# Presentation: 185174

## US children and adults with high-risk conditions

- Pen-Jung Lu PhD
- Surasak Youngpairoj, MD, MPH
- Carolyn Bridges, MD
- Guillermo Herrera, MD, MBA

## US children and adults with high-risk conditions

- Estimate number of children and adults with high-risk conditions
- Contribute to informed decision process on antiviral and influenza vaccine allocation/priorities in the event of influenza pandemic

## Data sources

- NHIS 2003
- High-risk conditions in adults:
- Asthma, emphysema, bronchitis, coronary heart disease, angina, myocardial infarction, diabetes, and cancer.
- High-risk conditions in children:
- Cystic fibrosis, sickle cell anemia, diabetes, congenital heart disease, other heart disease and conditions, asthma, cerebral palsy, muscular dystrophy, down syndrome, birth defects, other developmental disorders, mental retardation, and seizures.

## Data sources

- NHIS 2002
- Other possible high-risk conditions in adults:
- Stroke, birth defect, mental retardation, cerebral palsy, senility/dementia/Alzheimer, multiple sclerosis, Parkinson’s disease, and seizures.
- Cancer in children
- National Cancer Institute, cancer statistics review 1975-2001.
- American Cancer Society, Cancer facts and figures 2005.
- CDC/ NCCDPHP/Division of Cancer Prevention and Control, 2004 State Cancer Burden Data Fact Sheets.
- National Program of Cancer Registries, 2001 incidence and mortality data.

## Data sources

- Transplants and transplantation waiting list, children and adults:
- UNOS (united network for organ sharing) 2005
- HIV/AIDS children and adults:
- CDC/HIV/AIDS surveillance report 2003.
- UNAIDS 2004 report on the global AIDS epidemic.
- End stage renal disorder, dialysis patients, children and adults:
- United States renal data system (USRDS) 2004 annual data report.

## High-risk conditions in children aged 0-17:  NHIS 2003

|  Condition | Sample | Estimate | Lower Estimate | Upper Estimate |
| --- | --- | --- | --- | --- |
| Cystic Fibrosis | 3 | 19,946 | 7,273 | 65,459 |
| Sickle Cell Anemia | 23 | 152,186 | 94,552 | 247,289 |
| Diabetes | 19 | 85,955 | 50,912 | 145,464 |
|   |   |   | 0 | 0 |
| Congenital Heart D. | 31 | 212,101 | 145,464 | 312,748 |
| Other Heart | 113 | 748,070 | 603,677 | 930,971 |
| Asthma | 1046 | 6,213,435 | 5,783,657 | 6,668,985 |
|   |   |   |   |   |
| Cerebral Palsy | 34 | 168,475 | 109,098 | 261,836 |
| Dystrophy | 5 | 29,226 | 7,273 | 87,279 |
| Down Syndrome | 21 | 141,616 | 87,480 | 218,699 |
| Birth Defect | 35 | 203,687 | 123,918 | 335,306 |
| Other Development  | 80 | 506,748 | 386,331 | 663,323 |
| Mental Retardation | 73 | 441,326 | 342,973 | 569,188 |
| Seizures | 80 | 404,234 | 306,486 | 525,405 |
| Multiple | 1422 | 8,564,305 | 8,070,800 | 9,085,123 |

## High-risk conditions in children, number by age group:  NHIS 2003

| Age Group | Sample | Estimate | Lower Estimate | Upper Estimate |
| --- | --- | --- | --- | --- |
| <6 Months | 10 | 51,649 | 22,572 | 116,032 |
| 6-23 Months | 81 | 493,880 | 378,763 | 639,493 |
| 2-4 Years | 200 | 1,200,138 | 1,025,230 | 1,400,905 |
| 5-17 Years | 1131 | 6,818,638 | 6,395,233 | 7,266,344 |
| Total | 1422 | 8,564,305 | 8,070,800 | 9,085,123 |

## High-risk conditions in adults: NHIS 2003

| Condition  | Sample | Estimate | Lower Estimate | Upper Estimate |
| --- | --- | --- | --- | --- |
| Asthma | 1,108 | 7,071,068 | 6,592,534 | 7,570,781 |
| Emphysema | 481 | 3,114,666 | 2,785,877 | 3,487,663 |
| Bronchitis | 1,310 | 8,560,342 | 8,017,372 | 9,123,217 |
|   |   |   |   |   |
| Coronary D. | 1,118 | 7,321,612 | 6,804,295 | 7,867,466 |
| Angina | 764 | 4,947,320 | 4,528,393 | 5,400,056 |
| MI | 1,036 | 6,737,119 | 6,296,764 | 7,211,497 |
|   |   |   |   |   |
| Diabetes | 2,211 | 14,011,824 | 13,326,985 | 14,732,066 |
| Cancer | 358 | 2,366,813 | 2,107,198 | 2,660,604 |
| Multiple |  5,638 | 36,487,085 | 35,524,384 | 37,631,583 |

## High-risk conditions in adults, number by age group: NHIS 2003

| Age Group | Sample | Estimate | Lower Estimate | Upper Estimate |  |   |
| --- | --- | --- | --- | --- | --- | --- |
| 18-49 | 1,761 | 12,198,429 | 11,599,706 | 12,866,568 |   |  |
| 50-64 | 1,681 | 11,002,586 | 10,471,017 | 11,615,773 |   |  |
| 65+ | 2,196 | 13,286,070 | 12,819,308 | 13,885,874 |   |  |
| Total | 5,638 | 36,487,085 | 35,524,384 | 37,631,583 |   |  |

## Other possible high-risk conditions in adults: NHIS 2002

| Condition | Sample | # of person in population |  |  |
| --- | --- | --- | --- | --- |
|  |  | 18-49 years | 50-64 years | Total |
| Stroke | 250 | 533,664 | 1,131,856 | 1,665,520 |
| Birth defect | 32 | 163,362 | 37,111 | 200,473 |
| Mental retardation | 22 | 151,569 | 38,907 | 190,476 |
| Other probably/cerebral palsy | 13 | 71,763 | 16,098 | 87,861 |
| Senility/dementia/Alzheimer  | 7 | 6,784 | 26,962 | 33,746 |
| Multiple sclerosis | 62 | 266,120 | 177,036 | 443,156 |
| Parkinson's disease | 13 | 52,081 | 80,491 | 132,572 |
| Seizures | 293 | 1,629,422 | 425,047 | 2,054,469 |
| Multiple | 384 | 1,741,777 | 843,720 | 2,585,497 |

## Summary

## Summary

## Summary

- Children 6 months to 17 years
- High-risk condition: 8,647,462
- HR and age recommendation (ACIP): 14,025,878
- Adults 18 years and over
- High-risk condition: 44,526,841
- HR and age recommendation (ACIP): 65,225,952
- Total population
- High-risk condition: 53,174,303
- HR + age recommendation (ACIP): 79,393,147
- Person 50-64 without HR condition: 45,540,121
- Total including 50-64 age recommendation: 125,033,268

## Organ transplantation waiting list:  UNOS/HHS/HRSA 2005

- 0-17 = 2,286
- 18>  = 92,643

**Notes:**
UNOS has developed an online database system, called UNetsm, for the collection, storage, analysis and publication of all OPTN data pertaining to the patient waiting list, organ matching, and transplants.
Launched on October 25,1999, this system contains data regarding every organ donation and transplant event occurring in the U.S. since 1986. UNet is a fail-safe, 24/7, secure Internet-based transplant information database created to enable the nation's organ transplant institutions to:

## Organ transplantations:  UNOS/HHS/HRSA 2003-05

- 0-17 = 3.383
- 18>  = 50,975

**Notes:**
UNOS has developed an online database system, called UNetsm, for the collection, storage, analysis and publication of all OPTN data pertaining to the patient waiting list, organ matching, and transplants.
Launched on October 25,1999, this system contains data regarding every organ donation and transplant event occurring in the U.S. since 1986. UNet is a fail-safe, 24/7, secure Internet-based transplant information database created to enable the nation's organ transplant institutions to:

## Cancer in children aged 0-19: ACS/CDC-NCHS 2001 rates/2003 population

**Notes:**
UNOS has developed an online database system, called UNetsm, for the collection, storage, analysis and publication of all OPTN data pertaining to the patient waiting list, organ matching, and transplants.
Launched on October 25,1999, this system contains data regarding every organ donation and transplant event occurring in the U.S. since 1986. UNet is a fail-safe, 24/7, secure Internet-based transplant information database created to enable the nation's organ transplant institutions to:

## Estimated Number of Persons Alive in the U.S.Diagnosed With Cancer By Current Age*Invasive/1st Primary Cases OnlyN=9.8 Million Survivors)                                                     

- 1Data Source : November 2003 Submission: Populations from January 2001 were based on the average of the July 2000 and July 2001 population estimates from the _[US Bureau of Census](http://www.census.gov/)_. Complete prevalence is estimated using the completeness index method (Capocaccia et. al. 1997, Merrill et. al. 2000). US Estimated Prevalence counts were estimated by applying US populations to _[SEER 9 Limited Duration prevalence](http://www.seer.cancer.gov/registries/terms.html)_ proportions.

- < 19 = 98,000

## HIV/AIDS confidential name-based infection reporting: US, 2003—33 areas

- Source:  CDCHIV/AIDS surveillance report, 2003 (Volume 15)

- **2003 correspond to app. 43% of the total US cases.
- 40-45 thousand new cases; 300,00 persons living with HIV not diagnosed
- 50-100 thousand HIV not reported
- UNAIDS estimate 950,000 person living with HIV/AIDS in the US (2004)

## End stage renal disorder 

## The numbers expressed here are a count of

- events and each one of these events is a silent tribute to human life