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Pediatric Asthma in Southeastern New Mexico
Unwrapping the Enigma Brad Whorton Asthma
Epidemiologist
Hobbs, New Mexico October 6, 2008
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New Mexicos Health Regions
Southeastern New Mexico (Region 4)
Hobbs
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Asthma is a chronic inflammatory disease
characterized by wheezing, coughing,
breathlessness and chest tightness resulting from
the constriction of the airways.
Asthma symptoms can be triggered by allergens
(substances that cause an allergic response) or
irritants (substances that irritate the nose or
airways, provoking asthma symptoms), such as
animal dander, air pollution, dust mites, pollen,
mold, tobacco smoke, dust, or stress.
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While we know what can cause an asthma attack
(the triggers), we do NOT know what causes the
disease.
Some theories . . .

• Persistent exposure to asthma triggers by
  genetically predisposed individuals.
• Immunological over-activation of t-cells (TH1
  or TH2) caused by
• exposure to parasites
• exposure/non-exposure to bacteria
• exposure to psychological/social stress
• obesity and inactivity
• . . . in genetically predisposed individuals.

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Current Lifetime Child Asthma Prevalence, New
Mexico, 2005
NOTE Lifetime prevalence bars are in grey
current prevalence bars are in red. SOURCE NM
BRFSS, 2005.
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Current Lifetime Child Asthma Prevalence, New
Mexico, 2005
NOTE Lifetime prevalence bars are in grey
current prevalence bars are in red. SOURCE NM
BRFSS, 2005.
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NOTE Data provided by BVRHS, NMDOH.
Comparability ratios have been applied to
pre-1999 deaths.
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Rates derived from ICD-9 codes, NM and US data
from CDC Wonder. Rates derived from ICD-9
codes, NM data from BVRHS US data from CDC
Wonder. Rates derived from ICD-10 codes, NM
data from BVRHS US data from CDC Wonder. NOTE
Comparability ratios have been applied.
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plt.05. NOTE Rates are based on deaths to New
Mexico residents and are age-adjusted per 100,000
standard population. SOURCE BVRHS, NMDOH.
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SOURCE Data from non-federal emergency
departments in New Mexico.
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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.
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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.
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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.
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NOTE Crude rates per 10,000 population.
SOURCE NM Health Policy Commission.
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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.
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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.
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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.
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NOTE New Mexico residents who were discharged
from non-federal hospitals in the state are
included. American Indians are excluded. SOURCE
New Mexico Health Policy Commission.
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Primary Asthma Hospital Admissions by Season,
2000-2005
SOURCE NM Health Policy Commission.
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Primary Asthma Hospitalization Source of
Admissions (), 2000-2005
SOURCE NM Hospital Policy Commission.
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CO Emissions from Active Facilities by Youth
Asthma HID Rates, 2003-2005
CO Emission 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.
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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.
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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.
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Why are the asthma rates high in Southeastern New
Mexico?

• Do not know for sure. More study is needed.
• Appears to be a multifaceted problem.

• Lifestyle factors.
• More smoking (adults not children).
• More ETS exposure.
• More obesity (for adults and children).
• Access to medical care.
• Shortage of pediatricians.
• High rate of Medicaid paid hospitalizations.
• Lack of regular health insurance?
• Pediatricians not taking Medicaid patients?
• People using the ER and Hospital instead of
  primary care?

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• Medical training issue.
• Prescription pattern (high short acting beta2
  agonist use, low inhaled corticosteroid use)
• High rate of repeat hospitalizations.
• Treating asthma as an acute disease not as a
  chronic one?
• Lower hospital admission criteria.
• Related to access to care?
• Rural population long driving distances?
• Outdoor environment issue.
• Many point sources for Emissions associated with
  increased asthma.
• Only preliminary analysis of data?
• Hobbs monitoring station has not recorded high
  levels of PM 2.5?
• Other air pollutants?
• Endotoxins from animal waste?
• Pesticide exposure from agriculture?

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Thank You!
Contact Information 505-476-3580 Brad.Whorton_at_sta
te.nm.us