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Advance Data From Vital And Health Statistics No. 381 Revised 12/29/06

Number 381 + December 12, 2006 Revised as of December 29, 2006
The State of Childhood Asthma, United States,
1980–2005
By Lara J. Akinbami, M.D., Office of Analysis and Epidemiology
Introduction
Millions of children in the United
WA
WA
States are affected by asthma, a chronic
MT
MT
ND
ME
ND
ME
respiratory disease characterized by
OR
MN
MN
VT
OR
VT
NH
NH
MA
MA
attacks of difficulty breathing. An
ID
ID
SD
WI
WI
NY
SD
NY
WY
CT
WY
CT
MI
MI
RI
RI
asthma attack is a distressing and
IA
PA
IA
PA
potentially life-threatening experience.
NV
NV
NE
NJ
NE
NJ
OH
OH
IL
IL
IN
IN
DE
DE
Scientific advances have greatly
UT
UT
CO
CO
WV
MD
WV
MD
DC
VA
improved the understanding of the
CA
KS
CA
KS
MO
MO
KY
KY
mechanisms that cause asthma attacks
NC
NC
TN
TN
AZ
OK
OK
and have led to effective medical
AZ
NM
NM
AR
AR
SC
SC
interventions to prevent morbidity and
MS
MS
AL
AL
GA
GA
improve quality of life (1). Yet, the
TX
TX
LA
LA
burden in prevalence, health care use,
AK
AK
FL
FL
and mortality remains high. Asthma
4.4 - 7.8 percent
remains a significant public health
7.9 - 8.5 percent
problem in the United States.
8.6 - 9.7 percent
HI
HI
Over 9.8 percent
Keywords: childhood asthma c
Data not reliable
prevalence c health care use c mortality
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
Trend
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
+ Asthma prevalence rates among
equal to 50 percent and should be interpreted with caution as they do not meet the standard of reliability or precision. The
children remain at historically high
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.
levels following dramatic increases
SOURCE: CDC/NCHS, National Health Interview Survey.
from 1980 until the late 1990s.
Figure 1. Current asthma prevalence among children 0–17 years of age, by state, annual
+ Despite the plateau in asthma
average for the period 2001–2005
prevalence, ambulatory care for
asthma use has continued to grow
since 2000.
Current asthma prevalence rates are generally higher in the Northeast region
+ Since 1992, when data first became
(Figure 1). While it is tempting to attribute prevalence patterns to climate or air
available, the rate of emergency
quality, many factors affect prevalence and may also vary by region. Some
department visits for asthma has
examples include the likelihood that symptomatic children are diagnosed accurately
remained relatively stable.
with asthma (2), and population composition. For example, the Puerto Rican
population, in which asthma prevalence is highest, tends to be concentrated in the
Northeast region of the country (3).
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
2
Advance Data No. 381 + December 12, 2006
+ Hospitalization rates for asthma have
spectrum of conditions, and likewise,
severe enough to warrant emergency
followed a trend similar to those in
the causes of asthma are a complex
care or hospitalization can still lower
asthma prevalence rates since 1980 and
interaction of different factors. A
quality of life. Part of recent efforts to
also remain at historically high levels.
constellation of causes is likely to
address the burden of asthma involves
+ Asthma death rates appear to have
gradually emerge.
developing methods to track symptoms
declined recently following a rising
and disease management. When
Asthma is a priority for the
trend from 1980 through the mid­
available, these new sources of data will
research, medical, environmental, and
1990s.
provide greater insight into the burden
public health communities because:
of asthma and the impact of intervention
Recent patterns by age and
+ Asthma is one of the leading chronic
efforts.
race/ethnicity
childhood diseases in the United
States (6) and a major cause of
+ Asthma prevalence increases with
childhood disability (7).
age, but health care use is highest
+ Asthma places a huge burden on
among the youngest children. Boys
affected children and their families:
have higher prevalence and death
asthma may limit a child’s ability to
rates compared with girls throughout
play, learn, and sleep; necessitates
childhood.
potentially complex and expensive
+ Non-Hispanic black and Puerto Rican
interventions (8); and results in both
children have higher prevalence rates
direct medical costs and indirect costs
compared to non-Hispanic white
(e.g., missed school days and work
children. Moreover, rates in adverse
days).
outcomes such as emergency
+ Childhood asthma prevalence more
department visits, hospitalizations,
than doubled from 1980 to the
and death are substantially higher for
mid-1990s (9;10) and remains at
black children. The disparity in
historically high levels. The factors
asthma mortality between black and
driving this pattern are still not fully
white children has increased in recent
understood.
years.
+ The causes of asthma remain unclear
and current research paints a complex
The national picture of
picture (5).
childhood asthma
+ Although there are means to prevent
A major frustration in fighting
attacks or exacerbations among
asthma is the mystery of its
children with asthma (1), the majority
development. It remains unknown why
of children with asthma still suffer
some people get the disease and others
from attacks (11).
do not. Research has identified several
+ The burden of avoidable emergency
factors associated with the development
department visits and hospitalizations
of asthma, but none have proven to be
for asthma is high and has remained
the causative agent. Asthma is
relatively resistant to intervention
characterized by episodes or attacks of
efforts (9,11).
inflammation and narrowing of small
+ Evidence of the impact of the
airways. Symptoms can include
environment on asthma incidence and
shortness of breath, cough, wheezing,
morbidity—especially allergens and
and chest pain or tightness, and are
irritants such as cigarette smoke and
triggered by a variety of things such as
outdoor pollutants—has been
allergens (e.g., pollen, dust mites,
mounting (12).
animal dander, etc.), infections, exercise,
This brief report presents overall trends
changes in the weather, and exposure to
in childhood asthma over the past two
airway irritants (e.g., tobacco smoke).
decades and examines the burden of
Some people have mild asthma; others
asthma through each stage of childhood
have severe and life-threatening attacks;
and among children of different race
and some people may have attacks
and ethnic groups. While data for
ranging from mild to severe (4). People
prevalence, health care use, and
develop asthma at different stages of
mortality are major indicators of the
their lives, and many subsequently cease
impact of asthma on children, asthma
to have any symptoms (5). Most likely,
symptoms that are unrecognized or not
the disease known as asthma is a
Advance Data No. 381 + December 12, 2006
3
Asthma prevalence rates
among children remain at
14
Lifetime asthma diagnosis
historically high levels
12
following dramatic increases
from 1980 until the late 1990s
10
Current asthma prevalence
Currently, there are no national
Survey redesign
measures of asthma incidence, or the
8
ent
r
c
Asthma period prevalence
rate at which people develop asthma
e
Asthma attack prevalence
P 6
over a period of time. Instead, we focus
on asthma prevalence, the percentage of
4
the population that has asthma at a
given point in time, and thus face the
2
risk of suffering symptoms and adverse
effects of the disease. Prevalence is
0
important as it identifies the population
1980
1985
1990
1995
2000
2005
in need of effective measures to control
SOURCE: CDC/NCHS, National Health Interview Survey.
asthma symptoms. Figure 2 shows the
Figure 2. Asthma prevalence among children 0–17 years of age for measures of asthma
trend in asthma prevalence since
prevalence available in each year, United States, 1980–2005
1980. The major tracking system for
asthma prevalence is the National
Health Interview Survey (NHIS), which
is used to produce annual health
estimates based on self report of a
+ From 1980 to 1996, asthma period
In 2005, 5.2% of children had at least
nationally representative sample. From
prevalence among children 0–17
one asthma attack in the previous
1980 to 1996, the NHIS measured
years of age more than doubled, from
year (3.8 million children). Nearly
asthma period prevalence, that is, the
3.6% in 1980 to 7.5% at the peak of
two of every three children who
percentage of people with asthma in the
the trend in 1995.
currently have asthma had at least
past 12 months. In 1997, the NHIS
+ Although not strictly comparable, the
one attack in the past 12 months.
questionnaire was redesigned. Starting
most similar post-1997 measure is
+ Lifetime asthma diagnosis measures
in 1997, asthma prevalence estimates are
current asthma prevalence that has
the percentage of children who have
based on receiving an asthma diagnosis,
been measured since 2001 and has
ever received a diagnosis of asthma.
currently having the disease at the time
remained relatively stable since
It is a more general measure of the
of the interview, and experiencing an
then. Because current asthma
impact of asthma among children.
attack in the past year. The new
prevalence estimates are higher than
Many of these children do not
measure that is most similar to the
pre-1997 asthma period prevalence
currently have asthma. In 2005,
previous measure of asthma period
estimates, it may be tempting to
12.7% of children had been
prevalence is current asthma
conclude that asthma prevalence
diagnosed with asthma at some point
prevalence—the percentage of children
continued to increase after
in their lifetime (9 million children),
with asthma at the time of the health
1996. However, the difference
of whom 70% were reported to
interview. An analysis of NHIS data
between asthma period prevalence
currently have asthma (6.5 million).
before and after the 1997 redesign
estimates and current asthma
+ Measures of asthma morbidity and
indicates that if the redesign had not
prevalence estimates is likely due to
control are available periodically
been undertaken, the period prevalence
NHIS questionnaire changes (13).
from the NHIS. In 2003:
measurements would show a plateau in
Nonetheless, prevalence remains at
– Children with at least one asthma
the late 1990s (13). That is, most of the
historically high levels. In 2005, 8.9%
attack (4 million) in the previous
apparent jump between the 1996 asthma
of children currently had asthma (6.5
year missed an estimated 12.8 million
period prevalence estimate from the old
million children).
school days due to asthma.
NHIS and the 2001 current asthma
+ Asthma attack prevalence measures
– Among children with asthma, 39%
prevalence estimate is likely attributable
the percentage of children who had at
reported receiving an asthma
to the change in the NHIS questionnaire,
least one attack over the past 12
management plan from their health
and not a substantial change in
months. It is a crude estimate of the
care provider, 57% reported being
prevalence.
percentage of symptomatic children
taught how to monitor peak flow, and
who may have poorly controlled
52% reported being advised to
asthma, and thus are at risk of
change things at home or in school to
adverse outcomes such as emergency
improve asthma management.
department visits or hospitalization.
4
Advance Data No. 381 + December 12, 2006
Despite the plateau in asthma
Physician office
Hospital outpatient
Total
prevalence, ambulatory care
100
use has continued to grow
since 2000
80
Increasing rates of visits to
physician offices and hospital outpatient
0
00
departments for asthma may indicate
60
1,
increasing prevalence or severity, or
reflect progress in addressing the burden
40
of asthma. Clinical practice guidelines
i
s
i
t
s
per
V
from the National Asthma Education
and Prevention Program (1) recommend
20
that asthma symptoms be treated early
and aggressively. These guidelines also
0
recommend that patients be evaluated
1980
1985
1990
1995
2000
for asthma severity, initial treatment be
SOURCES: CDC/NCHS, National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey.
tailored to severity level, and close
Figure 3. Number of ambulatory visits for asthma per 1,000 children 0–17 years of age, by
monitoring of symptoms and adjustment
site, United States, 1980–2004
of therapy be continued over time. Poor
asthma outcomes such as
hospitalizations and deaths are at least
+ The periodic data available from
+ Ambulatory care use has continued to
partially sensitive to the quality of
1980 to 1990 show a relatively stable
increase after 2000 despite a plateau
ambulatory health care (14). An
rate of visits for asthma to physician
in prevalence trends. Factors driving
appropriate frequency of outpatient
offices. Since the early 1990s, there
this upward trend may include
visits is one component of quality
has been an increase in visit rates.
increasing disease severity, and
ambulatory care. Managing asthma
The temporary increase in 1998
increased health care use to improve
involves close monitoring by health care
appears to be due to random
asthma control due to increased
professionals both when asthma
variation.
public and provider awareness.
symptoms flare and when the disease is
+ The majority of nonurgent ambulatory
Increased ambulatory care use for
quiescent. Thus, trends in visits for
visits for asthma occur in physician
asthma has continued during an era
asthma in outpatient settings reflect a
offices. In 2004, there were 89 visits
when overall rate of ambulatory care
spectrum of reasons for making visits to
to physician offices per 1,000
use for children did not increase (15).
the doctor for asthma (Figure 3).
children (6.5 million visits) and 6 per
Visits to physician offices are
1,000 children (0.5 million visits) to
measured by the National Ambulatory
hospital outpatient departments, a
Medical Care Survey (NAMCS),
total of 95 visits per 1,000 children,
administered in 1980–1981, 1985, and
or 7 million ambulatory visits for
continuously since 1989. In 1992, the
asthma. Just over 2.5% of all
National Hospital Ambulatory Medical
ambulatory visits among children
Care Survey (NHAMCS) began to
0–17 years of age made in 2004 were
provide data on visits to hospital
for asthma.
outpatient departments. Information is
obtained on visit events rather than the
number of people who went to see
physicians.
Advance Data No. 381 + December 12, 2006
5
Since 1992, when data first
140
became available, the rate of
emergency department visits
120
for asthma has remained
relatively stable
100
00
Asthma attacks or exacerbations are
,
0
80
frequently managed in emergency
10
departments (EDs). Having an asthma
60
attack that warrants a visit to the ED
i
s
i
t
s
per
V
may be a sign of severe asthma or
40
uncontrolled disease, inadequate access
to specialist health care, or inappropriate
20
use of emergency services (16,17).
Recurrent ED visits and hospitalizations
0 1992
1994
1996
1998
2000
2002
2004
are risk factors for fatal asthma attacks
(18). In theory, asthma symptoms and
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.
poor outcomes are avoidable with
Figure 4. Number of visits to emergency departments for asthma per 10,000 children 0–17
implementation of environmental control
years of age, United States, 1992–2004
measures to minimize exposure to
allergens and irritants, appropriate
medication use, and patient and health
+ From 1992 to 2004, there is no
+ In 2004, there were 103 visits per
care provider education (1). However,
consistent trend in the rate of ED
10,000 children, for a total of
recognizing the early signs and
visits for children. There appears to
750,000 visits to EDs for asthma.
symptoms of the disease, avoiding
be an increase in rates until the late
Asthma ED visits represented about
asthma triggers, arranging appropriate
1990s followed by a plateau after
2.8% of all ED visits among children
health care, and managing the schedule
1999.
0–17 years of age in 2004.
of medication administration can be
complex for children and their families.
Indeed, evidence shows that children
who visit the ED for asthma continue to
suffer from symptoms and activity
limitations despite having the health
encounter in the ED (19). Trends in ED
visits (Figure 4) are a crude indicator of
the burden of severe and uncontrolled
disease on families and the health care
system, the impact of public health
interventions, the degree of uptake of
asthma guidelines in disease
management, and the successful
translation of research into medical
practice.
Data on ED visits are collected by
the National Hospital Ambulatory
Medical Care Survey (NHAMCS),
administered since 1992. Information is
available for visit events rather than the
number of people who visited EDs.
6
Advance Data No. 381 + December 12, 2006
Hospitalization rates for
40
asthma have followed a trend
similar to those in asthma
prevalence rates since 1980
30
and also remain at historically
high levels
An asthma hospitalization represents
20
a severe exacerbation that requires an
increased level of monitoring and care.
It also represents significant costs to the
health care system and to affected
10
Hospitalizations per 10,000
families. Risks for hospitalization for
asthma include previous asthma
admissions, previous intubation for
0 1980
1985
1990
1995
2000
asthma, and severe symptoms (20). In
SOURCE: CDC/NCHS, National Hospital Discharge Survey.
theory, hospitalizations for asthma
should be largely preventable if patients
Figure 5. Number of hospitalizations for asthma per 10,000 children 0–17 years of age,
and their families are adequately
United States, 1980–2004
educated about the disease and have
access to high quality health care (14).
Although some hospitalizations may not
+ From 1980 through the mid-1990s,
hospitalizations. Asthma
be avoidable, especially in very young
asthma hospitalization rates increased
hospitalizations represented about 3%
children suffering from respiratory
for children 0–17 years of age. This
of all hospitalizations among children.
infections, trends in hospitalization over
pattern follows that for prevalence,
+ Many factors drive hospitalization
time (Figure 5) can help determine if
although there is evidence that
rates among children. Overall
intervention and management strategies
improved diagnosis of asthma also
hospitalization use among children
are having an impact on the burden of
contributed to the increase in
has decreased over the time period
disease.
hospitalizations attributed to asthma
when asthma hospitalization rates
The National Hospital Discharge
(9). Since the late 1990s, it appears
remained level (22). The threshold of
Survey (NHDS) collects information on
that the asthma hospitalization rate
attack severity for a hospital
hospitalizations. The NHDS counts
among children plateaued at
admission has likely increased. That
events (hospitalizations) rather than the
historically high levels.
is, asthma hospitalizations in recent
number of people who are admitted to
+ In 2004, there were 27
years may represent more severe
hospitals. Although some of the
hospitalizations for asthma per 10,000
exacerbations compared with earlier
hospitalizations for asthma may be
children for a total of 198,000
years.
re-admissions, research suggests that
re-admissions are not driving the overall
pattern for asthma (21).
Advance Data No. 381 + December 12, 2006
7
Asthma death rates appear to
have
5
declined recently
following a rising trend from
1980 through the mid-1990s
4
Asthma deaths among children are
000
rare but potentially avoidable. Children
000, 3
most at risk of dying from asthma are
1,
1
those with severe, uncontrolled disease,
per
hs
a near-fatal attack of asthma, a history
2
at
e
of recurrent hospitalization or intubation
D
for asthma (18). Trends in asthma
1
deaths (Figure 6) are a stark indicator of
ICD Revision 1999
how well the disease is diagnosed and
controlled.
0 1980
1985
1990
1995
2000
2004
Information on deaths occurring in
the U.S. is collected by the Mortality
1 Beginning with data year 1999, cause-of-death statistics published by NCHS are classified according to
the Tenth Revision of the International Classification of Diseases (ICD-10).
Component of the National Vital
SOURCE: CDC/NCHS, Mortality Component of the National Vital Statistics System.
Statistics System. The National Center
Figure 6. Number of deaths due to asthma per 1,000,000 children 0–17 years of age,
for Health Statistics compiles
United States, 1980–2004
information abstracted by each state
from death records.
+ From 1980 to 1998, death rates for
deaths among children has apparently
The impact of asthma varies
asthma climbed steadily. In 1999, the
declined.
through the stages of
change from the International
+ In 2004, the rate of asthma deaths
childhood; prevalence
Classification of Diseases Ninth
was 2.5 asthma deaths per 1 million
increases with age, but health
Revision (ICD-9) to the International
children, a total of 186 asthma
care use is highest among the
Classification of Diseases Tenth
deaths.
youngest children
Revision (ICD-10) codes for cause of
The profile of asthma changes as
death resulted in an overall 11
children get older, as shown in Table A.
percent decline in deaths attributed to
In general, when asthma burden is
asthma. The coding change therefore
examined over the stages of childhood,
accounts for much of the decrease in
trends in levels of health care with age
rates from 1998 to 1999. From 1999
are inversely related to trends in
onward, however, the rate of asthma
prevalence rates. Understanding the
characteristics of asthma in each stage
of childhood helps to explain this
pattern.
Table A. Asthma prevalence, health care use, and mortality among children 0–17 years of
Wheezing is common among infants
age, by age group and sex, United States, 2003–2005
and toddlers because their small airways
Current asthma
Emergency
Hospital
are more susceptible to any mechanism
prevalence,1
Ambulatory
department
discharges
Deaths per
that impedes airflow, and they have a
percent
visits2 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)
high incidence of respiratory infections.
Definitively diagnosing asthma in
0–4 years . . . . . . . . . .
6.2
121.1
163.7
61.3
2.0
infants and toddlers can be difficult
Male . . . . . . . . . . . .
7.4
160.3
199.6
77.0
2.9
Female . . . . . . . . . .
5.0
80.0
126.2
44.9
1.1
given the many etiologies that cause
wheezing in very young children.
5–10 years. . . . . . . . . .
9.3
80.2
82.6
23.6
2.3
Male . . . . . . . . . . . .
11.1
86.5
91.8
31.3
2.9
Furthermore, young children who
Female . . . . . . . . . .
7.4
73.7
72.8
15.6
1.6
wheeze only during respiratory
11–17 years . . . . . . . . .
10.0
76.9
69.0
11.8
3.3
infections are likely to have transient
Male . . . . . . . . . . . .
11.1
71.8
63.5
13.3
4.0
symptoms (5,23–25). This pattern may
Female . . . . . . . . . .
8.8
82.2
74.8
10.2
2.5
make clinicians reluctant to label
Total. . . . . . . . . . . . . .
8.7
90.0
99.2
29.1
2.6
wheezing as a chronic disease among
1
young children. However, respiratory
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?’’
distress in young children can rapidly
2Includes visits to physician offices and hospital outpatient departments.
become life threatening and warrants
DATA SOURCES: CDC/NCHS: National Health Interview Survey, National Ambulatory Medical Care Survey, National Hospital
Ambulatory Medical Care Survey, National Hospital Discharge Survey, and the Mortality Component of the National Vital
prompt attention. For this reason,
Statistics System.
8
Advance Data No. 381 + December 12, 2006
utilization of emergency department
(ED) and hospital services for asthma is
high among this group.
11-17 years
Among school-age children,
Deaths 2003-2004
allergies/atopic sensitization starts to
become a more prominent cause of
Hospitalizations 2003-2004
wheezing, and displaces respiratory
Emergency department
infections as a main trigger of attacks
5-10 years
visits 2003-2004
(5,24). The emergence of more clearly
Current prevalence 2004-2005
identifiable and predictable symptoms in
school-age children allows easier
identification and management of
0-4 years
asthma compared with younger children.
Families, health care professionals, and
schools who work well together can
0%
100%
200%
successfully control symptoms.
Proportional impact relative to all children ages 0-17 years
However, families coping with other
SOURCES: CDC/NCHS, National Health Interview Survey, National Ambulatory Medical Care Survey,
factors that can interfere with good
National Hospital Ambulatory Medical Care Survey, and the Mortality Component of the National Vital Statistic System.
asthma management may be less
successful.
Figure 7. The proportional impact of asthma prevalence, health care use, and mortality
among children 0–17 years of age, by age group, United States, 2003–2005
Adolescents with asthma need to
learn to recognize and treat symptoms
independently. Issues with emerging
To better illustrate the impact of
Racial disparities in childhood
autonomy may accentuate good
asthma across age groups, the
asthma are extensive; black
management strategies, or exacerbate
prevalence, health care use, and death
and Puerto Rican children have
problems with asthma control. The
rates for each group are compared with
high prevalence rates, and
relatively low level of health care use
the rates for all children in Figure 7 to
black children have
for asthma among adolescents may
show all outcomes on the same scale.
dramatically higher mortality
indicate a combination of patterns
The 100 percent level represents the
rates compared with white
among this group: changes in disease
overall rate for children 0–17 years for
children
severity, higher success in controlling a
each measure, and is shown by the
chronic disease, or lack of medical
The higher rates of asthma
vertical line. Each bar on the chart
attention and poor use of medication to
prevalence, ED visits, hospitalizations
represents the proportional impact of
relieve symptoms. Of particular concern
and deaths among minority children
each outcome for each age group
for adolescents is the higher rate of
have been well documented (9,26–
relative to the total for all children ages
asthma deaths in this group compared
28). Racial disparities remained evident
0–17 years (e.g., the proportional impact
with younger children.
in asthma prevalence through 2005
of current asthma prevalence rates
The pattern over childhood differs
(Table B). Children of American Indian
among children 0–4 years is 6.2% over
for boys and girls. Boys experience a
or Alaska Native decent have current
the total prevalence for all children,
higher current asthma prevalence rate
asthma prevalence rates 25% higher and
8.7%, for a proportional impact of
throughout most of childhood. By ages
black children 60% higher than white
71%). Children 0–4 years have the
15–17 years, however, the current
children. Asian children have the lowest
lowest proportional impact of
prevalence rate in girls, 10.5%, has
prevalence rates. When race and
prevalence. However, the proportional
surpassed that among boys, 10.1%.
ethnicity are considered, Puerto Rican
impact of ED visit and hospitalization
Higher prevalence among females
children have the highest prevalence of
rates for asthma among the youngest
persists among adults. Use of
all groups, 140% higher than non-
children overshadows that among older
ambulatory and hospital health care
Hispanic white children, whereas
age groups. Unlike younger children,
services through age 10 years is higher
Mexican children have low reported
the proportional impact of mortality
among boys. During adolescence,
rates. In light of these differing
from asthma among adolescents is
however, ambulatory care use is greater
prevalence rates, the lower rate for
higher than that for health care use.
among 11–17 year old girls compared
ambulatory care visits among black
with boys. Hospitalization rates among
children compared with white children
adolescent boys, however, remain
suggests that black children may be
slightly higher. Asthma death rates
underutilizing ambulatory care.
among boys remain higher throughout
Considering the evidence that minority
childhood. Death rates rise between
children do not receive the same level
school-age and adolescent groups among
and quality of ambulatory health care
both genders.
Advance Data No. 381 + December 12, 2006
9
Table B. Asthma 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
prevalence1,
visits2 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
White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.9
94.8
73.0
16.9
1.5
Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12.8
76.4
263.7
59.2
9.0
American Indian or Alaska Native. . . . . . . . . . . . .
9.9
*
*
*
*
Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.9
*
*
*
*
Race/ethnicity
Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.8
83.3
108.1
**
1.8
Puerto Rican . . . . . . . . . . . . . . . . . . . . . . . . .
19.2
**
**
**
*
Mexican . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.4
**
**
**
1.7
Non-Hispanic white . . . . . . . . . . . . . . . . . . . . .
8.0
100.2
65.8
**
1.3
Non-Hispanic black . . . . . . . . . . . . . . . . . . . . .
12.7
71.5
251.6
**
9.2
Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.7
90.0
99.2
29.1
2.6
* Estimates are considered unreliable. For ambulatory visit rates, emergency department visit rates and hospital discharge rates, the relative standard error of the estimate is greater than 30%. For
death rates, rates based on a number of deaths fewer than 20 are not shown.
** Data not available.
1Current 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?’’
2Includes visits to physician offices and hospital outpatient departments.
DATA SOURCES: CDC/NCHS: National Health Interview Survey, National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, National Hospital Discharge Survey,
and the Mortality Component of the National Vital Statistic System.
for asthma (29,30), the disparity in
ambulatory care use may contribute to
the disparities in ED use,
Non-Hispanic black
hospitalization, and death. The racial
disparities in these adverse asthma
outcomes are much greater than those in
asthma prevalence. Compared with
Deaths 2003-2004
white children, black children have a
Non-Hispanic white
Emergency department
260% higher ED visit rate, a 250%
visits 2003-2004
higher hospitalization rate, and a 500%
Current prevalence 2004-2005
higher death rate from asthma.
Unfortunately, information about
race/ethnicity and income are not
Hispanic
consistently available across the health
care data systems used to measure the
impact of asthma.
0%
100%
200%
300%
Figure 8 illustrates the impact of
Proportional impact relative to all children ages 0-17 years
these disparities by comparing the rates
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.
for asthma prevalence, health care use,
and death for each group to the total
Figure 8. The proportional impact of asthma prevalence, health care use and mortality
among children 0–17 years of age, by race and ethnicity, United States, 2003–2005
rate to show all outcomes on the same
scale. The 100 percent level represents
the overall rate for children 0–17 years
for each measure and is shown by the
much higher. The pattern for the
vertical line. Only those groups with
Hispanic group is similar to non-
data available for all indicators are
Hispanic white children, although
shown. The proportional impact of
grouping all Hispanic subgroups
prevalence is highest among non-
together masks the possible varied
Hispanic black children. However,
patterns for Puerto Rican and Mexican
disparities in adverse asthma
children.
outcomes—ED visits and deaths—are
10
Advance Data No. 381 + December 12, 2006
12
8
7
10
Black
6
8
5
6
4
3
4
Black/white ratio
Deaths per 1,000,000
Total
2
2
1
White
0
0
1999 2000 2001 2002 2003 2004
1999 2000 2001 2002 2003 2004
SOURCE: CDC/NCHS, Mortality Component of the National Vital Statistics System.
Figure 9a (left). Number of deaths due to asthma per 1,000,000 children 0–17 years of age
by race, United States, 1999–2004
Figure 9b (right). Ratio of black to white asthma death rates, children 0–17 years,
United States, 1999–2004
Figures 9a and 9b present recent
may signal the accomplishments of the
trends in asthma death rates for black
many diverse groups working to lighten
children and white children. Although
the burden of asthma. However, asthma
overall asthma death rates have declined
deaths are theoretically preventable, and
since 1999 (Figure 9a), this pattern is
black children have not experienced a
not observed for black children among
decrease in asthma mortality.
whom death rates remained relatively
Furthermore, the measures presented in
level. As a result, the black and white
this report reveal only part of the burden
disparity for asthma deaths has
of asthma for children and their
increased since 1999 as measured by the
families, especially because the
ratio of the black rate to the white rate
measures used rely on a physician
(Figure 9b). The lack of progress among
accurately diagnosing asthma and either
black children in lowering mortality
relaying this information to the child’s
from asthma may reflect a number of
family (prevalence measures) or
factors such as more severe disease,
documenting the condition in medical
greater environmental obstacles (e.g.,
records (health care use). The most
residence in more polluted or high
current data show that the challenges of
poverty areas), lag in uptake of medical
childhood asthma remain and that
advances to control asthma symptoms
asthma persists as a significant public
among health care providers who treat
health problem.
black children, and lack of asthma
education or difficulties in adopting
certain asthma control methods by black
families.
Summary
The large increases in the burden of
childhood asthma seen in the 1980s
until the late 1990s appear to have
abated in recent years. Yet, the burden
remains at the highest levels recorded
for all measures except mortality. The
decrease in asthma death rates among
children since 1999 is encouraging, and
Advance Data No. 381 + December 12, 2006
11
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Advance Data No. 381 + December 12, 2006
Technical Notes
denominators are necessary to compute
the Ambulatory Health Care Data
percentages.
website at: http://www.cdc.gov/nchs/
Asthma prevalence data
For More Information: See the
about/major/ahcd/ahcd1.htm.
NHIS website at: http://www.cdc.gov/
Prevalence data were obtained from
nchs/nhis.htm.
Hospital outpatient and
the National Health Interview Survey
emergency department visit
(NHIS), a cross-sectional household
Physician office visit data
data
interview survey of the U.S. civilian
noninstitutionalized population.
Data on asthma visits to physician
Visit data to hospital outpatient
Excluded are patients in long-term care
offices are obtained from the National
departments (OPDs) and emergency
facilities, Armed Forces active duty
Ambulatory Medical Care Survey
departments (EDs) were obtained from
personnel (although dependents are
(NAMCS), a national survey designed to
the National Hospital Ambulatory
included), and U.S. nationals living in
provide information about the provision
Medical Care Survey (NHAMCS) that
foreign countries. NHIS interviewing is
and use of medical care services in
collects data on the utilization and
continuous throughout each year, and
office-based physician practices in the
provision of medical care services
follows a multistage area probability
U.S. The survey covers patient
provided in hospital OPDs and
design that permits the representative
encounters in the offices of nonfederally
EDs. The survey is a representative
sampling of households. From each
employed physicians classified by the
sample of visits to EDs and OPDs of
family in the NHIS, one sample adult
American Medical Association or
nonfederal, short-stay, or general
and, for families with children under 18
American Osteopathic Association as
hospitals. Telephone contacts are
years of age, one sample child are
‘‘office-based, patient care’’ physicians.
excluded. In the NHAMCS OPD
randomly selected to participate in the
Excluded are visits to hospital-based
survey, a clinic is defined as an
detailed health survey. A responsible
physicians, visits to specialists in
administrative unit of the OPD in which
adult, usually a parent, reports in proxy
anesthesiology, pathology, and radiology,
ambulatory medical care is provided
for the sample child.
and visits to physicians who are
under the supervision of a physician. If
NHIS obtains information on
principally engaged in teaching,
a hospital OPD has five or fewer
illnesses, injuries, activity limitation,
research, or administration. Telephone
in-scope clinics, all are included in the
chronic conditions, health insurance
contacts and nonoffice visits are also
sample. For hospital OPDs with more
coverage, utilization of health care,
excluded. A multistage probability
than five clinics, a systematic sample of
other health topics, demographic
design is employed. The final stage
clinics proportional to size is included in
information, and risk factor data. Special
involves systematic random samples of
the survey. Visits to eligible EDs and
modules and supplements focus on
office visits during randomly assigned
OPDs are systematically sampled over
different issues each year. Additional
7-day reporting periods. In 1985 the
the 4-week reporting period such that
questions about asthma were most
survey excluded Alaska and Hawaii.
about 100 ED encounters and about 200
recently included in the 2002 and 2003
Data are collected from medical
OPD encounters are selected.
NHIS.
records on type of providers seen;
Data are collected from medical
NHIS has been conducted annually
reason for visit; diagnoses; drugs
records on type of providers seen;
since 1957. In 1997, the questionnaire
ordered, provided, or continued; and
reason for visit; diagnoses; drugs
was redesigned and some basic concepts
selected procedures and tests ordered or
ordered, provided, or continued; and
were changed and other concepts were
performed during the visit. Patient data
selected procedures and tests performed
measured in different ways. Also in
include age, sex, race, and expected
during the visit. Patient data include
1997, the collection methodology
source of payment.
age, sex, race, and expected source of
changed from paper and pencil
The NAMCS, which began in 1973,
payment.
questionnaires to computer-assisted
was conducted annually until 1981,
Annual data collection began in
personal interviewing. Since 1997, the
again in 1985, and resumed an annual
1992. In any given year, the hospital
annual sample has numbered about
schedule in 1989. In 2004, 1,961
sample consists of approximately 500
100,000 persons with about 30,000
physicians were in scope and 1,372
hospitals, of which 80 percent have EDs
persons participating in the sample adult
participated for a response rate of 65%.
and about half have eligible OPDs.
and about 15,000 persons in the sample
Data were provided for 25,286 visits.
Typically, about 1,000 clinics are
child questionnaires. In recent years, the
National estimates of the number of
selected from participating hospital
total household response rate was about
asthma visits were calculated using
OPDs. In 2004, the hospital response
90%.
survey weights. To obtain visit rates for
rate was 89% for EDs and 75% for
National estimates from NHIS are
a group, national estimates of the
OPDs.
produced by using the sample weights.
number of visits were divided by the
Sample data are weighted to
Because the sample weights incorporate
civilian noninstitutionalized population
produce national estimates. To obtain
U.S. Census estimates of the civilian
for that group (see section on population
visit rates for a group, national estimates
noninstitutionalized population, no
estimates). For More Information: See
of number of visits were divided by the
Advance Data No. 381 + December 12, 2006
13
civilian population for that group (see
Mortality data
collected from 100% of the enumerated
section on population estimates).
population.
Data on deaths are obtained from
For More Information: See the
Postcensal population estimates are
the Mortality Component of the
Ambulatory Health Care website at:
estimates made for the years following a
National Vital Statistics System (NVSS)
http://www.cdc.gov/nchs/about/major/
census before the next census has been
that collects and publishes official
ahcd/ahcd1.htm.
taken, and are derived by updating
national statistics on births, deaths, and
counts in the decennial census using a
fetal deaths based on U.S. Standard
Hospital discharge visit data
‘‘components of population change’’
Certificates. Vital events occurring in
approach (accounting for births, deaths,
Data on asthma hospital discharges
the U.S. to non-U.S. residents and vital
net international migration and net
were obtained from the National
events occurring abroad to U.S.
movement of U.S Armed Forces and
Hospital Discharge Survey (NHDS) that
residents are excluded. By law, the
U.S. civilians). Postcensal population
collects and produces national estimates
registration of deaths is the
estimates were used to calculate
on characteristics of inpatient stays in
responsibility of the funeral director.
ambulatory visit rates, hospitalization
nonfederal short-stay hospitals in the
The funeral director obtains
rates and death rates for the years
U.S. Included in the survey are
demographic data for the death
2001–2004.
hospitals with an average length of stay
certificate from an informant.
With the completion of the
of less than 30 days for all inpatients,
The physician in attendance at the
decennial census at the end of the
general hospitals, and children’s general
death is required to certify the cause of
decade, intercensal estimates for the
hospitals. Excluded are federal, military,
death. The mortality file includes
preceding decade were prepared to
and Department of Veterans Affairs
demographic information on age, sex,
replace the less accurate postcensal
hospitals, as well as hospital units of
race, Hispanic origin, state of residence,
estimates. Intercensal population
institutions (such as prison hospitals),
and educational attainment, and medical
estimates take into account the census of
and hospitals with fewer than six beds
information on cause of death.
population at the beginning and end of
staffed for patient use. Two data
The International Classification of
the decade. Intercensal population
collection procedures are used in the
Diseases (ICD), by which cause of
estimates were used to calculate
survey. One is a manual system of
death is coded and classified, is revised
ambulatory visit rates, hospitalization
sample selection and medical
approximately every 10 to 15 years.
rates and death rates for the years
transcription from the hospital records to
Beginning with data year 1999, the
1980–1999.
abstract forms. The second is an
cause-of-death statistics are classified
A different data source was used to
automated system in which the National
according to the Tenth Revision of the
provide denominators to calculate death
Center for Health Statistics purchases
ICD (ICD-10). Discontinuities between
rates for Puerto Rican and Mexican
machine-readable medical record data
the Ninth and Tenth Revisions for
children for the period 2003–2004.
from commercial organizations, state
selected causes of death are measured
Population estimates for 0–17 year old
data systems, hospitals, or hospital
using comparability ratios. For asthma,
children by Hispanic subgroup are not
associations.
the comparability ratio for the overall
available. However, the Current
Patient information collected
population in 1999 was 0.89. That is,
Population Survey (CPS) website at:
includes demographics, length of stay,
the overall number of deaths attributed
http://www.census.gov/population/www/
diagnoses, and procedures. Hospital
to asthma was 11% lower using ICD-10
socdemo/hispanic.html collects
characteristics collected include
compared with ICD-9.
information on Hispanic subgroup, and
geographic region of the country,
Data obtained from the mortality
so CPS population estimates were used
ownership, and bed size.
file represent a complete count of
to calculate death rates for Puerto Rican
The NHDS has been conducted
deaths. To obtain asthma death rates for
and Mexican children. Because CPS
annually since 1965. Hospitals are
a group, the number of deaths was
estimates are based on survey data, they
selected using a modified three-stage
divided by the residential population of
are subject to sampling error. In
stratified design. For 2004, the sample
that group (see section on population
addition, studies have shown that
consisted of 501 hospitals, of which 439
estimates).
persons self-reported as Hispanic on
responded. Data were collected for
For More Information: See the
census and survey records may
approximately 371,000 discharges.
Mortality Data website at: http://
sometimes be reported as white or
Sample data are weighted to
www.cdc.gov/nchs/about/major/dvs/
non-Hispanic on the death certificate,
produce national estimates. To obtain
mortdata.htm.
resulting in an underestimation of deaths
hospitalization rates for a group,
and death rates for Hispanic groups. The
national estimates of hospitalizations
Population estimates
overall impact of these errors on asthma
were divided by the civilian population
The census of population (decennial
death rates for Puerto Rican and
of that group (see section on population
census) has been held in the United
Mexican children is unknown.
estimates). For More Information: See
States every 10 years since 1790. Data
the National Health Care Survey website
on sex, race, age, and marital status are
at: http://www.cdc.gov/nchs.nhcs.htm.
14
Advance Data No. 381 + December 12, 2006
Table I. Data for Figure 1: Percentage of current asthma prevalence among children 0–17 years of age, by state, annual average for the
period 2001–2005
95%
95%
Confidence
Confidence
Current asthma
interval
interval
prevalence
lower bound
upper bound
Massachusetts . . . . . . . . . . . . . . . . . . . . . . . .
12.1
9.7
14.5
Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.9
4.7
17.1
Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.8
7.7
14.0
Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.8
8.5
13.2
Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . .
10.5
4.7
16.2
Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.4
7.4
13.5
District of Columbia . . . . . . . . . . . . . . . . . . . . .
*10.3
2.2
18.4
Ohio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.2
8.4
12.0
New York. . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.2
9.0
11.4
Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . .
9.9
8.2
11.7
Connecticut . . . . . . . . . . . . . . . . . . . . . . . . . .
9.9
6.8
13.0
Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.4
7.5
11.2
Illinois. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.0
7.6
10.4
Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.9
7.7
10.1
Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.8
5.2
12.5
Delaware. . . . . . . . . . . . . . . . . . . . . . . . . . . .
*8.8
2.9
14.7
New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . .
8.8
7.1
10.5
Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.7
6.8
10.6
Nebraska. . . . . . . . . . . . . . . . . . . . . . . . . . . .
*8.7
3.1
14.3
Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.7
6.1
11.2
New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . .
8.6
4.6
12.7
Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.6
6.1
11.2
Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.6
6.4
10.7
Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.5
4.5
12.6
Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.5
5.8
11.1
Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . . .
*8.4
3.5
13.4
Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.4
6.1
10.7
Louisiana. . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.3
5.9
10.7
Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.1
4.8
11.5
North Carolina . . . . . . . . . . . . . . . . . . . . . . . .
8.1
6.3
9.8
South Carolina . . . . . . . . . . . . . . . . . . . . . . . .
8.1
4.9
11.2
Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.9
6.1
9.8
Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.9
6.9
8.8
Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.8
5.7
10.0
Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.7
5.7
9.6
New Hampshire . . . . . . . . . . . . . . . . . . . . . . .
*7.5
1.9
13.1
Washington . . . . . . . . . . . . . . . . . . . . . . . . . .
7.4
5.4
9.4
Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.3
5.0
9.6
California. . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.1
6.4
7.8
Iowa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7.1
3.1
11.1
Utah. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.4
2.0
6.8
Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*4.4
1.4
7.4
Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*
. . .
. . .
Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*
. . .
. . .
Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*
. . .
. . .
Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*
. . .
. . .
North Dakota . . . . . . . . . . . . . . . . . . . . . . . . .
*
. . .
. . .
South Dakota . . . . . . . . . . . . . . . . . . . . . . . . .
*
. . .
. . .
Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*
. . .
. . .
West Virginia . . . . . . . . . . . . . . . . . . . . . . . . .
*
. . .
. . .
Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . .
*
. . .
. . .
* Estimates are considered unreliable. Estimates preceded by an asterisk have a relative standard error greater than 30 percent and less than or equal to 50 percent and should be interpreted with
caution. Estimates not shown have a relative standard error greater than 50 percent.
. . . Category not applicable.
NOTE: 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?’’
DATA SOURCE: CDC/NCHS: National Health Interview Survey.
Advance Data No. 381 + December 12, 2006
15
Table II. Data for Figure 2: Percentage of children 0–17 years of age for measures of asthma prevalence by years of data availability,
United States, 1980–2005
Asthma
Lifetime
Current
Asthma
period
asthma
asthma
attack
prevalence1
diagnosis2
prevalence3
prevalence4
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
– – –
– – –
– – –
19975 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
11.4
– – –
5.5
1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
12.1
– – –
5.3
1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
10.8
– – –
5.3
2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
12.3
– – –
5.5
2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
12.7
8.7
5.7
2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
12.2
8.3
5.8
2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
12.5
8.5
5.5
2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
12.2
8.5
5.4
2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
12.7
8.9
5.2
– – – Data not available.
1Asthma period prevalence estimates are based on the question ‘‘During the past 12 months, did anyone in the family have asthma?’’
2Lifetime asthma diagnosis estimates are based on the question ‘‘Has a doctor or other health professional ever told you that {child’s name} had asthma?’’
3Current 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?’’
4Asthma attack prevalence estimates are based on the questions ‘‘Has a doctor or other health professional ever told you that {child’s name} had asthma?’’ and ‘‘Has {child’s name} had an
episode or attack of asthma in the past 12 months?’’
5The National Health Interview Survey was redesigned in 1997. Estimates from 1997 onward are not directly comparable to pre-1997 estimates.
DATA SOURCE: CDC/NCHS: National Health Interview Survey.
16
Advance Data No. 381 + December 12, 2006
Table III. Data for Figure 3: Number of ambulatory visits for asthma per 1,000 children 0–17 years of age, by site, United States,
1980–2004
Physician
Hospital
Total
office
outpatient
ambulatory
visit rate
visit rate
visit rate
1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42.0
– – –
– – –
1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36.3
– – –
– – –
1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
– – –
– – –
1983 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
– – –
– – –
1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
– – –
– – –
1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36.1
– – –
– – –
1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
– – –
– – –
1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
– – –
– – –
1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
– – –
– – –
– – –
1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29.2
– – –
– – –
1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38.2
– – –
– – –
1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
45.1
– – –
– – –
1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56.4
4.4
60.8
1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
54.2
9.0
63.3
1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49.8
5.4
55.1
1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46.9
8.0
55.0
1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50.4
5.3
55.7
1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
52.5
7.3
59.8
1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
76.0
6.5
82.5
1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46.8
8.9
55.7
2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55.2
8.1
63.3
2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60.7
7.9
68.6
2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
60.0
8.7
68.7
2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
74.0
10.3
84.3
2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
89.5
6.3
95.8
– – – Data not available.
DATA SOURCES: CDC/NCHS: National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey.
Table IV. Data for Figure 4: Number of visits to emergency departments for asthma per 10,000 children 0–17 years of age, United States,
1992–2004
Emergency
department
visit rate
1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
96.8
1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
106.0
1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
103.7
1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
91.2
1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
112.3
1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
109.7
1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
121.4
1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
101.7
2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
100.7
2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
91.7
2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
99.9
2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
95.5
2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
102.9
DATA SOURCE: CDC/NCHS: National Hospital Ambulatory Medical Care Survey.
Advance Data No. 381 + December 12, 2006
17
Table V. Data for Figure 5: Number of hospitalizations for asthma per 10,000 children 0–17 years of age, United States, 1980–2004
Hospitalization
rate
1980 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21.0
1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22.2
1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25.7
1983 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23.7
1984 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25.5
1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25.4
1986 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27.3
1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25.9
1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28.5
1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27.9
1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28.4
1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30.6
1992 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30.8
1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25.4
1994 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26.8
1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32.7
1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29.8
1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32.4
1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24.4
1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28.1
2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29.6
2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26.2
2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26.9
2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31.2
2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
27.1
DATA SOURCE: CDC/NCHS: National Hospital Discharge Survey.
Table VI. Data for Figure 6: Number of deaths due to asthma per 1,000,000 children 0–17 years of age, United States, 1980–2004
Death rate,
Death rate,
Year
ICD-91
ICD-102
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
. . . Category not applicable.
1International Classification of Diseases, Ninth Revision (ICD-9).
2Beginning with data year 1999, the cause-of-death statistics published by NCHS are classified according to the International Classification of Diseases, Tenth Revision (ICD-10). Discontinuities
between the Ninth and Tenth Revisions of the ICD for selected causes of death are measured using comparability ratios. For asthma, the comparability ratio for the overall population was 0.89.
That is, the overall number of deaths attributed to asthma in 1999 was 11 percent lower using ICD-10 compared with ICD-9.
DATA SOURCE: CDC/NCHS: Mortality Component of the National Vital Statistics System.
18
Advance Data No. 381 + December 12, 2006
Table VII. Data for Figure 7: Proportional impact of asthma prevalence, health care use, and mortality among children 0–17 years of age,
by age group, United States, 2003–2005
Current
Emergency
Death
prevalence
department visit
Hospitalization
rate
Age group
2004–2005
rate 2003–2004
rate 2003–2004
2003–2004
0–4 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
71%
165%
211%
77%
5–10 years. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
107%
83%
81%
88%
11–17 years . . . . . . . . . . . . . . . . . . . . . . . . . . . .
115%
70%
40%
127%
NOTE: Proportional impact is calculated by dividing the outcome for each age group by the outcome for all children 0–17 years of age. For example, the proportional impact of current asthma
prevalence rates among children 0–4 years is 6.2 percent over the total prevalence, 8.7 percent, for a proportional impact of 71 percent.
DATA SOURCES: CDC/NCHS: National Health Interview Survey, National Hospital Ambulatory Medical Care Survey, National Hospital Discharge Survey, and the Mortality Component of the
National Vital Statistic System.
Table VIII. Data for Figure 8: The proportional impact of asthma prevalence, health care use and 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
90%
109%
69%
Non-Hispanic white . . . . . . . . . . . . . . . . . . . . . . .
92%
66%
50%
Non-Hispanic black . . . . . . . . . . . . . . . . . . . . . . .
146%
254%
354%
NOTE: Proportional impact is calculated by dividing the outcome among each race/ethnicity by the outcome for all children 0–17 years of age. For example, the proportional impact of current
asthma prevalence rates among non-Hispanic black children is 12.7 percent over the total prevalence, 8.7 percent, for a proportional impact of 146 percent.
DATA SOURCES: CDC/NCHS: National Health Interview Survey, National Hospital Ambulatory Medical Care Survey, and the Mortality Component of the National Vital Statistic System.
Table IX. Data for Figure 9a: Number of asthma deaths per 1,000,000 children 0–17 years of age, by race, 1999–2004
White
Black
Total
1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.0
9.4
3.0
2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.8
9.5
2.9
2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.5
8.6
2.6
2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.6
10.6
3.0
2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.5
9.3
2.7
2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.4
8.7
2.5
DATA SOURCE: CDC/NCHS: Mortality Component of the National Vital Statistics System.
Table X. Data for Figure 9b: 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
DATA SOURCE: CDC/NCHS: Mortality Component of the National Vital Statistics System.
Selected federal data sets with asthma content
Data source
Purpose/Scope
Design/Sample/Geographic coverage
Selected asthma content
National Health Interview Survey (NHIS)
The main objective of the NHIS is to monitor the
c Continuous survey; annual data release
Asthma prevalence:
http://www.cdc.gov/nchs/nhis.htm
health of the U.S. population through the collection
c Household face-to-face interview
c Lifetime asthma diagnosis
c Questionnaires, data files and documentation:
and analysis of data on a broad range of health
c Nationally representative
c Current asthma prevalence
http://www.cdc.gov/nchs/about/major/nhis/
topics. A major strength of this survey lies in the
c Multistage probability sample of the civilian
c Asthma attack prevalence
quest_data_related_doc.htm
ability to display these health characteristics by many
noninstitutionalized population
Periodic supplements on asthma symptoms,
Centers
demographic
for Disease Control and Prevention
and socioeconomic characteristics.
c Geography: National, 4 regions (Northeast, South,
medication use, health care use, and disease
(CDC)
Midwest, West), some states
control measures (1999, 2002, 2003)
Administered by National Center for Health
Statistics, CDC
Behavioral Risk Factor Surveillance System
The BRFSS is a state-based system of health
c Continuous survey; annual data release
Asthma prevalence, adults 18 years of age and
(BRFSS)
surveys that collects information on health risk
c Telephone interview
over:
http://www.cdc.gov/brfss/
behaviors, preventive health practices, and health
c Nationally representative
c Lifetime asthma diagnosis
c Questionnaires:
care access primarily related to chronic disease and
c Stratified probability sample, households with
c Current asthma prevalence
Advance
http://www.cdc.gov/brfss/questionnaires/
injury. For many states, the BRFSS is the only
telephones among the adult civilian
Periodic supplements on asthma symptoms,
questionnaires.htm
available source of timely, accurate data on health-
noninstitutionalized population
medication use, health care use, severity and
c Data files:
related behaviors about issues such as asthma,
c Geography: National, 50 states, District of
control
http://www.cdc.gov/brfss/technical_infodata/
diabetes, health care access, alcohol use,
Columbia, U.S. Territories. Data available for large
surveydata.htm
hypertension, obesity, cancer screening, nutrition and
metropolitan areas (see Selected Metropolitan/
Supplement on childhood asthma (2001)

Centers
physical activity, tobacco use, and more. Federal,
Micropolitan Area Risk Trends:
Data
for Disease Control and Prevention
(CDC)
state, and local health officials and researchers use
http://apps.nccd.cdc.gov/brfss-smart/
this information to track health risks, identify
SelMMSAPrevData.asp)
emerging problems, prevent disease, and improve

Administered by National Center for Chronic Disease
No.
treatment.
Prevention and Health Promotion, CDC, conducted
by States

381
National Asthma Survey and Asthma call-back
This survey examines the health, socioeconomic,
c Periodic data collection
Asthma experiences:
survey
behavioral, and environmental predictors that relate
c Telephone interview
c Time since diagnosis

+
http://www.cdc.gov/nchs/about/major/slaits/
to better control of asthma. This survey also explores
c Initial survey (2003–2004) nationally representative
c Medication use

nas.htm
the content of care and health care experiences of
c Geography:
c Health care use
December
c Questionnaires and data files for 2002–2003:
persons with asthma. Data for the initial survey,
Initial survey 2003–2004: National and 4 pilot
c Symptoms
http://www.cdc.gov/nchs/about/major/slaits/
which included a national sample and 4 states, were
states (AL, CA, IL, TX)
c Risk factors
nas.htm
collected in 2003 and released in the fall of 2005.
Call-back survey: 2005: 3 states, 2006: 25 states,
c Disease management
Centers for Disease Control and Prevention
The survey is now conducted as a call-back interview
and 2007: 35 states
(CDC)
subsequent to identifying respondents with asthma
Sponsored by the National Center for Environmental
during the BRFSS interview (above).
Health, CDC

12,
National Health and Nutrition Examination Survey
The NHANES combines interviews and physical
c Continuous since 1999 with data release every 2
Asthma prevalence:
(NHANES)
examinations to assess the health and nutritional
years; periodic from 1971–1994
c Lifetime asthma diagnosis

2006
http://www.cdc.gov/nchs/nhanes.htm
status of adults and children in the U.S. The
c Household face-to-face interview, physical exam in
c Current asthma prevalence
c Questionnaires and data files: http://
interview includes demographic, socioeconomic,
mobile examination center
c Asthma attack prevalence
www.cdc.gov/nchs/about/major/nhanes/
dietary, and health-related questions. The
c Nationally representative
Spirometry/pulmonary function testing, 1988–

datalink.htm
examination component consists of medical and
c Multistage probability sample of the civilian
1994
Centers
dental
for Disease Control and Prevention
examinations, physiological measurements,
noninstitutionalized population
Household dust analysis and allergen
(CDC)
and

laboratory tests. Data from this survey are used
c Geography: National
in epidemiological studies and health sciences
sensitization data, 2005–2006
Administered by National Center for Health Statistics,
research, which help develop sound public health
CDC
Environmental

toxin exposure
policy, direct and design health programs and
Planned future relevant content:
services, and expand health knowledge.
c Spirometry 2007
National Survey of Children’s Health (NSCH)
The NSCH examines the physical and emotional
c Periodic data collection (2003–2004 data released)
Seven asthma questions (ages 0–17 years):
http://www.cdc.gov/nchs/about/major/slaits/
health of children ages 0–17 years. Special
c Telephone interview
c Lifetime asthma diagnosis
nsch.htm
emphasis is placed on factors that may relate to
c Nationally representative
c Current asthma prevalence
c Questionnaires and data files:
well-being of children, including medical homes,
c Stratified probability sample, households with
c Asthma attack prevalence
http://www.cdc.gov/nchs/about/major/slaits/
family interactions, parental health, school and
telephones among the civilian noninstitutionalized
c Asthma severity
nsch.htm
after-school experiences, and safe neighborhoods.
population (ages 0–17 years)
c Family burden
Centers for Disease Control and Prevention
c Geography: National and state estimates
c Time since medication taken
(CDC)
Sponsored by Health Resources and Services
c Hospitalization in past 12 months
19
Administration (HRSA)

20
Selected federal data sets with asthma content—Con.

Data source
Purpose/Scope
Design/Sample/Geographic coverage
Selected asthma content
Youth Risk Behavior Survey (YRBS)
The YRBS was developed in 1990 to monitor priority
c Conducted every 2 years
Asthma prevalence questions added in 2005 (not
http://www.cdc.gov/HealthyYouth/yrbs/index.htm
health risk behaviors that contribute to the leading
c Self-administered questionnaire in school setting
directly comparable to NHIS, BRFSS above):
c Questionnaires:
causes of death, disability, and social problems
c National, state, and local school-based surveys of
c Lifetime asthma diagnosis
http://www.cdc.gov/HealthyYouth/yrbs/
among youth and adults in the United States. Six
representative samples of 9th through 12th grade
c Current asthma prevalence
index.htm (see right lower panel)
categories of priority health-risk behaviors are
students
c Asthma attack prevalence
c Data files:
monitored.
c Geography: National and state estimates
http://www.cdc.gov/HealthyYouth/yrbs/data/
index.htm
Administered by the National Center for Chronic
Disease Prevention and Health Promotion, CDC
Centers for Disease Control and Prevention
(CDC)
National Longitudinal Survey of Youth (NLSY79)
The NLSY79 is a nationally representative sample of
c Longitudinal survey; annual interviews
Asthma questions were added for data collection
http://www.bls.gov/nls/nlsyouth.htm
12,686 young men and young women who where 14
c Face-to-face interview
in 2004.
c Questionnaires:
to 22 years of age when they were first surveyed in
c Nationally representative longitudinal sample
2002 data file contains question on special health
Advance
http://www.bls.gov/nls/79quex/y79quex.htm
1979. Annual data collections provide a unique
c Geography: National estimates
care needs and limitations from chronic
c Data files:
opportunity to study in detail the life course
Administered by the Bureau of Labor Statistics, U.S.
conditions, including asthma, for the children of
http://www.bls.gov/nls/nlsy79ch.htm
experiences of this sample. In 1986, a separate
Department of Labor
NLSY79 female respondents.
Bureau
survey
of Labor Statistics (BLS)
of all children born to NLSY79 female
respondents began, greatly expanding the breadth of
child-specific information collected. In addition to all

Data
of the mother’s information from the NLSY79, the
child survey includes assessments of each child as
well as additional demographic and development

information collected from either the mother or child.
No.
Medical Expenditure Panel Survey (MEPS)
The MEPS is a set of large-scale surveys of families
c Continuous survey; annual data release
Health care use, medication and device use, and

381
http://www.meps.ahrq.gov/
and individuals, their medical providers, and
c Household face-to-face interview
expenditures for asthma.
c Questionnaires: Household component,
employers across the United States. MEPS is the
c Nationally representative
including Priority Conditions:
most complete source of data on the cost and use of
c Overlapping panel design sample of the civilian

+
http://www.meps.ahrq.gov/mepsweb/survey_
health care and health insurance coverage.
noninstitutionalized population

December
comp/survey_results_ ques_sections.jsp
c Geography: National
?Section=PC&Year1=2004&Submit1=Search
Administered by AHRQ
c Data files:
http://www.meps.ahrq.gov/mepsweb/data_stats/
download_data_files.jsp
Agency for Healthcare Research and Quality
(AHRQ)

12,
National Health Care Survey (NHCS)
The NHCS embraces a family of health care provider
c Annual data release
Ambulatory, emergency department, and hospital

http://www.cdc.gov/nchs/nhcs.htm
surveys, obtaining data about the facilities that
c Multistage sampling design of health care facilities/
inpatient asthma visits and stays.
2006
c Data files:
supply health care, services rendered, and patient
providers/patient records; medical record
NAMCS: http://www.cdc.gov/nchs/about/major/
characteristics. Data offer the most accurate and
abstraction
ahcd/ahcd1.htm
detailed data on diagnosis and treatment, as well as
c Geography: National, 4 regions

NHAMCS: http://www.cdc.gov/nchs/about/
on the characteristics of the institutions. These data
1. National Ambulatory Medical Care Survey
major/ahcd/ahcd1.htm
are used by policymakers, planners, researchers,
(NAMCS): physician offices
NHDS: http://www.cdc.gov/nchs/about/major/
and others in the health community to monitor
2. National Hospital Ambulatory Medical Care
hdasd/nhds.htm
changes in the use of health care resources, to
Survey (NHAMCS): hospital emergency
Centers for Disease Control and Prevention
monitor specific diseases, and to examine the impact
departments and outpatient departments
(CDC)
of new medical technologies.
3. National Hospital Discharge Survey (NHDS):
nonfederal short-stay hospitals
Administered by the National Center for Health
Statistics, CDC
Selected federal data sets with asthma content—Con.
Data source
Purpose/Scope
Design/Sample/Geographic coverage
Selected asthma content
Healthcare Cost and Utilization Project (HCUP),
c HCUP: a family of health care databases and
c Annual data release
Ambulatory, emergency department, and hospital
HCUPNet, and KID
software tools developed through a Federal-state-
c Medical record abstraction
inpatient asthma visits and stays.
HCUP: http://www.ahrq.gov/data/hcup/
Industry partnership and sponsored by AHRQ.
c Geography: National and State
HCUPnet:
c HCUPnet: a free, on-line query system based on
1. State Inpatient Databases:
http://hcupnet.ahrq.gov/
data

from HCUP. It provides access to health
universe of inpatient discharge data from >35
statistics and information on hospital stays at the
KID: http://www.hcup-us.ahrq.gov/kidoverview.jsp
states; >90% of US community hospital
national, regional, and state level.
discharges.
Agency for Healthcare Research and Quality
c The Kids’ Inpatient Database (KID): a powerful
2. State Ambulatory Surgery Databases: data from
(AHRQ)
database of hospital inpatient stays for children.
ambulatory care encounters in >20 states.
Researchers and policymakers can identify, track,
3. State Emergency Department Databases:
and analyze national trends in health care use,
emergency dept. abstract data for >15 states
access, charges, quality, and outcomes.
4. Nationwide Inpatient sample: 20% stratified
sample of U.S. community hospitals.
5. KID: all-payer inpatient care for children.
Advance
Administered by AHRQ
Mortality Component of the National Vital
The vital statistics general mortality data are a
c Annual data release
Deaths with asthma as the underlying or
Statistics System (NVSS)
fundamental source of demographic, geographic, and
c Compilation of data from death certificates from 50
contributing cause of death.
http://www.cdc.gov/nchs/deaths.htm
cause-of-death information. This is one of the few
states and D.C.

Data
c Data files:
sources of comparable health-related data for small
c Residential population (includes all deaths within
underlying cause of death:
geographic areas and a long time period in the U.S.
the U.S.)
http://www.cdc.gov/nchs/products/elec_prods/
The data are also used to present the characteristics
c Geography: National and state

subject/mortucd.htm
of those dying in the U.S. to determine life
Administered by the National Center for Health
No.
multiple cause of death:
expectancy and to compare mortality trends with
Statistics, CDC
http://www.cdc.gov/nchs/products/elec_prods/
other countries.

subject/mortmcd.htm
381
Centers for Disease Control and Prevention
(CDC)


+

December

12,
2006

21

22
Selected federal asthma resources: pretabulated statistics, interactive data resources, and publications

Resource/Agency
Site content
Asthma-specific content
Behavioral Risk Factor Surveillance System
Interactive statistical tool
Interactive statistical tool: Prevalence data by geographic location (national/state/territory) and sex, age, race/ethnicity, income, or
(BRFSS)
(query system)
education: http://apps.nccd.cdc.gov/brfss/
Centers for Disease Control and Prevention
Statistical tables online
c Adults who have been told they currently have asthma
(CDC)
c Adults who have ever been told they have asthma
Online asthma prevalence tables by geographic location (state/territory) and sex, age, race/ethnicity, education, or education:
http://www.cdc.gov/asthma/brfss/default.htm
National Survey of Children’s Health (NSCH)
Interactive statistical tool
User can produce data tables for asthma by geographic location (National and state)
Data Resource Center
(query system)
c Percentage of children with asthma-related health issues in past 12 months
http://www.nschdata.org/Content/Default.aspx
Chartbooks
c Percentage of children with current asthma but no symptoms in past 12 months
Centers for Disease Control and Prevention
c The extent to which a child’s asthma affects the family
Publications & Presentations
(CDC)
c Percentage of children hospitalized for asthma in past 12 months
Advance
Youth Risk Behavior Survey (YRBS) Youth
Interactive statistical tool
View by health topic—user can choose ‘‘other’’ topics to view asthma results by geographic location (National and state), year, age,
Online: Comprehensive Results
(query system)
sex, and grade:
http://apps.nccd.cdc.gov/yrbss/
c Percentage of students who had ever been told by a doctor or nurse that they had asthma
Centers for Disease Control and Prevention
c Percentage of students who have ever been told by a doctor or nurse that they had asthma and who have asthma but had not had
(CDC)
an

episode of asthma or an asthma attack during the past 12 months, or who had an episode of asthma or an asthma attack
during the past 12 months (i.e., current asthma)

c Among students with current asthma, the percentage who had an episode of asthma or an asthma attack during the past 12
Data
months
Medical Expenditure Panel Survey
Interactive statistical tool
Interactive statistical tool:

No.
Agency
(query
for Healthcare Research and Quality
system)
c MEPSnet http://www.meps.ahrq.gov/mepsweb/data_stats/MEPSnetHC.jsp
(AHRQ)
Step

1: Data Source Selection - Select a data year; Step 2: Variable Selection - Choose variables to use; Step 3: (Optional)
Publications

Variable Recoding - Regroup variables your way; Step 4: (Optional) Record Selection - Select the records you want; Step 5:
381
Descriptive Statistics - Select Show Statistics to generate the statistics.
Statistical tables online
Statistical tables online:

+
c Expenditures by medical condition by service site (customizable by age)

http://www.meps.ahrq.gov/mepsweb/data_stats/quick_tables_results.jsp?component= 1&subcomponent=0&tableSeries=2&year=­
December
1&SearchMethod=1&Action=Search
Publications:
c Statistical brief ‘‘Demographic and Clinical Variations in Health Status’’
http://www.meps.ahrq.gov/mepsweb/data_stats/Pub_ProdResults_Details.jsp?pt=Methodology%20Report&opt=2&id=674
c Persons diagnosed with diabetes, asthma, or hypertension had worse physical health status overall than those who did not have
these conditions (adults only)

c Use of different medications and devices in children and adults with asthma (forthcoming)
12,
National Center for Health Statistics
Interactive statistical tools
Interactive statistical tools

2006
c Health Data for All Ages: http://www.cdc.gov/nchs/health_data_for_all_ages.htm, and Trends in Health and Aging: http://
Centers for Disease Control and Prevention
Publications
www.cdc.gov/nchs/agingact.htm. Enter ‘‘asthma’’ into the search box to access interactive tables on asthma prevalence, health care
(CDC)
use and mortality. Users can customize tables with any or all of the following characteristics: age, gender, race/ethnicity, and

geographic location (national/state depending on data source).
c Healthy People Data 2010: http://wonder.cdc.gov/DATA2010focus.htm. Users can view asthma data (national/state depending on
data source) on Healthy People Objectives by selecting focus area 24 (respiratory diseases).
Publications/Fact sheets
c Health E Stat: ‘‘Asthma Prevalence, Health Care Use and Mortality, United States’’ http://www.cdc.gov/nchs/products/pubs/pubd/
hestats/asthma/asthma.htm
c FASTSTATS asthma page: http://www.cdc.gov/nchs/fastats/asthma.htm
c Health, United States: http://www.cdc.gov/nchs/hus.htm (search for ‘‘asthma’)
Selected federal asthma resources: pretabulated statistics, interactive data resources, and publications—Con.
Resource/Agency
Site content
Asthma-specific content
National Center for Environmental Health
Publications
List of Morbidity and Mortality Weekly Reports (MMWR) on asthma: http://www.cdc.gov/asthma/asthmadata.htm#mmwr. Updated
MMWR Asthma Surveillance Summary to be released in 2007.
Centers for Disease Control and Prevention
Resources
(CDC)
Asthma Surveillance Data summary:
http://www.cdc.gov/asthma/asthmadata.htm#data. Includes overview of asthma surveillance questions on CDC surveys, and links to
asthma tables, maps, charts, and slides.
Statistical tables online:
c Asthma prevalence tables from the National Health Interview Survey (NHIS) for the U.S. by age, sex, race/ethnicity, geographic
region, and income: http://www.cdc.gov/asthma/nhis/default.htm.
c Asthma prevalence tables from the Behavioral Risk Factor Surveillance Survey (BRFSS) by geographic location (state/territory) and
sex, age, race/ethnicity, education, or education: http://www.cdc.gov/asthma/brfss/default.htm
CDC asthma resources: http://www.cdc.gov/health/asthma.htm
Agency for Healthcare Research and Quality
Research syntheses
Research syntheses:
Advance
(AHRQ)
Research findings
c Chronic Care for Low-Income Children with Asthma: Strategies for Improvement Research in Action, Issue 18
http://www.ahrq.gov/research/chasthria/chasthria.htm
Ongoing research
c Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies—Volume 5: Asthma (forthcoming–check http://
Quality improvement
www.ahrq.gov/clinic/epcix.htm)
resources
Research Findings:

c Child Health Research Findings: http://www.ahrq.gov/research/childfind/ (update in progress).
Data
Research in progress:
c Grants on Line Database http://www.gold.ahrq.gov/ (Type ‘‘pediatric asthma’’ into keyword search box.)
Quality Improvement Resources:

No.
c Asthma Care Quality Improvement Workbook and Resource Guide for States http://www.ahrq.gov/qual/asthmaqual.htm

381

+

December

12,
2006

23

24
Advance Data No. 381 + December 12, 2006
Suggested citation
Copyright information
National Center for Health Statistics
Akinbami LJ. The State of childhood asthma,
All material appearing in this report is in the
Director
United States, 1980–2005. Advance data from
public domain and may be reproduced or
Edward J. Sondik, Ph.D.
vital and health statistics; no 381, Hyattsville,
copied without permission; citation as to
Acting Co-Deputy Directors
MD: National Center for Health Statistics.
source, however, is appreciated.
Jennifer H. Madans, Ph.D.
2006.
Michael H. Sadagursky
U.S. DEPARTMENT OF
FIRST CLASS
HEALTH & HUMAN SERVICES
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