Asthma -- United States, 1980-1990

Since the 1970s, the prevalence, morbidity, and mortality of asthma * in the United States and other western countries have increased (1-3). In 1990, related health-care expenditures for asthma were estimated at $6.2 billion, or nearly 1% of all U.S. health-care costs (4). This report updates a previous report (5) on national trends in disease burden for asthma using the latest available data from CDC's National Center for Health Statistics' multiple-cause-of-death file, the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Discharge Survey, and the National Health Interview Survey (NHIS).

From 1980 through 1989, the age-adjusted death rate ** for asthma as the underlying cause of death increased 46% from 1.3 per 100,000 population (2891 deaths) to 1.9 per 100,000 (4867 deaths) (Figure 1). During this period, the death rate increased 54% for females (from 1.3 to 2.0 per 100,000) and 23% for males (from 1.3 to 1.6 per 100,000).

The annual asthma death rate was consistently higher for blacks than for whites *** during this period; for blacks, the rate increased 52% (from 2.5 to 3.8 per 100,000), compared with a 45% increase (from 1.1 to 1.6 per 100,000) for whites (Figure 1). The increase in the death rate for black and white females was similar; 63% (from 2.4 to 3.9 per 100,000) and 64% (from 1.1 to 1.8 per 100,000), respectively. However, the increase in the death rate for black males (37%; from 2.7 to 3.7 per 100,000) was more than twice that for white males (17%; from 1.2 to 1.4 per 100,000).

Asthma is generally treated in outpatient settings. Results from the NAMCS indicate that physician visits for asthma as a first-listed diagnosis increased from 6.5 million in 1985 to 7.1 million in 1990. The age-adjusted rate for physician visits increased 35% for blacks (from 2520 to 3390 per 100,000 population) but decreased 8% for whites (from 2790 to 2580 per 100,000). For blacks, the rate of visits decreased 46% for males (from 2410 to 1290 per 100,000) but increased 98% for females (from 2600 to 5140 per 100,000). For whites, the rate decreased 23% for males (from 2640 to 2020 per 100,000) but increased 8% for females (from 2930 to 3160 per 100,000).

From 1980 through 1990, the age-adjusted hospital discharge rate for asthma as the first-listed diagnosis varied slightly, from 180 per 100,000 to 188 per 100,000; the highest discharge rates occurred in the middle of the decade. Females had higher hospital discharge rates than males each year; blacks were more than twice as likely as whites to be hospitalized each year.

Based on NHIS results from 1980 through 1990, the age-adjusted prevalence rate for self-reported asthma increased 38%, from 3100 to 4290 per 100,000 population (from 6.8 million to 10.3 million persons affected). The rate increased 50% for females and 27% for males. From 1981 through 1988, the annual prevalence rate for black females increased from 2750 to 6060 per 100,000; from 1980 through 1989, the rate for white females increased from 2960 to 4700 per 100,000.

Reported by: Chronic Disease Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate substantial variation in patterns of disease burden of asthma among subpopulations in the United States -- especially during the latter 1980s. These variations may reflect changes in disease occurrence, disease severity, use of health-care facilities, trends in diagnostic and coding practices, and increased public awareness. For most persons with asthma, symptoms are mild and can be managed with outpatient care. An expert panel report recommends using daily patient diaries, regular peak-flow monitoring, developing a patient-provider partnership, and using corticosteroids and cromolyn preparations when appropriate (6).

The etiology, morbidity, and mortality of asthma are multifactorial with possible familial, infectious, allergenic, environmental, socioeconomic (7), and psychosocial influences. For persons with asthma, suspected precipitating factors -- such as res- piratory allergens (e.g., house-dust mites [8] and molds), respiratory infections, tobacco-smoke exposure, and environmental and other occupational exposures -- should be controlled. However, the role of these and other risk factors in the development and manifestation of this disease is not completely understood. The National Institute of Allergy and Infectious Diseases' National Cooperative Inner-City Asthma Study intends to clarify some of the risk factors for asthma among urban populations (9).

The national health objectives for the year 2000 include decreasing disability and hospitalizations for asthma and increasing education about asthma (objectives 11.1, 17.4, and 17.14) (10). In addition, the disproportionate increases in the morbidity and mortality of asthma among races other than white have resulted in increased use of emergency rooms and hospitals (9).

To decrease asthma morbidity and mortality, health-care providers and public health officials need to address the prevention and control of known risk factors, access to regular health care and follow-up, the increased role of primary care in treatment, effective use of emergency rooms, appropriate hospitalization, the availability and cost of pharmacotherapy, patient/provider education, and the effectiveness of these interventions. Further efforts to characterize asthma epidemiologically should address the effect of underlying patterns of illness on the distribution of disease severity, the use of health-care facilities (including emergency-room visits and hos- pitalizations), and the presence of comorbid conditions before death.

References

1. Evans R III, Mullally DI, Wilson RW, et al. National trends in the morbidity and mortality of asthma in the US. Prevalence, hospitalization and death from asthma over two decades: 1965-1984. Chest 1987;91(suppl):65S-74S.

2. Gergen PJ, Mullally DI, Evans R III. National survey of prevalence of asthma among children in the United States, 1976 to 1980. Pediatrics 1988;81:1-7.

3. Weiss KB, Wagener DK. Changing patterns of asthma mortality: identifying target populations at high risk. JAMA 1990;264:1683-7.

4. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med 1992;326:862-6.

5. CDC. Asthma -- United States, 1980-1987. MMWR 1990;39:493-7.

6. National Asthma Education Program. Executive summary: guidelines for the diagnosis and management of asthma. Bethesda, Maryland: National Institutes of Health, 1991; NIH publication no. 91-3042A.

7. Wissow LS, Gittelsohn AM, Szklo M, Starfield B, Mussman M. Poverty, race, and hospitalization for childhood asthma. Am J Public Health 1988;78;777-82.

8. Sporik R, Holgate ST, Platts-Mills TAE, Cogswell JJ. Exposure to house-dust mite allergen and the development of asthma in childhood. N Engl J Med 1990;323:502-7.

9. Wing JS, Weiss KB. Asthma among children and minority populations in the United States: working toward the year 2000 health objectives [Abstract]. In: Program and abstracts of the 119th annual meeting of the American Public Health Association. Washington, DC: American Public Health Association,1991:238.

10. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

• International Classification of Diseases, Ninth Revision, Clinical Modification, code 493. ** Intercensal population estimates were used to calculate age-adjusted rates standardized to the 1980 U.S. population. *** Death rates for other racial/ethnic groups were not included in this analysis.

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