Asthma in Michigan

1
Asthma in Michigan

• Prepared by Epidemiology and Surveillance Staff
  of the Asthma Initiative of Michigan, Michigan
  Department of Community Health

Last Updated 07.15.2004
2
Overview of Presentation

• What is Asthma?
• The Asthma Initiative of Michigan
• Asthma Surveillance in Michigan
• Asthma Prevalence
• Asthma Management and Quality of Life
• Work-Related Asthma
• Asthma Hospitalization
• Asthma Mortality
• Healthy People 2010 Goals for Asthma

3
What is asthma?
4
Asthma Defined

• Chronic inflammatory disease of the airways
• Causes recurrent episodes of
• Wheezing
• Breathlessness
• Chest tightness
• Coughing
• Episodes are usually associated with airflow
  obstruction that is often reversible either
  spontaneously or with treatment

Guidelines for the Diagnosis and Management of
Asthma, NIH Publication 97-4051, July 1997.
5
Risk Factors for Developing Asthma

• Family history of asthma
• Sociodemographic factors
• Prepubescent males
• Post-pubescent females
• Low socioeconomic status
• Minority races
• Allergy or family history of allergy
• Premature birth
• Low birth weight
• Small airways at birth
• Environmental exposures Indoor Outdoor (?)

6
During an asthma attack
7
Mechanisms Underlying the Definition of Asthma

• Adapted with permission from Stephen T. Holgate,
  M.D., D.Sc.
• Guidelines for the Diagnosis and Management of
  Asthma, NIH Publication 97-4051, July 1997.

8
Triggers of Asthma Attacks

• Narrowing of airways occurs in response to
  inflammation or hyperresponsiveness to triggers,
  including
• Allergens
• Infections
• Diet/Medications
• Strong Emotions
• Exercise
• Cold temperature
• Exposure to irritants

9
The Asthma Initiative of Michigan
10
Recommendation Categories of the Michigan Asthma
Strategic Planning Initiative Task Force (MASPI)

• Foundation for Michigan Asthma Activities
• Training for Clinical Diagnosis, Disease
  Management, and Asthma Education Services
• Access to and Coordination of Health Care and
  Education Services
• Environmental Action
• Community Action

11

• Asthma Coalition for Northeast MI
• Asthma Coalition of Northwest MI
• Detroit Asthma Coalition
• Eastern Upper Peninsula Asthma Coalition
• Genesee Co. Childhood Asthma Task Force
• Grayling Asthma Project
• Jackson Asthma Coalition
• Kalamazoo Area Asthma Coalition
• Mid-Michigan Asthma Coalition
• Oakland Asthma Coalition
• Pediatric Adult Asthma Network of West MI
• Southwest MI Asthma Coalition
• Tri-County Asthma Coalition
• Washtenaw Asthma Coalition

• Asthma Epidemiology Surveillance Work
  Group
• Asthma in Schools Work Group
• Environmental Quality Work Group
• Evaluation Committee
• Michigan Asthma Communication Network Committee
• Quality Improvement in Asthma Care Work
  Group

12
The Asthma Coalitions of Michigan
13
Asthma Surveillance
14
Asthma Surveillance The Ideal

• Track asthma occurrence and severity
• Identify regional/demographic variations
• Monitor asthma management control, access to
  care, and quality of life
• Track prevalence of risk factors and exposure to
  triggers
• Monitor the effectiveness of public health
  interventions

15
Asthma Surveillance A Conceptual Model
16
Asthma Surveillance in Michigan

• Prevalence
• Adult Self report from the Michigan Behavioral
  Risk Factor Surveillance Survey (BRFSS) core
  questions
• Child Self report from the BRFSS, ?18 years
  Self report from the Youth Tobacco Survey (YTS),
  grades 6-12 Self report from the Youth Risk
  Behavior Survey (YRBS), grades 9-12.
• Quality of Life and Asthma Management
• Self Report from the BRFSS asthma module
  questions - Adults with current asthma only
• School Health Education Profile (SHEP) Survey
• Work-Related Asthma
• Self Report from state added questions to the
  BRFSS
• SENSOR surveillance of sentinel work-related
  asthma incidence
• Hospitalization Michigan Inpatient Database
• Primary Diagnosis at Discharge, ICD-9-CM 493.XX
• Mortality Michigan Resident Death File
• Primary Cause of Death, 1990-1998 ICD-9 493,
  1999-2001ICD-10 J45 and J46

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Asthma Prevalence
18
Prevalence of Lifetime and Current Asthma for
Children (lt18 Years) and Adults (?18 Years),
Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
19
Prevalence of Lifetime and Current Asthma for
Adults (? 18 Years) by Race, Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
20
Prevalence of Lifetime and Current Asthma for
Adults (? 18 Years) by Education, Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
21
Prevalence of Lifetime and Current Asthma for
Adults (? 18 Years) by Household Income,
Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
22
Smoking Status for Adults (? 18 Years) with
Lifetime and Current Asthma, Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
23
Weight Status for Adults (? 18 Years) with
Lifetime and Current Asthma, Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
24
Prevalence of Lifetime and Current Asthma for
Children in Middle and High School, Michigan, 2001
Data Source Youth Tobacco Survey, 2001
25
Prevalence of Current Asthma for Children in
Middle and High School by Race, Michigan, 2001
Data Source Youth Tobacco Survey, 2001
26
Prevalence of Lifetime Asthma for Children in
High School by Race, Michigan, 2003
Data Source Youth Risk Behavior Survey, 2003
27
Asthma Management and Quality of Life
28
Frequency of Asthma Medication Use in the Past 30
Days Among Adults (? 18 Years) with Current
Asthma, Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
29
Percent of Adults (? 18 Years) with Current
Asthma that have Seen a Health Care Professional
for a Routine Checkup of the Asthma in the Past
12 Months, Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
30
Percent of Adults (? 18 Years) with Current
Asthma that have Sought Urgent Asthma Treatment
from either a Health Care Professional or
Emergency Department/Urgent Care Center in the
Past 12 Months, Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
31
Occurrence of Asthma Symptoms in the Past 30 Days
Among Adults (? 18 Years) with Current Asthma,
Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
32
Occurrence of Sleep Disturbing Asthma Symptoms in
the Past 30 Days Among Adults (? 18 Years) with
Current Asthma, Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
33
Number of Days Unable to Work or Carry Out Usual
Activities due to Asthma in the Past 12 Months
for Adults (? 18 Years) with Current Asthma
Michigan, 2001
Data Source Michigan Behavioral Risk Factor
Survey, 2001
34
Severity Distribution for Adults (? 18 Years)
with Current Asthma, Michigan, 2001
Asthma severity determined by the highest level
of severity of their daytime or nighttime
symptoms. Data Source Michigan Behavioral Risk
Factor Survey, 2001
35
Use of Asthma Medications in the Past 30 Days
Among Adults (? 18 Years) with Current Asthma by
Asthma Severity, Michigan, 2001
Prescription medications does not include over
the counter medications. Asthma severity
determined by the highest level of severity of
their daytime or nighttime symptoms. Data Source
Michigan Behavioral Risk Factor Survey, 2001
36
Prevalence of School-based Asthma Management
Activities Among Public Schools with Grade 6 or
higher, Michigan, 2002
Data Source School Health Education Profile
(SHEP) Survey, 2002
37
Prevalence of School-based Asthma Management
Activities Among Public Schools with Grade 6 or
higher, Michigan, 2002, Cont.
Data Source School Health Education Profile
(SHEP) Survey, 2002
38
Work-Related Asthma
39
Proportion of Adults whose Lifetime or Current
Asthma May be Work-Related, Michigan, 2001
Identified by
Data Source Michigan Behavioral Risk Factor
Survey, 2001
40
Proportion of Confirmed Work-Related Asthma
Patients by Major Industry Type, Michigan,
1988-2001
Data Source Rosenman KD, Reilly MJ, and
Kalinowski DJ. 2002 Annual Report on
Work-Related Asthma in Michigan.
(http//web2.chm.msu.edu/oem/asthma/02AsthmaAnnRpt
_ALL.pdf)
41
Hospitalization for Asthma
42
Rates of Hospitalization due to Asthma by Sex,
All Ages, Michigan, 1999-2001
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
43
Rates of Hospitalization due to Asthma by Sex
and Year, All Ages, Michigan, 1990-2001
Uses 1990-1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
44
Rates of Hospitalization due to Asthma by Age
Group, All Ages, Michigan, 1999-2001
Uses 1999 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
45
Rates of Hospitalization due to Asthma by Age
Group and Year, All Ages, Michigan, 1990-2001
Uses 1990-1999 MI population estimates. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
46
Rates of Hospitalization due to Asthma by Race,
All Ages, Michigan, 1999-2001
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
47
Rates of Hospitalization due to Asthma by Race
and Year, All Ages, Michigan, 1990-2001
Uses 1990-1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
48
Rates of Hospitalization due to Asthma by Sex,
Age Group, and Race, All Ages, Michigan, 1999-2001
Uses 1999 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
49
Rates of Hospitalization due to Asthma by
Income, All Ages, Michigan, 1999-2001
Uses 2000 MI population and age adjusted to the
2000 US standard population. Income level
determined by ranking median household income for
zip codes from Census 2000. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
50
Rates of Hospitalization due to Asthma by Age
Group and Month of Admission, All Ages, Michigan,
1999-2001
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
51
Average Length of Stay for a Hospitalization due
to Asthma by Year , All Ages, Michigan, 1990-2001
Data Source Michigan Inpatient Database, Bureau
of Epidemiology, MDCH.
52
Average Length of Stay for a Hospitalization due
to Asthma by Age Group and Year, All Ages,
Michigan, 1990-2001
Data Source Michigan Inpatient Database, Bureau
of Epidemiology, MDCH.
53
Estimates of Average Cost for an Asthma
Hospitalization in Michigan, 2001

• 7,001
• By Sex
• Males 6,209
• Females 7,522
• By Race
• Whites 6,564
• Blacks 7,137
• Generally the average cost of an asthma
  hospitalization increases with age 4,927 for
  children lt1 year to 9,836 for adults ?65 years.

Data Source Healthcare Cost and Utilization
Project, 2001 http//www.ahrq.gov/data/hcup/hcupn
et.htm
54
Rates of Hospitalization due to Asthma by County
of Residence, All Ages, Michigan, 1999-2001
State of Michigan Rate 15.8 (15.7, 16.0)
Rate per 10,000
5.6 11.6 11.7 17.7 17.8 23.7 23.8
29.7 Insufficient Data
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard
population. Number of events ?20 or lt5000
population Data Source Michigan Inpatient
Database, Bureau of Epidemiology, MDCH.
Rate higher than the Michigan Rate
55
Rates of Hospitalization due to Asthma for
Children lt18 Years by County of Residence,
Michigan, 1999-2001
State of Michigan Rate 24.2 (23.9, 24.6)
Rate per 10,000
7.7 17.6 17.7 27.4 27.5 37.3 37.4
47.1 Insufficient Data
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard
population. Number of events ?20 or lt5000
population Data Source Michigan Inpatient
Database, Bureau of Epidemiology, MDCH.
Rate higher than the Michigan Rate
56
Rates of Hospitalization due to Asthma for
Adults ?18 Years by County of Residence,
Michigan, 1999-2001
State of Michigan Rate 12.9 (12.8, 13.1)
Rate per 10,000
3.8 8.8 8.9 13.8 13.9 18.7 18.8
23.7 Insufficient Data
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard
population. Number of events ?20 or lt5000
population Data Source Michigan Inpatient
Database, Bureau of Epidemiology, MDCH.
Rate higher than the Michigan Rate
57
Rates of Hospitalization due to Asthma by County
of Residence for White Persons, All Ages,
Michigan, 1999-2001
State of Michigan Rate 10.6 (10.5, 10.8)
Rate per 10,000
5.6 8.6 8.7 11.6 11.7 14.5 14.6
17.5 Insufficient Data
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard
population. Number of events ?20 or lt5000
population Data Source Michigan Inpatient
Database, Bureau of Epidemiology, MDCH.
Rate higher than the Michigan Rate
58
Rates of Hospitalization due to Asthma by County
of Residence for Black Persons, All Ages,
Michigan, 1999-2001
State of Michigan Rate 45.5 (44.9, 46.2)
Rate per 10,000
18.3 29.4 29.5 40.5 40.6 51.6 51.7
62.7 Insufficient Data
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard
population. Number of events ?20 or lt5000
population Data Source Michigan Inpatient
Database, Bureau of Epidemiology, MDCH.
Rate higher than the Michigan Rate
59
Asthma Mortality
60
Rates of Mortality due to Asthma by Sex, All
Ages, Michigan, 1999-2001
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
61
Rates of Mortality due to Asthma by Sex and
Year, All Ages, Michigan, 1990-2001
Uses 1990-1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
62
Rates of Mortality due to Asthma by Age Group,
All Ages, Michigan, 1999-2001

Uses 1999 MI population estimates and age
adjusted to the 2000 US standard
population. Number of deaths lt5 and gt0. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
63
Rates of Mortality due to Asthma by Age Group
and Year, Michigan, 1990-2001
Uses 1990-1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
64
Rates of Mortality due to Asthma by Race, All
Ages, Michigan, 1999-2001
Uses 1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
65
Rates of Mortality due to Asthma by Race and
Year, All Ages, Michigan, 1990-2001
Uses 1990-1999 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
66
Rates of Mortality due to Asthma by Sex and Age
Group and Year, All Ages, Michigan, 1999-2001

Uses 1999 MI population estimates and age
adjusted to the 2000 US standard
population. Number of deaths lt5 and gt0. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
67
Rates of Mortality due to Asthma by Race and Age
Group and Year, All Ages, Michigan, 1999-2001

Uses 1999 MI population estimates and age
adjusted to the 2000 US standard
population. Number of deaths lt5 and gt0. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
68
Average Number of Deaths per Year due to Asthma
by County of Residence, All Ages, Michigan,
1990-2001
Less than 5 5 to 9 10 or More
Keweenaw County had 0 deaths all other counties
had at least 1 death. Data Source Michigan
Inpatient Database, Bureau of Epidemiology,
MDCH.
69
The Healthy People 2010 Objectives for Asthma

• For information about the Healthy People 2010
  Initiative, visit www.healthypeople.gov/

70
The Healthy People 2010 Objectives for Asthma

• Reduce hospitalization rates for three
  ambulatory-care-sensitive conditions pediatric
  asthma, uncontrolled diabetes, and immunization
  preventable pneumonia and influenza. (1-9a)
• Reduce asthma deaths. (24-1)
• Reduce hospitalizations for asthma. (24-2)
• Reduce emergency department visits for asthma.
  (24-3)
• Reduce activity limitations among persons with
  asthma. (24-4)
• Reduce the number of school or workdays missed by
  persons with asthma due to asthma. (24-5)
• Increase the proportion of persons with asthma
  who receive formal patient education, including
  information about community and self-help
  resources, as an essential part of the management
  of their condition. (24-6)
• Increase the proportion of persons with asthma
  who receive appropriate asthma care according to
  the National Asthma Education and Prevention
  Program (NAEPP) Guidelines. (24-7)

71
Rates of Hospitalization due to Asthma Compared
to Healthy People 2010 Target for Objective 1-9a,
Children lt 18 Years, Michigan, 1990-2001
Uses 1990-1999 MI population estimates. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
72
Rates of Mortality due to Asthma Compared to
Healthy People 2010 Target for Objective 24.1,
Age gt14 Years, Michigan, 1990-2001
15 to 34
35 to 64
65 and Older
Michigan HP 2010 Target
Uses 1990-1999 MI population estimates. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
73
Rates of Hospitalization due to Asthma by Race
Compared to Healthy People 2010 Target for
Objective 24-2, All Ages, Michigan, 1990-2001
0 to 4
5 to 64
65 and Older
Black White HP 2010 Target
Uses 1990-1999 MI population estimates. Age-adj
usted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
74
County Level Attainment of the Healthy People
2010 Target for Rate of Asthma Hospitalization
for Objective 24-2, Age 0 to 4 Years, Michigan,
1999-2001
State of Michigan Rate 46.2 per 10,000 HP 2010
Target Rate 25 per 10,000
Uses 1999 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
75
County Level Attainment of the Healthy People
2010 Target for Rate of Asthma Hospitalization
for Objective 24-2, Age 5 to 64 Years, Michigan,
1999-2001
State of Michigan Rate 13.1 per 10,000 HP 2010
Target Rate 7.7 per 10,000
Uses 1999 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
76
County Level Attainment of the Healthy People
2010 Target for Rate of Asthma Hospitalization
for Objective 24-2, Age 65 Years and Over,
Michigan, 1999-2001
State of Michigan Rate 16.3 per 10,000 HP 2010
Target Rate 11 per 10,000
Uses 1999 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
77
Data Summary

• 213,600 children and 654,100 adults currently
  have asthma in Michigan.
• gt50 of Michigan adults with asthma had an asthma
  attack in the last year.
• 20 of Michigan adults with asthma are
  experiencing asthma symptoms every day.
• Almost 10 of Michigan adults with asthma report
  that their asthma is work-related.
• Asthma hospitalization rates are highest in very
  young children, age 0 to 4 years.
• Hospitalization rates for blacks are 4 times the
  rate for whites.

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Data Summary Cont.

• Rates of asthma hospitalization are higher in low
  income areas than high income areas.
• Asthma causes 160 deaths each year in Michigan.
• Mortality rates are significantly higher among
  blacks than whites.
• Michigan is demonstrating progress toward meeting
  the Healthy People 2010 targets for asthma
  hospitalization, overall and among whites.
  Conversely, asthma hospitalization rates for
  blacks age 5 to 64 are moving away from the
  Healthy People 2010 Target.

79
For more information
Visit the Asthma Initiative of Michigan Website
www.GetAsthmaHelp.org
Call Toll Free
1.866.EZLUNGS
1.866.395.8647
80
Acknowledgements

• The Asthma Epidemiology and Surveillance
  Workgroup of the Michigan Asthma Advisory
  Committee
• This project is supported by Cooperative
  Agreement Number U59/CCU517742-03 from the
  Centers for Disease Control (CDC). Contents are
  solely the responsibility of the authors and do
  not necessarily represent the official views of
  the CDC.

81
If you have questions about the data or have a
specific data request, please contact the
Epidemiology and Surveillance staff of the Asthma
Initiative of Michigan

• Betsy Wasilevich, MPH
  Asthma Epidemiologist
  517.335.8164 wasileviche_at_michigan.
  gov
• Sarah Lyon-Callo, MA, MS
  Asthma Epidemiologist
  517.335.9315 lyoncallos_at_michigan.gov