Clearing the Air Asthma and Indoor Air Exposures (2000) / Chapter Skim
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3 Patterns of Asthma Morbidity and Mortality
3 Patterns of Asthma Morbidity and Mortality
Pages 67-86
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From page 67... ...
Studying the observed differences will identify risk factors contributing to the development and activity of a disease. Once these risk factors are understood, interventions can be developed to ameliorate their effects.
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From page 68... ...
The difference is greatest in the younger group approximately 10 times higher in 1- to 4-year-olds and decreases with age until the ratio is only 1.2 times greater at age 85 and over (Figure 3-1~. Little difference in asthma mortality rates is seen when the United States is divided into four census regions (U.S.
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From page 69... ...
UTILIZATION OF HEALTH CARE SERVICES Data on asthma health care utilization patterns in the United States are available from two national surveys the National Hospital Discharge Survey and the National Health Care Survey. In contrast to mortality, approximately 37°/O of asthma hospitaliza
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From page 70... ...
The prevalence of asthma varied almost threefold, from 3.6 to 9.5°/O, when various combinations of physician diagnosis and wheezing were used to define asthma among children age 3 to 17 who participated in the second National Health and Nutrition Examination Survey (NHANES II) from 1976 to 1980
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From page 71... ...
(Benson and Marano, 1998; Gergen et al., 1988; Turkeltaub and Gergen, l991~. Hispanics reported wide discrepancies in prevalence: Mexican-American children in the Southwest reported some of the lowest rates of asthma in the United States while Puerto Rican children living on the East Coast of the United States reported some of the highest rates (CarterPokras and Gergen, 1993~.
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From page 72... ...
72 60 50 o ~ 40Q 35 30 20 CLEARING THE AIR ~ Male -I- Female ,," a. 1980 1981 -1983 1984-1986 1987-1989 1990-1992 1993-1994 Year FIGURE 3-2 Asthma prevalence by gender, 1980-1994.
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From page 73... ...
The state-specific prevalence rates ranged from 5.8 to 7.2%, leading the authors to conclude that the demographic composition of states had minimal influence on estimated asthma prevalences (Rappaport and Boodram, 1998~. Based on data from the NHIS, the self-reported prevalence of asthma increased 75°/O between 1980 and 1994 (Manning et al., 1998~.
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From page 74... ...
74 CLEARING THE AIR TABLE 3-2 Forecastecl Estimates of Self-Reportecl Asthma Prevalence by State, 1 998 State Region or Number Estimated of Cases Prevalence (%) 95% Confidence Standard Interval (%)
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From page 75... ...
SEVERInr Based on the data shown above, one could conclude that the severity of asthma has increased. However, asthma mortality,
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From page 76... ...
76 UK New Zealand Australia Ireland Australia Canada Peru Costa Rica Brazil USA Paraguay Uruguay Panama Kuwait South Africa Malta Finland Lebanon Kenya Germany France Japan Thailand Sweden Hong Kong Philippines Belgium Austria Iran Argentina Estonia Nigeria Spain Chile Singapore Malaysia Portugal Uzbekistan Oman Italy Pakistan Larvia Poland Algeria South Korea Morocco Mexico Ethiopia I ndia Taiwan Russia China Greece Georgia Romania Albania I ndonesia CLEARING THE AIR ·. · .~ ~ FIGURE 3-4 Prevalence of asthma symptoms (percentage)
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From page 77... ...
Data from a number of sources imply that the increase in asthma is not due solely to an increase in its severity. Data collected on selfreported asthmatics participating in the Child Health Supplements of the NHIS a nationally representative health surveyfound that, in comparing 1988 with 1981, a number of markers of asthma impact had decreased: the percentage of asthmatics reporting fair or poor health status, the number reporting 30 or more days in bed over the past year, the rate of extreme behavior problem scores, and the number of school days missed.
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From page 78... ...
There is some evidence that infections early in life could be protective for asthma and allergies (Martinez, 1994~. However, this runs counter to data suggesting an increase in childhood asthma incidence at a time when the use of day care increased (from 13% in 1994 to 29.4% in 1997 according to a 1998 U.S.
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From page 79... ...
SOCIOECONOMIC STATUS VERSUS RACE OR ETHNICITY Poverty and minority status are consistently reported to be related to increased asthma morbidity and mortality (Carr et al., 1992; Gottlieb et al., 1995~. Thus far, research has not provided evidence that asthma is intrinsically a different disease among the various racial or ethnic groups in the United States.
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From page 80... ...
A second cross-sectional study was done in the same East Germany city four years later, during which time pollution levels had dropped and prosperity had increased. The allergic skin test reactivity and reported rates of hay fever were found to have increased, but the prevalence of asthma and BHR had not (von Mutius et al., 1998~.
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From page 81... ...
However, in the United States, allergen skin test reactivity increases with increasing socioeconomic status (Gergen et al., 1987~. Even mortality statistics should be interpreted with caution.
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From page 82... ...
1989. Association of asthma with serum IgE levels and skin-test reactivity to allergens.
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From page 83... ...
A retrospective study of Norwegian twins. American Journal of Respiratory and Critical Care Medicine 156~1~:43-49.
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1997. Outpatient management practices associated with reduced risk of pediatric asthma hospitalization and emergency department visits.
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American Journal of Respiratory and Critical Care Medicine 149~2 Pt 1~:358364. von Mutius E, Weiland SK, Fritzsch C, Duhme H
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From page 86... ...
The changing epidemiology of asthma morbidity and mortality. Annual Review of Public Health 14:491-513.
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