Understanding New Mexico

1
Understanding New Mexicos Regional Health
Disparity in Asthma An Examination of
Southeastern New Mexico Brad Whorton Asthma
Epidemiologist
2
ASTHMA STATISTICS AT A GLANCE

• Region 4 makes up 13 of the state population.
• Approximately 24,000 adults in Region 4 have
  asthma (almost 15 of the state total).
• Approximately 10,200 children in Region 4 have
  asthma (about 18 of the state total).
• Approximately 33 of the states primary Asthma
  hospital discharges occur to Region 4 residents.

• Just over 58 of the states primary Asthma
  hospital discharges to those under age 15 involve
  Region 4 youth.

3
SOURCE NM BRFSS, 2004-2006 combined dataset.
4
SOURCE NM BRFSS, 2005.
5

plt.05. SOURCE Public Education Department,
School Health Report data.
6

plt.05. NOTE Rates are based on deaths to New
Mexico residents and are age-adjusted per 100,000
standard population. SOURCE Data provided by
BVRHS, NMDOH.
7
Asthma Emergency Room Discharge Rates, 2001-2003
Average
All Ages
STATE RATE 30.6
NOTE Age-adjusted rates are per 10,000 standard
population. The data include state residents who
were admitted to in-state non-federal
hospitals. SOURCE Analysis by EHEB, NMDOH.
Data from statewide emergency departments.
Rates based on fewer than 20 cases are
statistically unreliable and should be
interpreted with caution.
8
ASTHMA Emergency Department Discharge Rates (All
Ages), 2001-2003 Average

plt.05. SOURCE Analysis by EHEB, NMDOH. Data
from non-federal emergency departments in New
Mexico.
9

plt.05. SOURCE Analysis by EHEB, NMDOH. Data
from non-federal emergency departments in New
Mexico.
10
Asthma Hospital Discharge Rates by County,
2003-2005 Average
Rates are age-adjusted per 10,000 standard
population.
Data are based on primary diagnosis. State
residents who were admitted to in-state
non-federal hospitals are included. American
Indians are excluded.
Rates based on fewer than 20 cases are
statistically unreliable and should be
interpreted with caution.
11
NOTE Rates include those cases where asthma was
the primary diagnosis and are per 10,000 standard
population. State residents who were admitted to
in-state non-federal hospitals are included.
American Indians are excluded. SOURCE Analysis
by EHEB, NMDOH Data from NM Health Policy
Commission.
12

• HID data currently does not collect out-of-state
  HID data on New Mexico residents.
• The Asthma Program collected HID data from
  selected Colorado and Texas (El Paso and Lubbock
  areas).
• In 2004, there were 526 New Mexico resident
  discharges from Colorado and Texas.
• 481 Region 5 SW
• 34 Region 4 SE
• 7 Region 2 NE
• 2 Region 3 Bern. Co.
• 2 Region 1 NW
• We hope to collect Texas HID data on a regular
  basis beginning with 2006 data (very expensive).

13
PRELIMINARY ANALYSIS OF OUT OF STATE HID
CAUTION These data are preliminary and have not
been verified by the Texas Department of State
Health Services. SOURCE In-state data
collected by NMHPC Out-of-state data collected
by the Asthma Program, NMDOH.
14
(No Transcript)
15
NOTE Rates include those cases where asthma was
the primary diagnosis and are per 10,000 standard
population. State residents who were admitted to
in-state non-federal hospitals are included.
American Indians are excluded. SOURCE Analysis
by EHEB, NMDOH Data from NM Health Policy
Commission.
16
plt.05. NOTE Rates include those cases where
asthma was the primary diagnosis and are per
10,000 standard population. State residents who
were admitted to in-state non-federal hospitals
are included. American Indians are excluded.
SOURCE Analysis by EHEB, NMDOH Data from NM
Health Policy Commission.
17
NOTE Rates are age-adjusted per 10,000 standard
population. Only in-state non-federal hospital
discharges are included. Since many American
Indians receive services from I.H.S. hospitals,
they are excluded from the analysis. SOURCE NM
Health Policy Commission.
18
NOTE Only in-state non-federal hospital
discharges are included. Since many American
Indians receive services from I.H.S. hospitals,
they are excluded from the analysis. SOURCE NM
Health Policy Commission.
19
NOTE Crude rates were calculated based on U.S.
Census population estimates. SOURCE NM Health
Policy Commission.
20
NOTE The red bars are for youth less than age
15 blue bars are for all ages. American Indians
are excluded from the analysis. Statistically
significant compared to state average. SOURCE NM
Health Policy Commission.
21

22

NOTE New Mexico residents who were discharged
from non-federal hospitals in the state are
included. American Indians are excluded. SOURCE
Data provided by the New Mexico Health Policy
Commission.
23
Primary Asthma Hospital Admissions by Season,
2000-2005
SOURCE NM Health Policy Commission.
24
NOTE Intubation procedure code 96.01-96.05
Ventilation procedure code 96.70-96.72.
American Indians are excluded from the
analysis. SOURCE NM Health Policy Commission.
25
Primary Asthma Hospitalization Source of
Admissions, 2000-2005
SOURCE NM Hospital Policy Commission.
26
NOTE Rates are per 10,000 standard
population. SOURCE Data from the New Mexico
Health Policy Commission.
27
NOTE Rates are per 10,000 standard
population. SOURCE Data from the New Mexico
Health Policy Commission.
28

SOURCE New Mexico Health Policy Commission.
29

SOURCE New Mexico Health Policy Commission.
30
SOURCE Molina Health Care. Data based on a
sample of cases.
31
SOURCE NM YRRS, 2005.
32

SOURCE NM BRFSS, 2004-2006 combined dataset.
33
SOURCE NM YRRS, 2005.
34



SOURCE YRRS data cited in the 2007
Tobacco-related Data for New Mexico High School
Youth, 2001-2005.
35
SOURCE NM YRRS, 2005.
36
(No Transcript)
37
NOx Emissions from Active Facilities by Youth
Asthma HID Rates, 2003-2005
NOx Quartiles
Youth HID Rate Quartiles
NOTE The data presented in this slide have not
been tested for statistical significance. Data
for Bernalillo County are not included. SOURCE
NM Environment Department, Air Quality
Bureau. SOURCE NM Environment Department, Air
Quality Bureau.
38
SO2 Emissions from Active Facilities by Youth
Asthma HID Rates, 2003-2005
SO2 Quartiles
Youth HID Rate Quartiles
NOTE The data presented in this slide have not
been tested for statistical significance. Data
for Bernalillo County are not included. SOURCE
NM Environment Department, Air Quality
Bureau. SOURCE NM Environment Department, Air
Quality Bureau.
39
PM10 Emissions from Active Facilities by Youth
Asthma HID Rates, 2003-2005
PM10 Quartiles
Youth HID Rate Quartiles
NOTE The data presented in this slide have not
been tested for statistical significance. Data
for Bernalillo County are not included. SOURCE
NM Environment Department, Air Quality
Bureau. SOURCE NM Environment Department, Air
Quality Bureau.
40
VOC Emissions from Active Facilities by Youth
Asthma HID Rates, 2003-2005
VOC Quartiles
Youth HID Rate Quartiles
NOTE The data presented in this slide have not
been tested for statistical significance. Data
for Bernalillo County are not included. SOURCE
NM Environment Department, Air Quality
Bureau. SOURCE NM Environment Department, Air
Quality Bureau.
41
Interpretation of Findings

• Appears to be a multifaceted problem.
• Asthma sufferers may be using the Emergency Room
  and the Hospital as a source of primary asthma
  care instead of PCP.
• High HID and ED rates
• High PCP referral to the hospital
• Asthma sufferers appear to be treated for acute
  asthma attacks but without an effective asthma
  management plan (chronic care).
• Higher number of repeat hospital visits
• PCPs prescribing vastly more acute asthma meds
  than chronic asthma management meds (short acting
  beta2 agonists versus Corticosteroids)

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• Hospitals in SE NM may have lower asthma
  admission criteria OR they are discharging
  patients too early and not providing the needed
  care.
• Shorter length of hospital stay
• More repeat visits
• High PCP referral to the hospital
• May be differences in procedures given
• Asthma sufferers confronted with more indoor and
  outdoor environmental exposures.
• More smoking or exposure to second-hand smoke
• More facilities with emissions known to
  cause/exacerbate asthma

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• Asthma sufferers confronted with more indoor and
  outdoor environmental exposures.
• More smoking or exposure to second-hand smoke
• More facilities with emissions known to
  cause/exacerbate asthma
• Socioeconomic and cultural factors may be
  contributing to the asthma disparity.
• Higher percent of claims paid by Medicaid in the
  region
• Hispanic youths have higher rate of asthma
  hospital discharges
• Asthma severity may be higher
• Higher death rates
• Higher ED and HID rates, and School Health
  prevalence

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Next Steps

• Working with the NMMRA to come up with a study
  proposal
• to do a chart review to assess the condition of
  the patient on admission
• to assess the quality of inpatient/outpatient
  care
• Holding Asthma Summits around the state
• to get buy-in for the need for PCP training on
  the newly updated standards of asthma care
• to address issues of access to care (consistent
  formularies, etc.)
• Analyze air quality data to look for
  temporal/spatial associations with asthma ED
  visits.

45

• Asthma Program continues to fund
• Child care provider training
• Indoor air quality measures in public schools
• Development of an asthma school manual
• PCP training