † People who (snore 5 or more nights per week) OR (snort, gasp, or stop breathing 5 or more nights per week) OR (feel excessively sleepy during the day 16-30 times per month AND usually sleep 7 or more hours per night). ‡ People who have ever told a doctor or other health professional that they have trouble sleeping. Note:  Data are for adults ages 20 years and over.  Data are age adjusted to the 2000 standard population.
- SOURCE:  National Health and Nutrition Examination Survey, CDC, NCHS

**Total**

**Female**

**Male**

**Told doctor have trouble sleeping****‡**

**20-39 years**

**40-59 years**

**60 + years**

**Percent**

**with symptoms****†**** (31.3%)**

**Adults, 20 years and over**

## Adults With Sleep Apnea Symptoms† who 

**Seek Medical Care, 2005-2006**

- I = 95% confidence interval. † People who (snore 5 or more nights per week) OR (snort, gasp, or stop breathing 5 or more nights per week) OR (feel excessively sleepy during the day 16-30 times per month AND usually sleep 7 or more hours per night). ‡ People who have ever told a doctor or other health professional that they have trouble sleeping. Note: Data are for adults ages 20 years and over. Data are age adjusted to the 2000 standard population.
- SOURCE:  National Health and Nutrition Examination Survey, CDC, NCHS

**Told doctor have trouble sleeping****‡**

**Percent**

**Diagnosed Sleep Apnea**

**Total**

**Female**

**Male**

**20-39 years**

**40-59 years**

**60 + years**

## Progress Toward 2010 Targets

- *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant.

**Progress Toward 2010 Targets**

_**Asthma**_
**24-1 a-e    Deaths from asthma**
**24-2 a-c    Hospitalizations for asthma**
**24-3 a-c    Hospital emergency department visits for asthma**
**24-4          Activity limitations—among persons with asthma**
**24-5          School or work days lost—among persons with asthma, due to asthma**
**24-6          Patient education—among persons with asthma**
**24-7 a-f    Appropriate asthma care**
**24-8          State-based asthma surveillance systems**
_**Chronic Obstructive Pulmonary Disease**_
**24-9          Activity limitations due to chronic lung and breathing problems**
**24-10        Deaths from chronic obstructive pulmonary disease**
_**Sleep Problems**_
**24-11 a, b Medical management of persons with symptoms of obstructive sleep apnea**
**24-12        Motor vehicle crash deaths caused by excessive sleepiness**

## Summary

**Summary**

**Most objectives are either moving towards or show little or no change with respect to their Healthy People 2010 targets**
**Asthma mortality has decreased for most age groups (16.6% decrease in number of deaths from 1999 to 2005)**
**Asthma hospitalizations for older adults in 65+ age group have increased**
**Asthma emergency department visits have changed very little**
**COPD mortality for ages 45+ has decreased (4.1% decrease in age adjusted rates 1999 to 2005)**
**American Indian or Alaska Native: 14.2% decrease**
**Hispanic: 14.7% decrease**
**Asian or Pacific Islander: 19.7% decrease**

## Acknowledgements

**Acknowledgements**

**Lesley Agress****	**
**Health Statistician**
**CDC/National Center for Health Statistics**
**LKA7@cdc.gov**
- Contributors:
- Christopher Barrett, HHS/ODPHP
- Thomas Croxton, NIH/NHLBI
- Ellis Davis, HHS/ODPHP
- Rob Fulwood, NIH/ NHLBI
- Paul Garbe, CDC/NCEH
- Peter Gergen, NIH/NIAID
- Jeanette Guyton-Krishnan, NIH/NHLBI

- Elizabeth Jackson, CDC/NCHS
- Bill Jirles, NIH/NIEHS
- Jeanne Moorman, CDC/NCEH
- Zakia Nelson, CDC/NCHS
- Jeff Pearcy, CDC/NCHS
- Daniel Rotrosen, NIH/NIAID
- Diana Schmidt, NIH/NHLBI
- Virginia Taggart, NIH/NHLBI

## Progress review data and slides

- can be found on the web at:

**http://www.cdc.gov/nchs/hphome.htm**