# Number 381 + December 12, 2006 

# Revised **as of**  **December 29,**  **2006**



# The **State o**  **f Childhood**  **Asthma, United**  **S tates,** 

**1980–2005**

By Lara J

. Akinbami, M .D., Of fice o f Analysis and Epidemiology



# Introduction

Millions of children i n t he United

States are a f f ected by asthma, a chronic

respiratory disease characterized by

attacks of dif ficulty breathing. An

asthma attack is a d istressing and

potentially life-threatening experience.

Scientific advances have greatly

improved the understanding of the

mechanisms t hat cause asthma attacks

and have led t o e f f ective medical

interventions to prevent morbidity and

improve quality of life (1). Y e t, the

burden in prevalence, health care u se,

and mortality remains high. Asthma

remains a s ignificant public health

problem in the United S tates.

Keywords : childhood asthma c

prevalence c health care use c mortality



### T **rend**

+ Asthma prevalence rates among

children r emain a t h istorically high

levels f ollowing dramatic increases MT

WY ID WA

OR

NV

UT

CA

AZ ND

SD

NE

CO

NM

TX OK KS

AR

LA MO IA MN

WI

IL IN

KY

TN

MS AL GA

FL SC NC

VA WV OH MI NY

PA

MD DE NJ CT RI MA ME

VT

NH

AK

HI MT

WY ID WA

OR

NV

UT

CA

AZ ND

SD

NE

CO

NM

TX OK KS

AR

LA MO IA MN

WI

IL IN

KY

TN

MS AL GA

FL SC NC

VA WV OH MI NY

PA

MD DE NJ CT RI MA ME

VT

NH

AK

HI DC

4.4 - 7.8 percent

7.9 - 8.5 percent

8.6 - 9.7 percent

O v er 9.8 per c e n t

Data n o t re lia b le

NOTES: Ranges are based on approximate quartiles among states with available estimates. Differences portrayed in this

map should be interpreted with caution. The 95 percent confidence intervals for many states overlap. Current asthma

prevalence estimates are based on the questions “Has a doctor or other health professional ever told you that {child's

name} had asthma?" and “Does {child’s name} still have asthma?” Estimates for Delaware, the District of Columbia,

Mississippi, Nebraska, Nevada, and New Hampshire have a relative standard error greater than 30 percent and less than or

equal to 50 percent and should be interpreted with caution as they do not meet the standard of reliability or precision. The

estimates for Alaska, Idaho, Maine, Montana, North Dakota, South Dakota, Vermont, West Virginia, and Wyoming have a

relative standard error greater than 50 percent and therefore are not represented in this figure.

SOURCE: CDC/NCHS, National Health Interview Survey.



### from 1980 until the l ate 1990s.

+ Despite the p lateau in asthma

prevalence, ambulatory care f or

asthma use has continued to grow

since 2000.

+ Since 1992, when data first became

available, the r ate o f emer gency

department visits for asthma has

remained relatively s table. **Figure 1** 

**. Current**  **asthma prevalence**  **among children**  **0–17 years**  **of age,**  **by state,**  **annual**

**average f**  **or the**  **p eriod**  **2001–2005**



### Current asthma prevalence rates a re generally higher in the Northeast r egion

( Figure 1 ). While it is tempting t o a ttribute p revalence patterns t o c limate o r a ir

quality

, many factors a f f ect prevalence and may also vary b y r egion. Some

examples include the likelihood that symptomatic children a re diagnosed accurately

with asthma (2), and population composition. For example, the Puerto Rican

population, in which asthma prevalence is highest, tends to be concentrated i n t he

Northeast r egion of the country (3).



### U.S. DEP AR TMENT OF HEAL TH AND HUMAN SER VICES

Centers for Disease Contr ol and Pr evention

National Center for Health Statistics

## 2 **Advance Data**  **No. 381**  + **December 12,**  **2006**

+ Hospitalization rates for asthma have

followed a trend similar to those in

asthma prevalence rates since 1980 and

also remain at historically high levels.

+ Asthma death r ates appear to have

declined recently following a rising

trend from 1980 through the m id1990s.



### Recent **p atterns**  **b y**  **a ge**  **and**

**race/ethnicity**

+ Asthma prevalence increases with

age, but health care use is highest

among the youngest children. Boys

have higher prevalence and death

rates compared with girls throughout

childhood.

+ Non-Hispanic b lack and Puerto Rican

children have higher prevalence rates

compared to non-Hispanic white

children. Moreover

, r ates in adverse

outcomes such as emer gency

department visits, hospitalizations,

and death a re substantially higher for

black children. The disparity in

asthma mortality between black and

white children has increased in recent

years.



### The **national p**  **icture of** 

**childhood asthma** 

A major frustration i n fighting

asthma is the mystery o f its

development. I t r emains unknown why

some people get the d isease and others

do not. Research has identified several

factors associated with the development

of asthma, but none have proven to be

the causative agent. Asthma is

characterized by episodes or attacks of

inflammation and narrowing of small

airways. Symptoms can include

shortness of breath, cough, wheezing,

and chest pain o r tightness, and are

triggered by a variety of things such as

aller gens (e.g., pollen, dust mites,

animal dander

, e tc.), infections, exercise,

changes in the weather

, and exposure t o

airway irritants ( e.g., t obacco smoke).

Some people have mild asthma; others

have severe and life-threatening attacks;

and some people may have attacks

ranging from m ild to severe ( 4). People

develop asthma at dif f erent stages of

their lives, and many subsequently cease

to have any symptoms (5). Most likely

, the d isease known as asthma is a spectrum o f conditions, and likewise,

the causes of asthma are a complex

interaction o f d if ferent factors. A

constellation o f causes is likely t o

gradually emer ge.

Asthma is a p riority for t he

research, medical, environmental, and

public health communities because:

+ Asthma is one of the l eading chronic

childhood diseases in the United

States (6) and a major cause of

childhood disability (7).

+ Asthma places a huge burden on

af

fected children and their f amilies:

asthma may limit a child’ s ability to

play

, l earn, and sleep; necessitates

potentially complex and expensive

interventions (8); and results in both

direct medical costs and indirect costs

(e.g., missed school days and work

days).

+ Childhood asthma prevalence more

than doubled from 1980 to the

mid-1990s (9;10) and remains at

historically high levels. The factors

driving t his pattern are s till not fully

understood.

+ The causes of asthma remain unclear

and current research paints a complex

picture ( 5).

+ Although there a re means to prevent

attacks or exacerbations among

children w ith asthma (1), the majority

of children w ith asthma still suf f er

from a ttacks (1 1).

+ The burden of avoidable emer gency

department visits and hospitalizations

for asthma is high and has remained

relatively r esistant to intervention

ef

forts (9,1 1).

+ Evidence of the i mpact of the

environment on asthma incidence and

morbidity—especially aller gens and

irritants such as cigarette smoke and

outdoor pollutants—has been

mounting ( 12).

This b rief r eport p resents overall trends

in childhood asthma over the past t wo

decades and examines the burden of

asthma through each stage of childhood

and among children o f d if ferent race

and ethnic g roups. While data f or

prevalence, health care u se, and

mortality are major indicators o f t he

impact of asthma on children, asthma

symptoms that are unrecognized or not severe enough to warrant emer gency

care o r hospitalization can still lower

quality of life. Part o f r ecent ef forts to

address the burden of asthma involves

developing methods to track symptoms

and disease management. When

available, these new sources of data w ill

provide greater insight into the burden

of asthma and the i mpact of intervention

ef

forts.

## 3 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**Asthma prevalence**  **rates**

**among children**  **remain a**  **t**

**historically high**  **levels**

**following dramatic**  **increases**

**from 1980**  **until the**  **l ate**  **1990s**

Currently

, t here a re no national

measures of asthma incidence, or the

rate at which people develop asthma

over a period o f time. Instead, we focus

on asthma prevalence, the percentage of

the population t hat has asthma at a

given point in time, and thus face the

risk o f suf fering symptoms and adverse

ef

fects o f t he disease. Prevalence is

important as it identifies t he population

in need of ef fective measures to control

asthma symptoms. Figure 2 shows the

trend in asthma prevalence since

1980. The major tracking system f or

asthma prevalence is the National

Health Interview Survey (NHIS), which

is used to produce annual health

estimates based on self r eport o f a

nationally representative sample. From

1980 to 1996, the NHIS measured

asthma period p revalence, that is, t he

percentage of people w ith asthma in the

past 12 months. In 1997, the NHIS

questionnaire was redesigned. Starting

in 1997, asthma prevalence estimates are

based on receiving an asthma diagnosis,

currently having the d isease at the time

of the i nterview

, and experiencing an

attack in the past year

. The new

measure t hat is most similar t o t he

previous measure o f asthma period

prevalence is current asthma

prevalence—the percentage of children

with asthma at the time o f t he health

interview

. An analysis o f NHIS data

before and after t he 1997 redesign

indicates that if the r edesign had not

been undertaken, the period p revalence

measurements would show a p lateau in

the l ate 1990s (13). That is, most of the

apparent jump between the 1996 asthma

period p revalence estimate from t he old

NHIS and the 2001 current asthma

prevalence estimate i s likely a ttributable

to the change in the NHIS questionnaire,

and not a substantial change in

prevalence. A s t h ma per i od pre v a l ence Li fe ti me as t h ma diag nosis

A s th ma a t tack pre v a lence Current asthma pre v a l enceSurvey redesign

SOURCE: CDC/NCHS, National Health Interview Survey

. 0 2 4 6 8 10 12 14

1980 1985 1990 1995 2000 2005Percent

**Figure 2** 

**. A**  **sthma prevalence**  **among children**  **0–17 years**  **of age**  **f or**  **measures of**  **asthma**

**prevalence available**  **in each**  **year**

**, United**  **States, 1980–2005** 



### + From 1980 to 1996, asthma period

prevalence among children 0–17

years o f age more t han doubled, from

3.6% in 1980 to 7.5% at the peak of

the trend in 1995.

+ Although not strictly comparable, the

most similar post-1997 measure i s

current asthma prevalence that has

been measured since 2001 and has

remained relatively s table since

then. Because current asthma

prevalence estimates are h igher than

pre-1997 asthma period p revalence

estimates, it may be tempting t o

conclude that asthma prevalence

continued to increase a fter

1996. However

, t he dif f erence

between asthma period p revalence

estimates and current asthma

prevalence estimates is likely due to

NHIS questionnaire changes (13).

Nonetheless, prevalence remains at

historically high levels. In 2005, 8.9%

of children currently had asthma (6.5

million children).

+ Asthma attack prevalence measures

the percentage of children who had at

least one attack over the past 1 2

months. It is a c rude estimate o f t he

percentage of symptomatic children

who may have poorly controlled

asthma, and thus are a t risk o f

adverse outcomes such as emer gency

department visits or hospitalization. In 2005, 5.2% of children had at least

one asthma attack in the p revious

year (3.8 million children). Nearly

two o f every t hree children who

currently have asthma had at least

one attack in the past 1 2 months.

+ Lifetime asthma diagnosis measures

the percentage of children who have

ever received a d iagnosis o f asthma.

It is a more general measure o f t he

impact of asthma among children.

Many of these children d o not

currently have asthma. In 2005,

12.7% of children had been

diagnosed with asthma at some point

in their lifetime ( 9 m illion children),

of whom 70% were r eported t o

currently have asthma (6.5 million).

+ Measures of asthma morbidity and

control a re available periodically

from t he NHIS. In 2003:

– Children w ith at least one asthma

attack (4 million) in the p revious

year missed an estimated 12.8 m illion

school days due to asthma.

– Among children w ith asthma, 39%

reported r eceiving an asthma

management plan from t heir health

care p rovider

, 57% reported being

taught how to monitor peak flow

, and

52% reported being advised t o

change things at home or in school to

improve asthma management.

## 4 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**Despite the**  **p lateau**  **in asthma** 

**prevalence, ambulatory**  **care**

**use h**  **as continued**  **t o**  **g row** 

**since 2000** 

Increasing rates o f v isits to

physician of fices and hospital outpatient

departments f or asthma may indicate

increasing prevalence or severity

, o r

reflect progress in addressing the burden

of asthma. Clinical practice guidelines

from t he National Asthma Education

and Prevention P rogram (1) r ecommend

that asthma symptoms be treated early

and aggressively

. These guidelines also

recommend that patients b e evaluated

for asthma severity

, i nitial treatment be

tailored t o severity level, and close

monitoring o f symptoms and adjustment

of therapy be continued over time. Poor

asthma outcomes such as

hospitalizations and deaths are a t l east

partially sensitive t o t he quality of

ambulatory health care ( 14). A n

appropriate frequency of outpatient

visits is one component of quality

ambulatory care. Managing asthma

involves close monitoring b y health care

professionals both when asthma

symptoms flare and when the d isease is

quiescent. Thus, trends in visits for

asthma in outpatient settings reflect a

spectrum o f r easons for making visits to

the doctor for asthma ( Figure 3 )

. V

i sits to physician of fices are

measured by the National Ambulatory

Medical Care Survey (NAMCS),

administered in 1980–1981, 1985, and

continuously s ince 1989. In 1992, the

National Hospital Ambulatory Medical

Care Survey (NHAMCS) began to

provide data o n v isits to hospital

outpatient departments. Information i s

obtained on visit events r ather than the

number of people who went to see

physicians. SOURCES: CDC/NCHS, National Ambulatory Medical Care Survey , National Hospital Ambulatory Medical Care Survey

. 0 20 40 60 80 100

1980 1985 1990 1995 2000Visitsper1,000 P h y s i c i a n of f i c e H o s p i t al out p at i ent To t a l

**Figure 3** 

**. Number**  **o f**  **a mbulatory**  **visits for**  **asthma per**  **1,000 children**  **0–17 years**  **of age,**  **by**

**site, United**  **States, 1980–2004** 



### + The periodic data available from

1980 to 1990 show a r elatively stable

rate of visits for asthma to physician

of

fices. S ince the early 1990s, there

has been an increase i n v isit rates.

The temporary i ncrease in 1998

appears t o b e due to random

variation.

+ The majority of nonur gent ambulatory

visits for a sthma occur in physician

of

fices. I n 2004, there were 8 9 v isits

to physician of fices per 1,000

children ( 6.5 m illion v isits) and 6 per

1,000 children ( 0.5 m illion v isits) to

hospital outpatient departments, a

total o f 9 5 v isits per 1,000 children,

or 7 m illion ambulatory v isits for

asthma. Just over 2.5% of all

ambulatory v isits among children

0–17 years o f age made in 2004 were

for asthma. + Ambulatory care use has continued to

increase a fter 2000 despite a p lateau

in prevalence trends. Factors d riving

this upward trend may include

increasing d isease s everity

, and

increased health care u se to improve

asthma control due to increased

public and provider awareness.

Increased ambulatory care use for

asthma has continued during a n e ra

when overall r ate o f ambulatory care

use f or children d id not increase (15).

## 5 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**Since 1992,**  **when d**  **ata first** 

**became available,**  **the rate**  **o f**  140



### emergency **department visits** 

120 

### for **asthma h**  **as remained** 

**relatively s**  **table** 100



### Asthma attacks or exacerbations are

frequently managed in emer gency

departments ( EDs). Having an asthma

attack that warrants a v isit to the E D

may be a s ign o f severe asthma orVisitsper10,000

80

60

40



### uncontrolled d isease, inadequate access

to specialist health care, or inappropriate

use of emer gency services (16,17).

Recurrent ED visits and hospitalizations

are risk f actors f or fatal asthma attacks

(18). I n t heory

, asthma symptoms and

poor outcomes are avoidable w ith

implementation o f environmental control

measures to minimize exposure t o

aller gens and irritants, appropriate

medication use, and patient and health

care p rovider education ( 1). However

, recognizing the early signs and

symptoms of the d isease, avoiding

asthma triggers, arranging appropriate

health care, and managing the schedule

of medication administration can be

complex for children and their f amilies.

Indeed, evidence shows that children

who visit t he ED for asthma continue to

suf fer from symptoms and activity

limitations despite having the health

encounter in the E D ( 19). T rends in ED

visits ( Figure 4 ) a re a c rude indicator of

the burden of severe and uncontrolled

disease on families and the health care

system, the i mpact of public health

interventions, the degree of uptake of

asthma guidelines in disease

management, and the successful

translation o f r esearch into medical

practice.

Data o n E D v isits are collected by

the National Hospital Ambulatory

Medical Care Survey (NHAMCS),

administered since 1992. Information i s

available f or visit events r ather than the

number of people who visited EDs. 20

0

1992 1994 1996 1 998 2 000 2 002 2 004

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey

.

**Figure 4** 

**. Number**  **o f**  **visits to**  **emergency departments**  **for asthma**  **per 10,000**  **children 0–17** 

**years of**  **age, United**  **States, 1992–2004** 



### + From 1992 to 2004, there i s n o + In 2004, there were 103 visits per

consistent trend in the r ate o f E D 10,000 children, for a t otal of

visits for children. There appears t o 750,000 visits to EDs for asthma.

be an increase i n r ates until the l ate Asthma ED visits represented about

1990s followed by a p lateau after 2.8% of all E D v isits among children

1999. 0–17 years o f age in 2004.

## 6 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**Hospitalization rates**  **for**

40 

### asthma **h ave**  **followed a**  **trend**

**similar t**  **o t**  **hose i**  **n asthma** 

**prevalence rates**  **since 1980** 

30Hospitalizations per 10,000



### and **a lso**  **remain a**  **t h**  **istorically**

**high levels** 

An asthma hospitalization r epresents

a severe exacerbation t hat requires a n

increased level of monitoring and care.

It also represents s ignificant costs to the

health care system and to af fected

families. Risks for hospitalization f or

asthma include previous asthma 20

10



### admissions, previous intubation f or

asthma, and severe symptoms (20). I n

theory

, hospitalizations for asthma

should b e l ar gely p reventable i f patients

and their f amilies a re adequately

educated about the d isease and have

access to high quality health care ( 14).

Although some hospitalizations may not

be avoidable, especially in very young

children suf fering from r espiratory

infections, trends in hospitalization over

time ( Figure 5 ) can help determine if

intervention and management strategies

are having an impact on the burden of

disease.

The National Hospital D ischar ge

Survey (NHDS) collects i nformation o n

hospitalizations. The NHDS counts

events ( hospitalizations) rather than the

number of people who are admitted t o

hospitals. A lthough some of the

hospitalizations for asthma may be

re-admissions, research suggests t hat

re-admissions are not driving t he overall

pattern for asthma (21). 0

1980 1985 1990 1995 2000

SOURCE: CDC/NCHS, National Hospital Discharge Survey

.

**Figure 5** 

**. Number**  **o f**  **hospitalizations for**  **asthma per**  **10,000 children**  **0–17 years**  **of age,** 

**United States,**  **1980–2004**



### + From 1980 through the m id-1990s,

asthma hospitalization r ates increased

for children 0–17 years o f age. This

pattern follows that for p revalence,

although there i s evidence that

improved diagnosis o f asthma also

contributed to the i ncrease i n

hospitalizations attributed to asthma

(9). Since the l ate 1990s, it appears

that the a sthma hospitalization r ate

among children p lateaued at

historically high levels.

+ In 2004, there were 2 7

hospitalizations for a sthma per 10,000

children f or a t otal of 198,000 hospitalizations. A sthma

hospitalizations represented about 3%

of all hospitalizations among children.

+ Many factors d rive hospitalization

rates among children. Overall

hospitalization u se among children

has decreased over the time period

when asthma hospitalization r ates

remained level (22). The threshold o f

attack severity for a hospital

admission has likely i ncreased. That

is, asthma hospitalizations in recent

years may represent more s evere

exacerbations compared with earlier

years.

## 7 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**Asthma death**  **rates appear**  **to**

**have declined**  **recently** 5



### following **a r**  **ising t**  **rend f**  **rom**

**1980 through**  **the m**  **id-1990s** 4



### Asthma deaths among children a reDeathsper1,000,000



### rare but potentially avoidable. Children

most at risk o f dying from a sthma are

those with severe, uncontrolled d isease,

a near -fatal a ttack of asthma, a h istory

of recurrent hospitalization o r i ntubation 3

2ICD Revision 19991



### for asthma (18). T rends in asthma 1



### deaths ( Figure 6 ) a re a s tark indicator of

how well t he disease is diagnosed and

controlled.

Information o n deaths occurring i n

the U .S. i s collected by the Mortality

Component of the National V ital

Statistics System. The National Center

for Health Statistics compiles

information abstracted by each state

from death r ecords.



### The **impact of**  **asthma varies** 

**through the**  **s tages**  **o f** 

**childhood; prevalence** 

**increases with**  **age, but**  **health**

**care use**  **i s**  **h ighest**  **among the** 

**youngest children** 

The profile of asthma changes as

children get older

, a s shown in T able A

. In general, when asthma burden is

examined over the s tages of childhood,

trends in levels o f health care w ith age

are i nversely r elated to trends in

prevalence rates. Understanding the

characteristics o f asthma in each stage

of childhood helps to explain t his

pattern.

Wheezing is common among infants

and toddlers because their small a irways

are more susceptible to any mechanism

that impedes airflow

, and they have a

high incidence of respiratory infections.

Definitively d iagnosing asthma in

infants and toddlers can be dif ficult

given the many etiologies that cause

wheezing in very young children.

Furthermore, young children who

wheeze only during r espiratory

infections are likely t o have transient

symptoms (5,23–25). This pattern may

make clinicians reluctant to label

wheezing as a chronic d isease among

young children. However

, r espiratory

distress in young children can rapidly

become life threatening and warrants

prompt attention. For this reason, 0

1980 1985 1990 1995 2000 2004

1 Beginning with data year 1999, cause-of -death statistics published by NCHS are classified according to

the T e nth Revision of the International Classification of Diseases (ICD

- 10).

SOURCE: CDC/NCHS, Mortality Component of the National Vital Statistics System.

**Figure 6** 

**. Number**  **o f**  **d eaths**  **due to**  **asthma per**  **1,000,000 children**  **0–17 years**  **of age,** 

**United States,**  **1980–2004**



### + From 1980 to 1998, death r ates for deaths among children has apparently

asthma climbed steadily

. I n 1999, the declined.

change from t he International + In 2004, the r ate o f a sthma deaths

Classification o f D iseases Ninth was 2.5 a sthma deaths per 1 m illion

Revision (ICD-9) to the International children, a t otal of 186 asthma

Classification o f D iseases T enth deaths.

Revision (ICD-10) codes for cause o f

death r esulted i n a n overall 1 1

percent decline i n deaths attributed to

asthma. The coding change therefore

accounts f or much of the decrease i n

rates from 1998 to 1999. From 1999

onward, however

, t he rate of asthma

**T**

**a ble**  **A**

**. A**  **sthma prevalence,**  **health care**  **use, and**  **mortality among**  **children 0–17**  **years of** 

**age, by**  **age g**  **roup and**  **sex, United**  **States, 2003–2005** 

Current asthma Emergency Hospital

prevalence, 1 Ambulatory department discharges Deaths per

percent visits 2 per 1,000 visits per per 10,000 1,000,000

Age and sex (2004–2005) (2003–2004) 10,000 (2003–2004) (2003–2004) (2003–2004)

0–4 years

.......... 6

. 2 121.1 163.7 61.3 2 .0

M a l e

............ 7

. 4 160.3 199.6 77.0 2 .9

F e m a l e

.......... 5

. 0 8 0

. 0 126.2 44.9 1 .1

5–10 years

.......... 9

. 3 8 0

. 2 8 2

. 6 2 3

. 6 2

. 3

M a l e

............ 1 1

. 1 8 6

. 5 9 1

. 8 3 1

. 3 2

. 9

F e m a l e

.......... 7

. 4 7 3

. 7 7 2

. 8 1 5

. 6 1

. 6

1 1–17 years

......... 1 0

. 0 7 6

. 9 6 9

. 0 1 1

. 8 3

. 3

M a l e

............ 1 1

. 1 7 1

. 8 6 3

. 5 1 3

. 3 4

. 0

F e m a l e

.......... 8

. 8 8 2

. 2 7 4

. 8 1 0

. 2 2

. 5

T o t a l

.............. 8

. 7 9 0

. 0 9 9

. 2 2 9

. 1 2

. 6

1 Current asthma prevalence e stimates are based on the questions ‘ ‘ Has a doctor o r o ther health professional ever told you that

{child’ s name} had asthma?’ ’ and ‘ ‘ Does {child’ s name} still have asthma?’ ’

2 Includes visits to physician of fices and hospital outpatient departments.

DA

T A SOURCES: CDC/NCHS: National Health Interview S urvey

, National Ambulatory M edical Care Survey

, N ational Hospital

Ambulatory M edical C are S urvey

, National Hospital D ischarge Survey

, and the M ortality Component of the N ational V ital

Statistics S ystem.

## 8 **Advance Data**  **No. 381**  + **December 12,**  **2006**

utilization o f emer gency department

(ED) and hospital services for asthma is

high among this group.

Among school-age children,

aller g ies/atopic sensitization s tarts to

become a more p rominent cause o f

wheezing, and displaces respiratory

infections as a main trigger of attacks

(5,24). The emer gence of more c learly

identifiable and predictable s ymptoms in

school-age children a llows easier

identification and management of

asthma compared with younger children.

Families, health care p rofessionals, and

schools who work well t ogether can

successfully control symptoms.

However

, f amilies coping with other

factors t hat can interfere with good

asthma management may be less

successful.

Adolescents w ith asthma need to

learn t o r ecognize and treat symptoms

independently

. I ssues with emer ging

autonomy may accentuate good

management strategies, or exacerbate

problems with asthma control. The

relatively l ow level of health care u se

for asthma among adolescents may

indicate a combination o f patterns

among this group: changes in disease

severity

, h igher success in controlling a

chronic d isease, or lack of medical

attention and poor use of medication t o

relieve symptoms. Of particular concern

for adolescents i s t he higher rate of

asthma deaths in this group compared

with younger children.

The pattern over childhood dif f ers

for boys and girls. Boys experience a

higher current asthma prevalence rate

throughout most of childhood. By ages

15–17 years, however

, t he current

prevalence rate in girls, 10.5%, has

surpassed that among boys, 10.1%.

Higher prevalence among females

persists among adults. Use of

ambulatory and hospital health care

services through age 10 years i s h igher

among boys. During adolescence,

however

, ambulatory care u se is greater

among 1 1–17 year old g irls compared

with boys. Hospitalization r ates among

adolescent boys, however

, r emain

slightly higher

. Asthma death r ates

among boys remain h igher throughout

childhood. Death r ates rise between

school-age and adolescent groups among

both genders. 11-17 years

5-10 years

0-4 years Deaths 2003-2004

Hospitalizations 2003-2004

Emergency department

visits 2003-2004

Current prevalence 2004-2005

0% 100% 200%

Proportional impact relative to all children ages 0-17 years

SOURCES: CDC/NCHS, National Health Interview Survey , National Ambulatory Medical Care Survey

, National Hospital Ambulatory Medical Care Survey , and the Mortality Component of the National Vital Statistic System.

**Figure 7** 

**. The**  **proportional i**  **mpact of**  **asthma prevalence,**  **health care**  **use, and**  **mortality**

**among children**  **0–17 years**  **of age,**  **by age**  **g roup,**  **United States,**  **2003–2005**



### T

o better illustrate the i mpact of

asthma across age groups, the

prevalence, health care u se, and death

rates f or each group are compared with

the r ates for a ll children i n Figure 7 to

show all outcomes on the s ame scale.

The 100 percent level represents t he

overall r ate f or children 0–17 years f or

each measure, and is shown by the

vertical line. Each bar on the chart

represents t he proportional impact of

each outcome for each age group

relative t o t he total f or all children ages

0–17 years ( e.g., t he proportional impact

of current asthma prevalence rates

among children 0–4 years i s 6 .2% over

the t otal prevalence for a ll children,

8.7%, for a p roportional impact of

71%). Children 0–4 years have the

lowest proportional impact of

prevalence. However

, t he proportional

impact of ED visit and hospitalization

rates f or asthma among the youngest

children overshadows that among older

age groups. Unlike younger children,

the p roportional impact of mortality

from asthma among adolescents i s

higher than that for health care u se. 

### Racial **disparities i**  **n c**  **hildhood**

**asthma are**  **extensive; black** 

**and Puerto**  **R ican**  **children have** 

**high prevalence**  **rates, and** 

**black children**  **have**

**dramatically higher**  **m ortality** 

**rates compared**  **with white** 

**children**

The higher rates o f a sthma

prevalence, ED visits, hospitalizations

and deaths among minority children

have been well documented (9,26–

28). Racial disparities r emained evident

in asthma prevalence through 2005

( T

able B )

. Children o f American Indian

or Alaska Native decent have current

asthma prevalence rates 25% higher and

black children 60% higher than white

children. Asian children have the l owest

prevalence rates. When race and

ethnicity are considered, Puerto Rican

children have the h ighest p revalence of

all g roups, 140% higher than nonHispanic white children, whereas

Mexican children have low r eported

rates. In light of these d if fering

prevalence rates, the l ower rate for

ambulatory care v isits among black

children compared with white children

suggests t hat black children may be

underutilizing ambulatory care.

Considering t he evidence that minority

children d o not receive the s ame level

and quality of ambulatory health care

## 9 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**T**

**a ble**  **B**

**. A**  **sthma prevalence,**  **health care**  **use, and**  **mortality among**  **children 0–17**  **years of**  **age, by**  **race and**  **ethnicity**

**, United**  **States,**

**2003–2005**

Emergency

Current Ambulatory department Hospital

prevalence 1

, visits 2 per visits per discharges Deaths per

percent 1,000 10,000 per 10,000 1,000,000

Race and ethnicity (2004–2005) (2003–2004) (2003–2004) (2003–2004) (2003–2004)

Race only

W h i t e

.............................. 7

. 9 9 4

. 8 7 3

. 0 1 6

. 9 1

. 5

B l a c k

.............................. 1 2

. 8 7 6

. 4 263.7 59.2 9 .0

American Indian or Alaska Native

............. 9

. 9 * * * *

A s i a n

.............................. 4

. 9 * * * *

Race/ethnicity

Hispanic

............................ 7

. 8 8 3

. 3 108.1 * * 1 .8

P u e r t o R i c a n

......................... 1 9

. 2 * * * * * * *

M e x i c a n

............................ 6

. 4 * * * * * * 1

. 7

Non-Hispanic w hite

..................... 8

. 0 100.2 65.8 * * 1 .3

Non-Hispanic b lack

..................... 1 2

. 7 7 1

. 5 251.6 * * 9 .2

T o t a l

............................... 8

. 7 9 0

. 0 9 9

. 2 2 9

. 1 2

. 6

* E stimates are c onsidered unreliable. For ambulatory v isit rates, emergency department visit r ates and hospital d ischarge rates, the r elative s ta ndard e rror o f t he estimate i s g reater than 30%. For

death r ates, r ates based on a number of deaths fewer t han 20 are not shown.

** Data not available.

1 Current asthma prevalence e stimates are based on the questions ‘ ‘ Has a doctor o r o ther health professional ever told you t hat {child’ s name} had asthm a?’ ’ and ‘ ‘ Does {child’ s name} still have

asthma?’ ’

2 Includes visits to physician of fices and hospital outpatient departments.

DA

T A SOURCES: CDC/NCHS: National Health Interview S urvey

, National Ambulatory M edical C are S urvey

, National Hospital A mbulatory M edical C are S ur vey

, National Hospital D ischarge Survey

, and the M ortality Component of the N ational V ital S tatistic System.



### for asthma (29,30), t he disparity in

ambulatory care use may contribute t o

the d isparities i n E D use,

hospitalization, and death. The racial

disparities i n t hese adverse asthma

outcomes are much greater than those in

asthma prevalence. Compared with

white children, black children have a

260% higher ED visit r ate, a 250%

higher hospitalization r ate, and a 500%

higher death r ate from asthma.

Unfortunately

, information about

race/ethnicity and income are not

consistently available across the health

care data systems used to measure t he

impact of asthma.

Figure 8 illustrates t he impact of

these disparities b y comparing t he rates

for asthma prevalence, health care u se,

and death f or each group to the t otal

rate to show all outcomes on the same

scale. The 100 percent level represents

the overall r ate f or children 0–17 years

for each measure and is shown by the

vertical line. Only t hose groups with

data available f or all i ndicators a re

shown. The proportional impact of

prevalence is highest among nonHispanic b lack children. However

, disparities i n adverse asthma

outcomes—ED visits and deaths—are 0% 100% 200% 300% Hispanic Non-Hispanic white Non-Hispanic black

Deaths 2003-2004

Emergency department

visits 2003-2004

Current prevalence 2004-2005

SOURCES: CDC/NCHS, National Health Interview Survey , National Ambulatory Medical Care Survey , National Hospital

Ambulatory Medical Care Survey

, and the Mortality Component of the National Vital Statistic System. Proportional impact relative to all children ages 0-17 years

**Figure 8** 

**. The**  **proportional i**  **mpact of**  **asthma prevalence,**  **health care**  **use a**  **nd mortality** 

**among children**  **0–17 years**  **of age,**  **by race**  **and ethnicity** 

**, United**  **States, 2003–2005** 



### much higher

. The pattern for t he

Hispanic g roup is similar t o nonHispanic white children, although

grouping all H ispanic subgroups

together masks the possible varied

patterns f or Puerto Rican and Mexican

children.

## 10 **Advance Data**  **No. 381**  + **December 12,**  **2006**

12 8

7

Black 10

6Deaths per 1,000,000 8Black/white ratio 5

4

3 6

4

Total

2

2

White 1

0 0

1999 2000 2 001 2002 2 003 2 004 1999 2000 2001 2002 2003 2004

SOURCE: CDC/NCHS, Mortality Component of the National Vital Statistics System.

**Figure 9**  **a (left).**  **Number o**  **f d**  **eaths due**  **to asthma**  **per 1,000,000**  **children 0–17**  **years of**  **age**

**by race,**  **United States,**  **1999–2004**

**Figure 9**  **b (right).**  **Ratio of**  **black to**  **white asthma**  **death rates,**  **children 0–17**  **years,**

**United States,**  **1999–2004**



### Figures 9a and 9b present recent

trends in asthma death r ates for b lack

children and white children. Although

overall asthma death r ates have declined

since 1999 ( Figure 9 a ), this pattern is

not observed for b lack children among

whom death r ates remained relatively

level. A s a r esult, the b lack and white

disparity for asthma deaths has

increased since 1999 as measured by the

ratio of the b lack rate to the white rate

( Figure 9 b )

. The lack of progress among

black children i n l owering mortality

from asthma may reflect a number of

factors such as more severe d isease,

greater environmental obstacles (e.g.,

residence in more polluted o r h igh

poverty areas), l ag in uptake of medical

advances to control asthma symptoms

among health care p roviders who treat

black children, and lack of asthma

education o r d if ficulties i n adopting

certain asthma control methods by black

families.



### Summary

The lar g e i ncreases in the burden of

childhood asthma seen in the 1980s

until the l ate 1990s appear to have

abated in recent years. Y e t, the burden

remains at the h ighest levels r ecorded

for a ll measures except mortality

. The

decrease in asthma death r ates among

children s ince 1999 is encouraging, and may signal the accomplishments o f t he

many diverse groups working to lighten

the burden of asthma. However

, a sthma

deaths are t heoretically preventable, and

black children have not experienced a

decrease i n a sthma mortality

. Furthermore, the measures presented in

this report r eveal only part o f t he burden

of asthma for children and their

families, especially because t he

measures used rely on a physician

accurately d iagnosing asthma and either

relaying this information t o t he child’ s

family (prevalence measures) o r

documenting t he condition i n medical

records (health care u se). The most

current data s how that the challenges of

childhood asthma remain and that

asthma persists as a s ignificant public

health problem.

## 11 **Advance Data**  **No. 381**  + **December 12,**  **2006**



# References

1. National Heart L ung and Blood

Institute. N ational Asthma Education

and Prevention P rogram Expert P anel

report 2 : G uidelines for t he diagnosis

and management of asthma. N IH

Report N o.: 97–4051. 1997.

2. Akinbami L J, Rhodes JC, L ara M

. Racial and ethnic d if ferences in

asthma diagnosis among children

who w heeze. Pediatrics 1 15(5):1254–

60. 2005.

3. Sutton P D, Mathews T J. Birth and

fertility rates b y H ispanic o rigin

subgroups: U nited S tates, 1990 and

2000. National Center for H ealth

Statistics. V ital H ealth Stat 21(57).

2006.

4. Cairns CB. Acute a sthma

exacerbations: phenotypes and

management. C lin Chest M ed

27(1):99–108. 2006.

5. Reed CE. The natural history o f

asthma. J Aller g y C lin Immunol

1 18(3):543–8. 2006.

6. Adams P F

, Hendershot GE. C urrent

estimates from t he National Health

Interview S urvey

, 1996. V ital H ealth

Stat 10(200). N ational Center for

Health Statistics. 1999.

7. Newacheck PW

, H alfon N

. Prevalence, impact, and trends in

childhood disability due to asthma.

Arch Pediatr A dolesc M ed

154(3):287–93. 2000.

8. W illiams DM. C onsiderations in the

long-term management of asthma in

ambulatory patients. Am J H ealth

Sys Pharm 63(10 Suppl 3):S14–S21.

2006.

9. Akinbami L J, Schoendorf K C.

T

r ends in childhood asthma:

prevalence, health care u tilization,

and mortality

. P ediatrics 1 1 0 ( 2 P t 1 )

:315–22. 2002.

10. Mannino DM, H oma D M, Akinbami

LJ, M oorman J E, Gwynn C, Redd

SC. S urveillance for a sthma—United

States, 1980–1999. MMWR S urveill

Summ. 51(1):1–13. 2002.

1 1

. N ational Center for H ealth Statistics,

Centers f or Disease C ontrol and

Prevention. Asthma prevalence,

health care u se and mortality

, 2003–2005. A vailable from http://

www .cdc.gov/nchs/products/pubs/

pubd/hestats/asthma03-05/asthma03­

05.htm

. A ccessed N ovember 29,

2006.

12. Gilmour MI, J aakkola M S, London

SJ, N el AE, R ogers C A. How

exposure t o environmental tobacco smoke, outdoor air pollutants, and the f irst six years o f life. The G roup

increased pollen burdens influences Health Medical Associates. N Engl J

the i ncidence of asthma. E nviron Med 332(3):133–8. 1995.

Health Perspect 1 14(4):627–33. 2006. 24. W r ight AL. E pidemiology of asthma

13. Akinbami L J, Schoendorf K C, Parker and recurrent wheeze in childhood.

J. US childhood asthma prevalence Clin Rev A ller g y I mmunol 22(1):33–

estimates: t he Impact of the 1997 44. 2002.

National Health Interview S urvey 25. Eggleston P A, Diette G, Lipsett M

, redesign. Am J E pidemiol 158(2):99– Lewis T

, e t a l. Lessons learned for

104. 2003. the s tudy of childhood asthma from

14. Homer C J, Szilagyi P

, Rodewald L

, the C enters f or Children’s

Bloom SR, et al. D oes quality of Environmental Health and Disease

care a f f ect rates o f hospitalization f or Prevention R esearch. Environ H ealth

childhood asthma? P ediatrics Perspect 1 13(10):1430–6. 2005.

98(1):18–23. 1996. 26. Grant EN, W agner R, W e iss K B.

15. Hing E, Cherry DK, W oodwell DA. Observations on emer ging patterns o f

National Ambulatory M edical Care asthma in our society

. J A ller g y C lin

Survey: 2004. Advance data from Immunol 104(2 P t 2 ):S1–S9. 1999.

vital and health statistics; no 374. 27. Halterman JS, A ligne CA, A uinger P

, National Center for H ealth Statistics. McBride J T

, Szilagyi PG. I nadequate

Hyattsville, M D. 2006. therapy for a sthma a mong children i n

16. Halfon N, Newacheck PW

, W ood the U nited S tates. Pediatrics 105(1 P t

DL, S t P eter RF

. R outine e mer gency 3):272–6. 2000.

department use f or sick care b y 28. Schwartz J, Gold D, Dockery D W

, children i n t he United S tates. W e iss S T

, Speizer FE. Predictors o f

Pediatrics 98(1):28–34. 1996. asthma and persistent wheeze in a

17. Shields A E, Comstock C, W e iss K B. national sample of children i n t he

V

a riations in asthma care b y United S tates. Association w ith social

race/ethnicity among children class, perinatal events, and race. Am

enrolled i n a s tate Medicaid p rogram. Rev R espir D is 142(3):555–62. 1990.

Pediatrics 1 13(3 P t 1 ):496–504. 29. Halfon N, Newacheck PW

. 2004. Childhood asthma and poverty:

18. McFadden ER, Jr

., W a rren EL. dif f erential i mpacts and utilization o f

Observations on asthma mortality

. health services. P ediatrics 91(1):56–

Ann I ntern M ed 127(2):142–7. 1997. 61. 1993.

19. Lenhardt RO, C atrambone CD, 30. Akinbami L J, LaFleur BJ,

McDermott M F

, W a lter J

, W illiams Schoendorf K C. Racial and income

SG, W eiss KB. I mproving pediatric disparities i n childhood asthma in the

asthma care t hrough surveillance: the United S tates. Ambul Pediatr

Illinois e mer gency department 2(5):382–7. 2002.

asthma collaborative. Pediatrics

1 17(4 P t 2 ):S96–S105. 2006.

20. Pollack CV

, J r

. , P ollack ES, Baren

JM, S mith SR, et al. A prospective

multicenter study of patient factors

associated with hospital admission

from t he emer gency department

among children w ith acute a sthma.

Arch Pediatr A dolesc M ed

156(9):934–40. 2002.

21. T o T

, Dick P

, Feldman W

, H ernandez

R. A cohort s tudy on childhood

asthma admissions and readmissions.

Pediatrics (2 Pt 1):191–5. 1996.

22. DeFrances CJ, P odgornik M N. 2004

National Hospital D ischar ge Survey

. Advance data from v ital and health

statistics; no 371. National Center for

Health Statistics. Hyattsville, M D.

2006.

23. Martinez FD, W right AL, T aussig

LM, H olber g C J, Halonen M,

Mor gan WJ. A sthma and wheezing in

## 12 **Advance Data**  **No. 381**  + **December 12,**  **2006**



# T

**echnical Notes** 

**Asthma prevalence**  **data**

Prevalence data were obtained from

the National Health Interview Survey

(NHIS), a c ross-sectional household

interview survey of the U .S. c ivilian

noninstitutionalized population.

Excluded are patients i n l ong-term care

facilities, Armed Forces active duty

personnel (although dependents a re

included), and U.S. nationals living i n

foreign countries. NHIS i nterviewing is

continuous throughout each year

, and

follows a multistage area probability

design that permits the r epresentative

sampling o f households. From each

family in the NHIS, one sample adult

and, for f amilies w ith children under 18

years o f age, one sample child are

randomly selected to participate i n t he

detailed health survey

. A responsible

adult, usually a parent, r eports in proxy

for t he sample child.

NHIS obtains information o n

illnesses, injuries, activity limitation,

chronic conditions, health insurance

coverage, utilization o f health care,

other health topics, demographic

information, and risk f actor data. Special

modules and supplements f ocus on

dif f erent issues each year

. Additional

questions about asthma were most

recently included in the 2002 and 2003

NHIS.

NHIS has been conducted annually

since 1957. In 1997, the questionnaire

was redesigned and some basic concepts

were changed and other concepts were

measured in dif f erent ways. Also in

1997, the collection methodology

changed from paper and pencil

questionnaires t o computer -assisted

personal interviewing. Since 1997, the

annual sample has numbered about

100,000 persons with about 30,000

persons participating i n t he sample adult

and about 15,000 persons in the sample

child questionnaires. In recent years, the

total household r esponse rate was about

90%.

National estimates from NHIS a re

produced by using the sample weights.

Because the sample weights i ncorporate

U.S. Census estimates of the c ivilian

noninstitutionalized population, no denominators a re necessary to compute

percentages.

For More I nformation: See the

NHIS website at: http://www .cdc.gov/

nchs/nhis.htm

.



### Physician **office v**  **isit data** 

Data o n asthma visits to physician

of

fices are obtained from t he National

Ambulatory Medical Care Survey

(NAMCS), a national survey designed to

provide information about the p rovision

and use of medical care s ervices in

of

fice-based physician practices in the

U.S. The survey covers patient

encounters i n t he of fices of nonfederally

employed physicians classified b y t he

American Medical Association o r

American Osteopathic Association a s

‘ ‘ of fice-based, patient care’ ’ physicians.

Excluded are v isits to hospital-based

physicians, v isits to specialists in

anesthesiology

, pathology

, and radiology

, and visits to physicians who are

principally engaged in teaching,

research, or administration. T e lephone

contacts and nonof fice v isits are a lso

excluded. A multistage probability

design i s employed. The final stage

involves systematic random samples of

of

fice v isits during r andomly assigned

7-day reporting periods. In 1985 the

survey excluded Alaska and Hawaii.

Data a re collected from medical

records on type of providers s een;

reason for v isit; diagnoses; d rugs

ordered, provided, or continued; and

selected procedures and tests ordered or

performed during t he visit. Patient data

include age, sex, race, and expected

source of payment.

The NAMCS, which began in 1973,

was conducted annually until 1981,

again i n 1985, and resumed an annual

schedule i n 1989. In 2004, 1,961

physicians were i n scope and 1,372

participated for a r esponse rate of 65%.

Data were p rovided for 25,286 visits.

National estimates of the number of

asthma visits were calculated using

survey weights. T o obtain v isit rates f or

a g roup, national estimates of the

number of visits were d ivided by the

civilian noninstitutionalized population

for t hat group (see s ection o n population

estimates). For More I nformation: See the Ambulatory Health Care Data

website at: http://www .cdc.gov/nchs/

about/major/ahcd/ahcd1.htm

.



### Hospital **outpatient and** 

**emergency department**  **visit**

**data**

V

isit data t o hospital outpatient

departments ( OPDs) and emer gency

departments ( EDs) were obtained from

the National Hospital Ambulatory

Medical Care Survey (NHAMCS) that

collects data o n t he utilization and

provision o f medical care services

provided in hospital OPDs and

EDs. The survey is a r epresentative

sample o f v isits to EDs and OPDs of

nonfederal, s hort-stay

, or general

hospitals. T e lephone contacts a re

excluded. In the NHAMCS OPD

survey

, a c linic is defined as an

administrative unit o f t he OPD in which

ambulatory medical care i s p rovided

under the s upervision o f a physician. If

a hospital OPD has five o r f ewer

in-scope clinics, all a re included in the

sample. For hospital OPDs with more

than five c linics, a s ystematic sample o f

clinics p roportional to size i s i ncluded in

the survey

. V isits to eligible EDs and

OPDs are s ystematically sampled over

the 4 -week reporting period s uch that

about 100 ED encounters and about 200

OPD encounters a re selected.

Data a re collected from medical

records on type of providers seen;

reason for v isit; diagnoses; d rugs

ordered, provided, or continued; and

selected procedures and tests performed

during t he visit. Patient data i nclude

age, sex, race, and expected source of

payment.

Annual data collection began in

1992. In any given year

, t he hospital

sample consists of approximately 500

hospitals, of which 80 percent have EDs

and about half have eligible OPDs.

T

ypically

, about 1,000 clinics a re

selected from participating hospital

OPDs. I n 2004, the hospital r esponse

rate was 89% for EDs and 75% for

OPDs.

Sample data a re weighted to

produce national estimates. T o obtain

visit r ates for a g roup, national estimates

of number of visits were d ivided by the

## 13 **Advance Data**  **No. 381**  + **December 12,**  **2006**

civilian population f or that group (see

section o n population estimates).

For More I nformation: See the

Ambulatory Health Care website at:

http://www .cdc.gov/nchs/about/major/

ahcd/ahcd1.htm

.



### Hospital **d ischarge**  **v isit**  **data**

Data o n asthma hospital d ischar ges

were obtained from t he National

Hospital D ischar ge Survey (NHDS) that

collects and produces national estimates

on characteristics o f i npatient stays in

nonfederal short-stay hospitals in the

U.S. Included in the survey are

hospitals with an average length o f s tay

of less than 30 days for a ll inpatients,

general hospitals, and children’ s general

hospitals. Excluded are f ederal, m ilitary

, and Department of V e terans Af fairs

hospitals, a s well a s hospital units of

institutions (such as prison hospitals),

and hospitals with fewer than six beds

staf fed f or patient use. T w o data

collection p rocedures are used in the

survey

. One is a manual system of

sample selection and medical

transcription from t he hospital r ecords to

abstract forms. The second is an

automated system in which the National

Center for Health Statistics purchases

machine-readable medical record data

from commercial or ganizations, s tate

data systems, hospitals, o r hospital

associations.

Patient information collected

includes demographics, length o f stay

, diagnoses, and procedures. Hospital

characteristics collected include

geographic r egion of the country

, ownership, and bed size.

The NHDS has been conducted

annually since 1965. Hospitals are

selected using a modified t hree-stage

stratified design. For 2004, the sample

consisted of 501 hospitals, o f which 439

responded. Data were collected for

approximately 371,000 dischar ges.

Sample data a re weighted to

produce national estimates. T o obtain

hospitalization r ates for a g roup,

national estimates of hospitalizations

were d ivided by the c ivilian population

of that group (see section o n population

estimates). For More I nformation: See

the National Health Care Survey website

at: http://www .cdc.gov/nchs.nhcs.htm

. 

### Mortality **data**

Data o n deaths are obtained from

the Mortality Component of the

National V ital S tatistics System ( NVSS)

that collects and publishes of ficial

national statistics o n b irths, deaths, and

fetal deaths based on U.S. Standard

Certificates. V ital events occurring i n

the U .S. t o non-U.S. residents and vital

events occurring abroad to U.S.

residents a re excluded. By law

, the

registration o f deaths is the

responsibility of the f uneral director

. The funeral director obtains

demographic data f or the death

certificate from a n i nformant.

The physician i n a ttendance at the

death i s r equired t o certify the cause of

death. The mortality file includes

demographic i nformation o n age, sex,

race, Hispanic o rigin, state of residence,

and educational attainment, and medical

information o n cause o f death.

The International Classification o f

Diseases (ICD), b y which cause o f

death i s coded and classified, is revised

approximately every 1 0 t o 1 5 years.

Beginning with data year 1999, the

cause-of-death statistics a re classified

according to the T enth Revision o f t he

ICD (ICD-10). D iscontinuities between

the N inth and T enth Revisions for

selected causes of death a re measured

using comparability ratios. For asthma,

the comparability ratio for t he overall

population i n 1999 was 0.89. That is,

the overall number of deaths attributed

to asthma was 1 1 % l ower using I CD-10

compared with ICD-9.

Data obtained from t he mortality

file represent a complete count of

deaths. T o obtain a sthma death r ates for

a g roup, the number of deaths was

divided by the r esidential population o f

that group (see section o n population

estimates).

For More I nformation: See the

Mortality Data website at: http://

www .cdc.gov/nchs/about/major/dvs/

mortdata.htm

.



### Population **estimates**

The census of population ( decennial

census) has been held i n t he United

States every 1 0 years s ince 1790. Data

on sex, race, age, and marital status a re collected from 100% of the enumerated

population.

Postcensal population estimates are

estimates made for t he years f ollowing a

census before t he next census has been

taken, and are derived by updating

counts i n t he decennial census using a

‘ ‘ components o f population change’ ’

approach (accounting f or births, deaths,

net international migration and net

movement of U.S A rmed Forces and

U.S. civilians). Postcensal population

estimates were u sed t o calculate

ambulatory v isit rates, hospitalization

rates and death r ates for t he years

2001–2004.

W

ith the completion o f t he

decennial census at the end of the

decade, intercensal estimates for t he

preceding decade were p repared to

replace the l ess accurate postcensal

estimates. Intercensal population

estimates take into account the census of

population a t t he beginning and end of

the decade. Intercensal population

estimates were u sed t o calculate

ambulatory v isit rates, hospitalization

rates and death r ates for t he years

1980–1999.

A d if ferent data s ource was used to

provide denominators t o calculate death

rates f or Puerto Rican and Mexican

children f or the period 2003–2004.

Population e stimates for 0–17 year old

children b y H ispanic s ubgroup are not

available. However

, t he Current

Population Survey (CPS) website at:

http://www .census.gov/population/www/

socdemo/hispanic.html collects

information o n H ispanic s ubgroup, and

so CPS population e stimates were used

to calculate death r ates for Puerto Rican

and Mexican children. Because CPS

estimates are based on survey data, they

are subject to sampling e rror

. In

addition, studies have shown that

persons self-reported a s H ispanic o n

census and survey records may

sometimes be reported a s white or

non-Hispanic o n t he death certificate,

resulting i n a n underestimation o f deaths

and death r ates for H ispanic g roups. The

overall i mpact of these e rrors on asthma

death r ates for Puerto Rican and

Mexican children i s unknown.

## 14 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**T**

**a ble**  **I**

**. D**  **ata for**  **F igure**  **1 :**  **P ercentage**  **o f**  **c urrent**  **asthma prevalence**  **among c**  **hildren 0–17**  **years of**  **age, by**  **state, annual**  **average f**  **or the** 

**period 2001–2005** 

95% 95%

Confidence Confidence

Current asthma interval interval

prevalence lower bound upper bound

Massachusetts

........................ 1 2

. 1 9

. 7 1 4

. 5

H a w a i i

............................. 1 0

. 9 4

. 7 1 7

. 1

Oklahoma

........................... 1 0

. 8 7

. 7 1 4

. 0

M a r y l a n d

............................ 1 0

. 8 8

. 5 1 3

. 2

Rhode Island

......................... 1 0

. 5 4

. 7 1 6

. 2

Kentucky

............................ 1 0

. 4 7

. 4 1 3

. 5

D i s t r i c t o f C o l u m b i a

..................... * 1 0

. 3 2

. 2 1 8

. 4

O h i o

............................... 1 0

. 2 8

. 4 1 2

. 0

N e w Y o r k

............................ 1 0

. 2 9

. 0 1 1

. 4

Pennsylvania

......................... 9

. 9 8

. 2 1 1

. 7

Connecticut

.......................... 9

. 9 6

. 8 1 3

. 0

M i c h i g a n

............................ 9

. 4 7

. 5 1 1

. 2

I l l i n o i s

.............................. 9

. 0 7

. 6 1 0

. 4

F l o r i d a

............................. 8

. 9 7

. 7 1 0

. 1

Kansas

............................. 8

. 8 5

. 2 1 2

. 5

D e l a w a r e

............................ * 8

. 8 2

. 9 1 4

. 7

N e w J e r s e y

.......................... 8

. 8 7

. 1 1 0

. 5

V i r g i n i a

............................. 8

. 7 6

. 8 1 0

. 6

Nebraska

............................ * 8

. 7 3

. 1 1 4

. 3

Alabama

............................ 8

. 7 6

. 1 1 1

. 2

N e w M e x i c o

.......................... 8

. 6 4

. 6 1 2

. 7

Wisconsin

........................... 8

. 6 6

. 1 1 1

. 2

Missouri

............................ 8

. 6 6

. 4 1 0

. 7

Arkansas

............................ 8

. 5 4

. 5 1 2

. 6

C o l o r a d o

............................ 8

. 5 5

. 8 1 1

. 1

M i s s i s s i p p i

........................... * 8

. 4 3

. 5 1 3

. 4

I n d i a n a

............................. 8

. 4 6

. 1 1 0

. 7

Louisiana

............................ 8

. 3 5

. 9 1 0

. 7

Oregon

............................. 8

. 1 4

. 8 1 1

. 5

N o r t h C a r o l i n a

........................ 8

. 1 6

. 3 9

. 8

S o u t h C a r o l i n a

........................ 8

. 1 4

. 9 1 1

. 2

G e o r g i a

............................. 7

. 9 6

. 1 9

. 8

T exas

.............................. 7

. 9 6

. 9 8

. 8

Minnesota

........................... 7

. 8 5

. 7 1 0

. 0

Arizona

............................. 7

. 7 5

. 7 9

. 6

New H ampshire

....................... * 7

. 5 1

. 9 1 3

. 1

W ashington

.......................... 7

. 4 5

. 4 9

. 4

T ennessee

........................... 7

. 3 5

. 0 9

. 6

C a l i f o r n i a

............................ 7

. 1 6

. 4 7

. 8

I o w a

............................... 7

. 1 3

. 1 1 1

. 1

U t a h

............................... 4

. 4 2

. 0 6

. 8

Nevada

............................. * 4

. 4 1

. 4 7

. 4

Alaska

............................. *

. . . . . .

Idaho

.............................. *

. . . . . .

M a i n e

.............................. *

. . . . . .

M o n t a n a

............................ *

. . . . . .

North Dakota

......................... *

. . . . . . South D akota

......................... *

. . . . . .

V e r m o n t

............................ *

. . . . . .

W e s t V i r g i n i a

......................... *

. . . . . .

W y o m i n g

............................ *

. . . . . .

* E stimates are c onsidered unreliable. Estimates preceded by an asterisk have a r elative s tandard e rror g reater than 30 percent and less than or equal to 50 percent and should b e i nterpreted with

caution. Estimates not shown have a r elative s tandard e rror g reater than 50 percent.

...C a t egory not applicable.

NOTE: C urrent asthma prevalence e stimates are based on the questions ‘ ‘ Has a doctor o r o ther health professional ever told you t hat {child’ s name} had asthma?’ ’ and ‘ ‘ Does {child’ s name} still

have a sthma?’ ’

DA

T A SOURCE: CDC/NCHS: National Health Interview S urvey

.

## 15 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**T**

**a ble**  **II. Data**  **for F**  **igure 2**  **: P**  **ercentage o**  **f c**  **hildren 0–17**  **years of**  **age f**  **or measures**  **of asthma**  **prevalence by**  **years of**  **data availability** 

**, United**  **States, 1980–2005** 

Asthma Lifetime Current Asthma

period asthma asthma attack

prevalence 1 diagnosis 2 prevalence 3 prevalence 4

1980

.............................. 3

. 6

– – – – – – – – –

1981

.............................. 3

. 7

– – – – – – – – –

1982

.............................. 4

. 0

– – – – – – – – –

1983

.............................. 4

. 5

– – – – – – – – –

1984

.............................. 4

. 3

– – – – – – – – –

1985

.............................. 4

. 8

– – – – – – – – –

1986

.............................. 5

. 1

– – – – – – – – –

1987

.............................. 5

. 3

– – – – – – – – –

1988

.............................. 5

. 0

– – – – – – – – –

1989

.............................. 6

. 1

– – – – – – – – –

1990

.............................. 5

. 8

– – – – – – – – –

1991

.............................. 6

. 3

– – – – – – – – –

1992

.............................. 6

. 3

– – – – – – – – –

1993

.............................. 7

. 2

– – – – – – – – –

1994

.............................. 6

. 9

– – – – – – – – –

1995

.............................. 7

. 5

– – – – – – – – –

1996

.............................. 6

. 2

– – – – – – – – –

1997 5

.............................. – – – 1 1

. 4

– – – 5

. 5

1998

.............................. – – – 1 2

. 1

– – – 5

. 3

1999

.............................. – – – 1 0

. 8

– – – 5

. 3

2000

.............................. – – – 1 2

. 3

– – – 5

. 5

2001

.............................. – – – 1 2

. 7 8

. 7 5

. 7

2002

.............................. – – – 1 2

. 2 8

. 3 5

. 8

2003

.............................. – – – 1 2

. 5 8

. 5 5

. 5

2004

.............................. – – – 1 2

. 2 8

. 5 5

. 4

2005

.............................. – – – 1 2

. 7 8

. 9 5

. 2

–––D a t a n o t a v a i l a b l e

. 1 Asthma period p revalence e stimates are based on the question ‘ ‘During t he past 1 2 m onths, d id anyone in the f amily have a sthma?’ ’

2 Lifetime a sthma d iagnosis estimates are based on the question ‘ ‘Has a doctor o r o ther health professional ever told you t hat {child’ s name} had asthma ?’ ’

3 Current asthma prevalence e stimates are based on the questions ‘ ‘ Has a doctor o r o ther health professional ever told you t hat {child’ s name} had asthm a?’ ’ and ‘ ‘ Does {child’ s name} still have

asthma?’ ’

4 Asthma attack prevalence e stimates are based on the questions ‘ ‘ Has a doctor o r o ther health professional ever told you t hat {child’ s name} had asthma ?’ ’ and ‘ ‘ Has { child’ s name} had an

episode or attack of asthma in the past 1 2 m onths?’ ’

5 The National Health Interview S urvey w as redesigned in 1997. Estimates from 1997 onward a re not directly comparable t o p re-1997 estimates.

DA

T A SOURCE: CDC/NCHS: National Health Interview S urvey

.

## 16 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**T**

**a ble**  **III. Data**  **for F**  **igure 3**  **: Number**  **o f**  **a mbulatory**  **visits for**  **asthma per**  **1,000 children**  **0–17 years**  **of age,**  **by site,**  **United States,** 

**1980–2004**

Physician Hospital To t a l

of fice outpatient ambulatory

visit r ate visit r ate visit r ate

1980

................................... 4 2

. 0

– – – – – –

1981

................................... 3 6

. 3

– – – – – –

1982

................................... – – – – – – – – –

1983

................................... – – – – – – – – –

1984

................................... – – – – – – – – –

1985

................................... 3 6

. 1

– – – – – –

1986

................................... – – – – – – – – –

1987

................................... – – – – – – – – –

1988

................................... – – – – – – – – –

1989

................................... 2 9

. 2

– – – – – –

1990

................................... 3 8

. 2

– – – – – –

1991

................................... 4 5

. 1

– – – – – –

1992

................................... 5 6

. 4 4

. 4 6 0

. 8

1993

................................... 5 4

. 2 9

. 0 6 3

. 3

1994

................................... 4 9

. 8 5

. 4 5 5

. 1

1995

................................... 4 6

. 9 8

. 0 5 5

. 0

1996

................................... 5 0

. 4 5

. 3 5 5

. 7

1997

................................... 5 2

. 5 7

. 3 5 9

. 8

1998

................................... 7 6

. 0 6

. 5 8 2

. 5

1999

................................... 4 6

. 8 8

. 9 5 5

. 7

2000

................................... 5 5

. 2 8

. 1 6 3

. 3

2001

................................... 6 0

. 7 7

. 9 6 8

. 6

2002

................................... 6 0

. 0 8

. 7 6 8

. 7

2003

................................... 7 4

. 0 1 0

. 3 8 4

. 3

2004

................................... 8 9

. 5 6

. 3 9 5

. 8

–––D a t a n o t a v a i l a b l e

.

DA

T A SOURCES: CDC/NCHS: National Ambulatory M edical C are S urvey

, National Hospital A mbulatory M edical C are S urvey

.

**T**

**a ble**  **I V** 

**. Data**  **for F**  **igure 4**  **: Number**  **o f**  **visits to**  **emergency departments**  **for asthma**  **per 10,000**  **children 0–17**  **years of**  **age, United**  **States,**

**1992–2004**

Emergency

department

visit r ate

1992

................................................................................ 9 6

. 8

1993

................................................................................ 106.0

1994

................................................................................ 103.7

1995

................................................................................ 9 1

. 2

1996

................................................................................ 1 1 2

. 3

1997

................................................................................ 109.7

1998

................................................................................ 121.4

1999

................................................................................ 101.7

2000

................................................................................ 100.7

2001

................................................................................ 9 1

. 7

2002

................................................................................ 9 9

. 9

2003

................................................................................ 9 5

. 5

2004

................................................................................ 102.9

DA

T A SOURCE: CDC/NCHS: National Hospital A mbulatory M edical C are S urvey

.

## 17 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**T**

**a ble**  **V**

**. D**  **ata for**  **F igure**  **5 :**  **Number o**  **f hospitalizations**  **for asthma**  **per 10,000**  **children 0–17**  **years of**  **age, United**  **States, 1980–2004** 

Hospitalization

rate

1980

................................................................................ 2 1

. 0

1981

................................................................................ 2 2

. 2

1982

................................................................................ 2 5

. 7

1983

................................................................................ 2 3

. 7

1984

................................................................................ 2 5

. 5

1985

................................................................................ 2 5

. 4

1986

................................................................................ 2 7

. 3

1987

................................................................................ 2 5

. 9

1988

................................................................................ 2 8

. 5

1989

................................................................................ 2 7

. 9

1990

................................................................................ 2 8

. 4

1991

................................................................................ 3 0

. 6

1992

................................................................................ 3 0

. 8

1993

................................................................................ 2 5

. 4

1994

................................................................................ 2 6

. 8

1995

................................................................................ 3 2

. 7

1996

................................................................................ 2 9

. 8

1997

................................................................................ 3 2

. 4

1998

................................................................................ 2 4

. 4

1999

................................................................................ 2 8

. 1

2000

................................................................................ 2 9

. 6

2001

................................................................................ 2 6

. 2

2002

................................................................................ 2 6

. 9

2003

................................................................................ 3 1

. 2

2004

................................................................................ 2 7

. 1

DA

T A SOURCE: CDC/NCHS: National Hospital D ischarge Survey

.

**T**

**a ble**  **V I.**  **Data for**  **F igure**  **6 :**  **Number o**  **f d**  **eaths due**  **to asthma**  **per 1,000,000**  **children 0–17**  **years of**  **age, United**  **States, 1980–2004** 

Death r ate, Death r ate,

Y

ear ICD-9 1 ICD-10 2

1980

................................ 1

. 7

. . .

1981

................................ 1

. 9

. . .

1982

................................ 2

. 3

. . .

1983

................................ 2

. 4

. . .

1984

................................ 2

. 2

. . .

1985

................................ 2

. 5

. . .

1986

................................ 2

. 8

. . .

1987

................................ 2

. 9

. . .

1988

................................ 2

. 6

. . .

1989

................................ 2

. 7

. . .

1990

................................ 2

. 9

. . .

1991

................................ 3

. 0

. . .

1992

................................ 2

. 8

. . .

1993

................................ 3

. 0

. . .

1994

................................ 3

. 2

. . .

1995

................................ 3

. 4

. . .

1996

................................ 3

. 7

. . .

1997

................................ 2

. 9

. . .

1998

................................ 3

. 2

. . .

1999

................................ . . . 3

. 0

2000

................................ . . . 2

. 9

2001

................................ . . . 2

. 6

2002

................................ . . . 3

. 0

2003

................................ . . . 2

. 7

2004

................................ . . . 2

. 5

...C a t egory not applicable.

1 International Classification o f D iseases, N inth Revision (ICD-9).

2 Beginning with data y ear 1999, the c ause-of-death s tatistics published by NCHS are c lassified a ccording t o t he International Classification o f D iseases, T enth R evision (ICD-10). D iscontinuities

between the N inth and T enth R evisions of the I CD for s elected c auses of death a re measured using c omparability ratios. For asthma, t he comparability r atio for t he overall population w as 0.89.

That is, t he overall number of deaths attributed to asthma in 1999 was 1 1 percent lower u sing ICD-10 compared with ICD-9.

DA

T A SOURCE: CDC/NCHS: Mortality Component of the N ational V ital S tatistics S ystem.

## 18 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**T**

**a ble**  **V II.**  **Data for**  **F igure**  **7 :**  **P roportional**  **i mpact**  **of asthma**  **prevalence, health**  **care use,**  **and mortality**  **among children**  **0–17 years**  **of age,** 

**by age**  **g roup,**  **United States,**  **2003–2005**

Current Emergency Death

prevalence department visit Hospitalization rate

Age g roup 2004–2005 rate 2003–2004 rate 2003–2004 2003–2004

0–4 years

............................. 7 1 % 165% 21 1% 77%

5–10 years

............................. 107% 83% 81% 88%

1 1–17 years

............................ 1 1 5 % 7 0 % 4 0 % 127%

NOTE: P roportional impact i s c alculated b y d ividing t he outcome for each age group by the outcome for a ll children 0–17 years o f age. For example, the p r oportional impact o f c urrent asthma

prevalence r ates among children 0–4 years i s 6 .2 percent over the t otal prevalence, 8.7 percent, f or a p roportional impact o f 7 1 percent.

DA

T A SOURCES: CDC/NCHS: National Health Interview S urvey

, National Hospital A mbulatory M edical C are S urvey

, National Hospital Discharge Survey

, and the M ortality Component of the

National V ital S tatistic System.

**T**

**a ble**  **V III.**  **Data for**  **F igure**  **8 :**  **The proportional**  **i mpact**  **of asthma**  **prevalence, health**  **care use**  **a nd**  **mortality among**  **children 0–17**  **years of** 

**age, by**  **race and**  **ethnicity**

**, United**  **States, 2003–2005** 

Current Emergency Death

prevalence department visit rate

Race/ethnicity 2004–2005 rate 2003–2004 2003–2004

Hispanic

.............................. 9 0 % 109% 69%

Non-Hispanic w hite

....................... 9 2 % 6 6 % 5 0 %

Non-Hispanic b lack

....................... 146% 254% 354%

NOTE: P roportional impact i s c alculated b y d ividing t he outcome among each r ace/ethnicity by the outcome for a ll children 0–17 years o f age. For examp le, t he proportional impact of current

asthma prevalence r ates among non-Hispanic b lack children i s 12.7 percent over the t otal prevalence, 8.7 percent, f or a p roportional impact o f 146 pe rcent.

DA

T A SOURCES: CDC/NCHS: National Health Interview S urvey

, National Hospital A mbulatory M edical C are S urvey

, and the M ortality Component of the N at ional V i tal S tatistic System.

**T**

**a ble**  **I X.**  **Data for**  **F igure**  **9a: Number**  **o f**  **asthma deaths**  **per 1,000,000**  **children 0–17**  **years of**  **age, by**  **race, 1999–2004** 

White B lack T o tal

1999

................................ 2

. 0 9

. 4 3

. 0

2000

................................ 1

. 8 9

. 5 2

. 9

2001

................................ 1

. 5 8

. 6 2

. 6

2002

................................ 1

. 6 1 0

. 6 3

. 0

2003

................................ 1

. 5 9

. 3 2

. 7

2004

................................ 1

. 4 8

. 7 2

. 5

DA

T A SOURCE: CDC/NCHS: Mortality Component of the N ational V ital S tatistics S ystem.

**T**

**a ble**  **X**

**. D**  **ata for**  **F igure**  **9 b:**  **Ratio of**  **black to**  **white asthma**  **death rates,**  **children 0–17**  **years, 1999–2004** 

Ratio

1999

................................................................................ 4

. 7

2000

................................................................................ 5

. 4

2001

................................................................................ 5

. 6

2002

................................................................................ 6

. 8

2003

................................................................................ 6

. 1

2004

................................................................................ 6

. 3

DA

T A SOURCE: CDC/NCHS: Mortality Component of the N ational V ital S tatistics S ystem.19 **Advance Data**  **No. 381**  + **December 12,**  **2006 Selected** **federal data** **sets with** **asthma content** DatasourcePurpose/ScopeDesign/Sample/GeographiccoverageSelectedasthmacontentNationalHealthInterviewSurvey(NHIS)http://www.cdc.gov/nchs/nhis.htmcQuestionnaires,datafilesanddocumentation:http://www.cdc.gov/nchs/about/major/nhis/quest_data_related_doc.htmCentersforDiseaseControlandPrevention(CDC)ThemainobjectiveoftheNHISistomonitorthehealthoftheU.S.populationthroughthecollectionandanalysisofdataonabroadrangeofhealthtopics.Amajorstrengthofthissurveyliesintheabilitytodisplaythesehealthcharacteristicsbymanydemographicandsocioeconomiccharacteristics.cContinuoussurvey;annualdatareleasecHouseholdface-to-faceinterviewcNationallyrepresentativecMultistageprobabilitysampleoftheciviliannoninstitutionalizedpopulationcGeography:National,4regions(Northeast,South,Midwest,West),somestatesAdministeredbyNationalCenterforHealthStatistics,CDCAsthmaprevalence:cLifetimeasthmadiagnosiscCurrentasthmaprevalencecAsthmaattackprevalencePeriodicsupplementsonasthmasymptoms,medicationuse,healthcareuse,anddiseasecontrolmeasures(1999,2002,2003)BehavioralRiskFactorSurveillanceSystem(BRFSS)http://www.cdc.gov/brfss/cQuestionnaires:http://www.cdc.gov/brfss/questionnaires/questionnaires.htmcDatafiles:http://www.cdc.gov/brfss/technical_infodata/surveydata.htmCentersforDiseaseControlandPrevention(CDC)TheBRFSSisastate-basedsystemofhealthsurveysthatcollectsinformationonhealthriskbehaviors,preventivehealthpractices,andhealthcareaccessprimarilyrelatedtochronicdiseaseandinjury.Formanystates,theBRFSSistheonlyavailablesourceoftimely,accuratedataonhealthrelatedbehaviorsaboutissuessuchasasthma,diabetes,healthcareaccess,alcoholuse,hypertension,obesity,cancerscreening,nutritionandphysicalactivity,tobaccouse,andmore.Federal,state,andlocalhealthofficialsandresearchersusethisinformationtotrackhealthrisks,identifyemergingproblems,preventdisease,andimprovetreatment.cContinuoussurvey;annualdatareleasecTelephoneinterviewcNationallyrepresentativecStratifiedprobabilitysample,householdswithtelephonesamongtheadultciviliannoninstitutionalizedpopulationcGeography:National,50states,DistrictofColumbia,U.S.Territories.Dataavailableforlargemetropolitanareas(seeSelectedMetropolitan/MicropolitanAreaRiskTrends:http://apps.nccd.cdc.gov/brfss-smart/SelMMSAPrevData.asp)AdministeredbyNationalCenterforChronicDiseasePreventionandHealthPromotion,CDC,conductedbyStatesAsthmaprevalence,adults18yearsofageandover:cLifetimeasthmadiagnosiscCurrentasthmaprevalencePeriodicsupplementsonasthmasymptoms,medicationuse,healthcareuse,severityandcontrolSupplementonchildhoodasthma(2001)NationalAsthmaSurveyandAsthmacall-backsurveyhttp://www.cdc.gov/nchs/about/major/slaits/nas.htmcQuestionnairesanddatafilesfor2002–2003:http://www.cdc.gov/nchs/about/major/slaits/nas.htmCentersforDiseaseControlandPrevention(CDC)Thissurveyexaminesthehealth,socioeconomic,behavioral,andenvironmentalpredictorsthatrelatetobettercontrolofasthma.Thissurveyalsoexploresthecontentofcareandhealthcareexperiencesofpersonswithasthma.Datafortheinitialsurvey,whichincludedanationalsampleand4states,werecollectedin2003andreleasedinthefallof2005.Thesurveyisnowconductedasacall-backinterviewsubsequenttoidentifyingrespondentswithasthmaduringtheBRFSSinterview(above).cPeriodicdatacollectioncTelephoneinterviewcInitialsurvey(2003–2004)nationallyrepresentativecGeography:Initialsurvey2003–2004:Nationaland4pilotstates(AL,CA,IL,TX)Call-backsurvey:2005:3states,2006:25states,and2007:35statesSponsoredbytheNationalCenterforEnvironmentalHealth,CDCAsthmaexperiences:cTimesincediagnosiscMedicationusecHealthcareusecSymptomscRiskfactorscDiseasemanagementNationalHealthandNutritionExaminationSurvey(NHANES)http://www.cdc.gov/nchs/nhanes.htmcQuestionnairesanddatafiles:http://www.cdc.gov/nchs/about/major/nhanes/datalink.htmCentersforDiseaseControlandPrevention(CDC)TheNHANEScombinesinterviewsandphysicalexaminationstoassessthehealthandnutritionalstatusofadultsandchildrenintheU.S.Theinterviewincludesdemographic,socioeconomic,dietary,andhealth-relatedquestions.Theexaminationcomponentconsistsofmedicalanddentalexaminations,physiologicalmeasurements,andlaboratorytests.Datafromthissurveyareusedinepidemiologicalstudiesandhealthsciencesresearch,whichhelpdevelopsoundpublichealthpolicy,directanddesignhealthprogramsandservices,andexpandhealthknowledge.cContinuoussince1999withdatareleaseevery2years;periodicfrom1971–1994cHouseholdface-to-faceinterview,physicalexaminmobileexaminationcentercNationallyrepresentativecMultistageprobabilitysampleoftheciviliannoninstitutionalizedpopulationcGeography:NationalAdministeredbyNationalCenterforHealthStatistics,CDCAsthmaprevalence:cLifetimeasthmadiagnosiscCurrentasthmaprevalencecAsthmaattackprevalenceSpirometry/pulmonaryfunctiontesting,1988–1994Householddustanalysisandallergensensitizationdata,2005–2006EnvironmentaltoxinexposurePlannedfuturerelevantcontent:cSpirometry2007NationalSurveyofChildren’sHealth(NSCH)http://www.cdc.gov/nchs/about/major/slaits/nsch.htmcQuestionnairesanddatafiles:http://www.cdc.gov/nchs/about/major/slaits/nsch.htmCentersforDiseaseControlandPrevention(CDC)TheNSCHexaminesthephysicalandemotionalhealthofchildrenages0–17years.Specialemphasisisplacedonfactorsthatmayrelatetowell-beingofchildren,includingmedicalhomes,familyinteractions,parentalhealth,schoolandafter-schoolexperiences,andsafeneighborhoods.cPeriodicdatacollection(2003–2004datareleased)cTelephoneinterviewcNationallyrepresentativecStratifiedprobabilitysample,householdswithtelephonesamongtheciviliannoninstitutionalizedpopulation(ages0–17years)cGeography:NationalandstateestimatesSponsoredbyHealthResourcesandServicesAdministration(HRSA)Sevenasthmaquestions(ages0–17years):cLifetimeasthmadiagnosiscCurrentasthmaprevalencecAsthmaattackprevalencecAsthmaseveritycFamilyburdencTimesincemedicationtakencHospitalizationinpast12months20 **Advance Data**  **No. 381**  + **December 12,**  **2006 Selected** **federal data** **sets with** **asthma content—Con.** DatasourcePurpose/ScopeDesign/Sample/GeographiccoverageSelectedasthmacontentYouthRiskBehaviorSurvey(YRBS)http://www.cdc.gov/HealthyYouth/yrbs/index.htmcQuestionnaires:http://www.cdc.gov/HealthyYouth/yrbs/index.htm(seerightlowerpanel)cDatafiles:http://www.cdc.gov/HealthyYouth/yrbs/data/index.htmCentersforDiseaseControlandPrevention(CDC)TheYRBSwasdevelopedin1990tomonitorpriorityhealthriskbehaviorsthatcontributetotheleadingcausesofdeath,disability,andsocialproblemsamongyouthandadultsintheUnitedStates.Sixcategoriesofpriorityhealth-riskbehaviorsaremonitored.cConductedevery2yearscSelf-administeredquestionnaireinschoolsettingcNational,state,andlocalschool-basedsurveysofrepresentativesamplesof9ththrough12thgradestudentscGeography:NationalandstateestimatesAdministeredbytheNationalCenterforChronicDiseasePreventionandHealthPromotion,CDCAsthmaprevalencequestionsaddedin2005(notdirectlycomparabletoNHIS,BRFSSabove):cLifetimeasthmadiagnosiscCurrentasthmaprevalencecAsthmaattackprevalenceNationalLongitudinalSurveyofYouth(NLSY79)http://www.bls.gov/nls/nlsyouth.htmcQuestionnaires:http://www.bls.gov/nls/79quex/y79quex.htmcDatafiles:http://www.bls.gov/nls/nlsy79ch.htmBureauofLaborStatistics(BLS)TheNLSY79isanationallyrepresentativesampleof12,686youngmenandyoungwomenwhowhere14to22yearsofagewhentheywerefirstsurveyedin1979.Annualdatacollectionsprovideauniqueopportunitytostudyindetailthelifecourseexperiencesofthissample.In1986,aseparatesurveyofallchildrenborntoNLSY79femalerespondentsbegan,greatlyexpandingthebreadthofchild-specificinformationcollected.Inadditiontoallofthemother’sinformationfromtheNLSY79,thechildsurveyincludesassessmentsofeachchildaswellasadditionaldemographicanddevelopmentinformationcollectedfromeitherthemotherorchild.cLongitudinalsurvey;annualinterviewscFace-to-faceinterviewcNationallyrepresentativelongitudinalsamplecGeography:NationalestimatesAdministeredbytheBureauofLaborStatistics,U.S.DepartmentofLaborAsthmaquestionswereaddedfordatacollectionin2004.2002datafilecontainsquestiononspecialhealthcareneedsandlimitationsfromchronicconditions,includingasthma,forthechildrenofNLSY79femalerespondents.MedicalExpenditurePanelSurvey(MEPS)http://www.meps.ahrq.gov/cQuestionnaires:Householdcomponent,includingPriorityConditions:http://www.meps.ahrq.gov/mepsweb/survey_comp/survey_results_ques_sections.jsp?Section=PC&Year1=2004&Submit1=SearchcDatafiles:http://www.meps.ahrq.gov/mepsweb/data_stats/download_data_files.jspAgencyforHealthcareResearchandQuality(AHRQ)TheMEPSisasetoflarge-scalesurveysoffamiliesandindividuals,theirmedicalproviders,andemployersacrosstheUnitedStates.MEPSisthemostcompletesourceofdataonthecostanduseofhealthcareandhealthinsurancecoverage.cContinuoussurvey;annualdatareleasecHouseholdface-to-faceinterviewcNationallyrepresentativecOverlappingpaneldesignsampleoftheciviliannoninstitutionalizedpopulationcGeography:NationalAdministeredbyAHRQHealthcareuse,medicationanddeviceuse,andexpendituresforasthma.NationalHealthCareSurvey(NHCS)http://www.cdc.gov/nchs/nhcs.htmcDatafiles:NAMCS:http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htmNHAMCS:http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htmNHDS:http://www.cdc.gov/nchs/about/major/hdasd/nhds.htmCentersforDiseaseControlandPrevention(CDC)TheNHCSembracesafamilyofhealthcareprovidersurveys,obtainingdataaboutthefacilitiesthatsupplyhealthcare,servicesrendered,andpatientcharacteristics.Dataofferthemostaccurateanddetaileddataondiagnosisandtreatment,aswellasonthecharacteristicsoftheinstitutions.Thesedataareusedbypolicymakers,planners,researchers,andothersinthehealthcommunitytomonitorchangesintheuseofhealthcareresources,tomonitorspecificdiseases,andtoexaminetheimpactofnewmedicaltechnologies.cAnnualdatareleasecMultistagesamplingdesignofhealthcarefacilities/providers/patientrecords;medicalrecordabstractioncGeography:National,4regions1.NationalAmbulatoryMedicalCareSurvey(NAMCS):physicianoffices2.NationalHospitalAmbulatoryMedicalCareSurvey(NHAMCS):hospitalemergencydepartmentsandoutpatientdepartments3.NationalHospitalDischargeSurvey(NHDS):nonfederalshort-stayhospitalsAdministeredbytheNationalCenterforHealthStatistics,CDCAmbulatory,emergencydepartment,andhospitalinpatientasthmavisitsandstays.21 **Advance Data**  **No. 381**  + **December 12,**  **2006 Selected** **federal data** **sets with** **asthma content—Con.** DatasourcePurpose/ScopeDesign/Sample/GeographiccoverageSelectedasthmacontentHealthcareCostandUtilizationProject(HCUP),HCUPNet,andKIDHCUP:http://www.ahrq.gov/data/hcup/HCUPnet:http://hcupnet.ahrq.gov/KID:http://www.hcup-us.ahrq.gov/kidoverview.jspAgencyforHealthcareResearchandQuality(AHRQ)cHCUP:afamilyofhealthcaredatabasesandsoftwaretoolsdevelopedthroughaFederal-stateIndustrypartnershipandsponsoredbyAHRQ.cHCUPnet:afree,on-linequerysystembasedondatafromHCUP.Itprovidesaccesstohealthstatisticsandinformationonhospitalstaysatthenational,regional,andstatelevel.cTheKids’InpatientDatabase(KID):apowerfuldatabaseofhospitalinpatientstaysforchildren.Researchersandpolicymakerscanidentify,track,andanalyzenationaltrendsinhealthcareuse,access,charges,quality,andoutcomes.cAnnualdatareleasecMedicalrecordabstractioncGeography:NationalandState1.StateInpatientDatabases:universeofinpatientdischargedatafrom>35states;>90%ofUScommunityhospitaldischarges.2.StateAmbulatorySurgeryDatabases:datafromambulatorycareencountersin>20states.3.StateEmergencyDepartmentDatabases:emergencydept.abstractdatafor>15states4.NationwideInpatientsample:20%stratifiedsampleofU.S.communityhospitals.5.KID:all-payerinpatientcareforchildren.AdministeredbyAHRQAmbulatory,emergencydepartment,andhospitalinpatientasthmavisitsandstays.MortalityComponentoftheNationalVitalStatisticsSystem(NVSS)http://www.cdc.gov/nchs/deaths.htmcDatafiles:underlyingcauseofdeath:http://www.cdc.gov/nchs/products/elec_prods/subject/mortucd.htmmultiplecauseofdeath:http://www.cdc.gov/nchs/products/elec_prods/subject/mortmcd.htmCentersforDiseaseControlandPrevention(CDC)Thevitalstatisticsgeneralmortalitydataareafundamentalsourceofdemographic,geographic,andcause-of-deathinformation.Thisisoneofthefewsourcesofcomparablehealth-relateddataforsmallgeographicareasandalongtimeperiodintheU.S.ThedataarealsousedtopresentthecharacteristicsofthosedyingintheU.S.todeterminelifeexpectancyandtocomparemortalitytrendswithothercountries.cAnnualdatareleasecCompilationofdatafromdeathcertificatesfrom50statesandD.C.cResidentialpopulation(includesalldeathswithintheU.S.)cGeography:NationalandstateAdministeredbytheNationalCenterforHealthStatistics,CDCDeathswithasthmaastheunderlyingorcontributingcauseofdeath.22 **Advance Data**  **No. 381**  + **December 12,**  **2006 Selected** **federal asthma** **resources: pretabulated** **statistics, interactive** **data resources,** **and publications** Resource/AgencySitecontentAsthma-specificcontentBehavioralRiskFactorSurveillanceSystem(BRFSS)CentersforDiseaseControlandPrevention(CDC)Interactivestatisticaltool(querysystem)StatisticaltablesonlineInteractivestatisticaltool:Prevalencedatabygeographiclocation(national/state/territory)andsex,age,race/ethnicity,income,oreducation:http://apps.nccd.cdc.gov/brfss/cAdultswhohavebeentoldtheycurrentlyhaveasthmacAdultswhohaveeverbeentoldtheyhaveasthmaOnlineasthmaprevalencetablesbygeographiclocation(state/territory)andsex,age,race/ethnicity,education,oreducation:http://www.cdc.gov/asthma/brfss/default.htmNationalSurveyofChildren’sHealth(NSCH)DataResourceCenterhttp://www.nschdata.org/Content/Default.aspxCentersforDiseaseControlandPrevention(CDC)Interactivestatisticaltool(querysystem)ChartbooksPublications&PresentationsUsercanproducedatatablesforasthmabygeographiclocation(Nationalandstate)cPercentageofchildrenwithasthma-relatedhealthissuesinpast12monthscPercentageofchildrenwithcurrentasthmabutnosymptomsinpast12monthscTheextenttowhichachild’sasthmaaffectsthefamilycPercentageofchildrenhospitalizedforasthmainpast12monthsYouthRiskBehaviorSurvey(YRBS)YouthOnline:ComprehensiveResultshttp://apps.nccd.cdc.gov/yrbss/CentersforDiseaseControlandPrevention(CDC)Interactivestatisticaltool(querysystem)Viewbyhealthtopic—usercanchoose‘‘other’’topicstoviewasthmaresultsbygeographiclocation(Nationalandstate),year,age,sex,andgrade:cPercentageofstudentswhohadeverbeentoldbyadoctorornursethattheyhadasthmacPercentageofstudentswhohaveeverbeentoldbyadoctorornursethattheyhadasthmaandwhohaveasthmabuthadnothadanepisodeofasthmaoranasthmaattackduringthepast12months,orwhohadanepisodeofasthmaoranasthmaattackduringthepast12months(i.e.,currentasthma)cAmongstudentswithcurrentasthma,thepercentagewhohadanepisodeofasthmaoranasthmaattackduringthepast12monthsMedicalExpenditurePanelSurveyAgencyforHealthcareResearchandQuality(AHRQ)Interactivestatisticaltool(querysystem)PublicationsStatisticaltablesonlineInteractivestatisticaltool:cMEPSnethttp://www.meps.ahrq.gov/mepsweb/data_stats/MEPSnetHC.jspStep1:DataSourceSelection-Selectadatayear;Step2:VariableSelection-Choosevariablestouse;Step3:(Optional)VariableRecoding-Regroupvariablesyourway;Step4:(Optional)RecordSelection-Selecttherecordsyouwant;Step5:DescriptiveStatistics-SelectShowStatisticstogeneratethestatistics.Statisticaltablesonline:cExpendituresbymedicalconditionbyservicesite(customizablebyage)http://www.meps.ahrq.gov/mepsweb/data_stats/quick_tables_results.jsp?component=1&subcomponent=0&tableSeries=2&year=­1&SearchMethod=1&Action=SearchPublications:cStatisticalbrief‘‘DemographicandClinicalVariationsinHealthStatus’’http://www.meps.ahrq.gov/mepsweb/data_stats/Pub_ProdResults_Details.jsp?pt=Methodology%20Report&opt=2&id=674cPersonsdiagnosedwithdiabetes,asthma,orhypertensionhadworsephysicalhealthstatusoverallthanthosewhodidnothavetheseconditions(adultsonly)cUseofdifferentmedicationsanddevicesinchildrenandadultswithasthma(forthcoming)NationalCenterforHealthStatisticsCentersforDiseaseControlandPrevention(CDC)InteractivestatisticaltoolsPublicationsInteractivestatisticaltoolscHealthDataforAllAges:http://www.cdc.gov/nchs/health_data_for_all_ages.htm,andTrendsinHealthandAging:http://www.cdc.gov/nchs/agingact.htm.Enter‘‘asthma’’intothesearchboxtoaccessinteractivetablesonasthmaprevalence,healthcareuseandmortality.Userscancustomizetableswithanyorallofthefollowingcharacteristics:age,gender,race/ethnicity,andgeographiclocation(national/statedependingondatasource).cHealthyPeopleData2010:http://wonder.cdc.gov/DATA2010focus.htm.Userscanviewasthmadata(national/statedependingondatasource)onHealthyPeopleObjectivesbyselectingfocusarea24(respiratorydiseases).Publications/FactsheetscHealthEStat:‘‘AsthmaPrevalence,HealthCareUseandMortality,UnitedStates’’http://www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htmcFASTSTATSasthmapage:http://www.cdc.gov/nchs/fastats/asthma.htmcHealth,UnitedStates:http://www.cdc.gov/nchs/hus.htm(searchfor‘‘asthma’)23 **Advance Data**  **No. 381**  + **December 12,**  **2006 Selected** **federal asthma** **resources: pretabulated** **statistics, interactive** **data resources,** **and publications—Con.** Resource/AgencySitecontentAsthma-specificcontentNationalCenterforEnvironmentalHealthCentersforDiseaseControlandPrevention(CDC)PublicationsResourcesListofMorbidityandMortalityWeeklyReports(MMWR)onasthma:http://www.cdc.gov/asthma/asthmadata.htm#mmwr.UpdatedMMWRAsthmaSurveillanceSummarytobereleasedin2007.AsthmaSurveillanceDatasummary:http://www.cdc.gov/asthma/asthmadata.htm#data.IncludesoverviewofasthmasurveillancequestionsonCDCsurveys,andlinkstoasthmatables,maps,charts,andslides.Statisticaltablesonline:cAsthmaprevalencetablesfromtheNationalHealthInterviewSurvey(NHIS)fortheU.S.byage,sex,race/ethnicity,geographicregion,andincome:http://www.cdc.gov/asthma/nhis/default.htm.cAsthmaprevalencetablesfromtheBehavioralRiskFactorSurveillanceSurvey(BRFSS)bygeographiclocation(state/territory)andsex,age,race/ethnicity,education,oreducation:http://www.cdc.gov/asthma/brfss/default.htmCDCasthmaresources:http://www.cdc.gov/health/asthma.htmAgencyforHealthcareResearchandQuality(AHRQ)ResearchsynthesesResearchfindingsOngoingresearchQualityimprovementresourcesResearchsyntheses:cChronicCareforLow-IncomeChildrenwithAsthma:StrategiesforImprovementResearchinAction,Issue18http://www.ahrq.gov/research/chasthria/chasthria.htmcClosingtheQualityGap:ACriticalAnalysisofQualityImprovementStrategies—Volume5:Asthma(forthcoming–checkhttp://www.ahrq.gov/clinic/epcix.htm)ResearchFindings:cChildHealthResearchFindings:http://www.ahrq.gov/research/childfind/(updateinprogress).Researchinprogress:cGrantsonLineDatabasehttp://www.gold.ahrq.gov/(Type‘‘pediatricasthma’’intokeywordsearchbox.)QualityImprovementResources:cAsthmaCareQualityImprovementWorkbookandResourceGuideforStateshttp://www.ahrq.gov/qual/asthmaqual.htm

## 24 **Advance Data**  **No. 381**  + **December 12,**  **2006**

**Suggested citation** 

Akinbami LJ. The S tate of childhood asthma,

United States, 1980–2005. Advance data from

vital and health statistics; no 381, Hyattsville,

MD: National Center for Health Statistics.

2006. **Copyright information** 

All m aterial appearing in this report is in the

public domain and may b e reproduced or

copied without permission; citation as to

source, however

, i s appreciated. **National C**  **enter for**  **H ealth**  **Statistics**

Director

Edward J. Sondik, Ph.D.

Acting Co-Deputy Directors

Jennifer H. Madans, Ph.D.

Michael H. Sadagursky

U.S. DEP AR TMENT OF

HEAL TH & HUMAN SER VICES

Centers for Disease Control and Prevention

National Center for Health Statistics

331 1 T oledo Road

Hyattsville, MD 20782 FIRST C LASS

POST AGE & FEES P A ID

CDC/NCHS

PERMIT NO. G-284

OFFICIAL BUSINESS

PENAL TY FOR PRIV A

T E USE, $ 300

T

o receive this publication regularly

, contact

the National Center for Health Statistics by

calling 1-866-441-NCHS (6247)

E-mail: nchsquery@cdc.gov

Internet: www .cdc.gov/nchs

07-0017 (12/06)

CS107789

T27014

DHHS Publication No. ( PHS) 2007-1250