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 February 2006
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
• Asthma Network of West MI
• Detroit Alliance for Asthma Awareness
• 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
• 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
Asthma Coalitions of Michigan

• Asthma Coalition for Northeast MI
• Asthma Coalition of Northwest MI
• Asthma Network of West MI
• Detroit Alliance for Asthma Awareness
• 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
• Southwest MI Asthma Coalition
• Tri-County Asthma Coalition
• Washtenaw Asthma Coalition

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 core and 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-presentICD-10 J45 and J46

17
Asthma Prevalence
18
Prevalence Current Asthma for Children (lt18
Years) and Adults (?18 Years), Michigan
Data Source Michigan Behavioral Risk Factor
Survey, 2002 and 2004
19
Prevalence of Current Asthma for Adults (? 18
Years) by Race, Michigan, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
20
Prevalence of Current Asthma for Adults (? 18
Years) by Education, Michigan, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
21
Prevalence of Current Asthma for Adults (? 18
Years) by Household Income, Michigan, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
22
Health Care Coverage for Michigan Adults (? 18
Years) by Current Asthma Status, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
23
Prevalence of Lifetime Asthma for Children in
Middle and High School, Michigan, 2003
Data Source Youth Tobacco Survey, 2003
24
Prevalence of Lifetime Asthma for Children in
High School by Race, Michigan, 2003
Data Source Youth Risk Behavior Survey, 2003
25
Quality of Life and Disease Management for People
with Asthma
26
Perceived Health Status for Adults (? 18 Years)
by Current Asthma Status, Michigan, 2004


Statistically significant, p lt 0.05
Data Source Michigan Behavioral Risk Factor
Survey, 2004
27
Cigarette Smoking for Adults (? 18 Years) by
Current Asthma Status, Michigan, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
28
Weight Status for Adults (? 18 Years) by Current
Asthma Status, Michigan, 2004


Statistically significant, p lt 0.05
Data Source Michigan Behavioral Risk Factor
Survey, 2004
29
Illness/Symptoms Caused by Poor Air Quality for
Adults (? 18 Years) by Current Asthma Status,
Michigan, 2004


Statistically significant, p lt 0.05
Cook ML, Rafferty AP. 2005. Health Risk
Behaviors in the State of Michigan 2004
Behavioral Risk Factor Survey. Lansing, MI
MDCH, Bureau of Epidemiology, Epidemiology
Services Division.
30
Leisure-Time Physical Activity in the Last Month
for Adults (? 18 Years) by Current Asthma Status,
Michigan, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
31
Flu Vaccination in the Past Year for Adults
(? 18 Years) by Current Asthma Status,
Michigan, 2004


Statistically significant, p lt 0.05
Data Source Michigan Behavioral Risk Factor
Survey, 2004
32
Frequency of Asthma Medication Use in the Past 30
Days Among Adults (? 18 Years) with Current
Asthma, Michigan, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
33
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, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
34
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, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
35
Occurrence of Asthma Symptoms in the Past 30 Days
Among Adults (? 18 Years) with Current Asthma,
Michigan, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
36
Occurrence of Sleep Disturbing Asthma Symptoms in
the Past 30 Days Among Adults (? 18 Years) with
Current Asthma, Michigan, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
37
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, 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
38
Symptom Severity for Michigan Adults with Asthma
who took Asthma Medication Daily in the Past 30
Days, 2002 - 2004
Data Source Michigan Behavioral Risk Factor
Survey, 2004
39
Prevalence of School-based Asthma Management
Activities Among Public Schools with Grade 6 or
higher, Michigan, 2004
Activity Percent of Schools
Full time registered nurse. 12.0
Identify track all students with asthma. 72.3
Obtain use an asthma action plan for students with asthma. 43.2
Assure immediate access to medications prescribed by a physician approved by parents. 94.2
Provide intensive case management for students with asthma missing 10 school days per year. 21.9
Data Source School Health Education Profile
(SHEP) Survey, 2004
40
Prevalence of School-based Asthma Management
Activities Among Public Schools with Grade 6 or
higher, Michigan, 2004, Cont.
Activity Percent of Schools
Educate school staff about asthma. 50.1
Educate students with asthma about asthma management. 24.4
Teach asthma awareness to all students in at least 1 grade. 21.4
Encourage full participation in physical education activity when students with asthma are doing well. 95.2
Provide modified physical education and activities as indicated by the students asthma action plan. 79.4
Data Source School Health Education Profile
(SHEP) Survey, 2004
41
Work-Related Asthma
42
Proportion of Adults whose Current Asthma May be
Work-Related, Michigan, 2004
Identified by
Data Source Michigan Behavioral Risk Factor
Survey, 2004
43
Proportion of Confirmed Work-Related Asthma
Patients by Major Industry Type, Michigan,
1988-2004
Data Source Rosenman KD, Reilly MJ, and
Kalinowski DJ. 2004 Annual Report on
Work-Related Asthma in Michigan.
(http//oem.msu.edu//asthma/04AsthmaAnnRpt_all.pdf
)
44
Hospitalization for Asthma
45
Rates of Hospitalization due to Asthma by Sex,
All Ages, Michigan, 2001-2003
Uses 2002 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
46
Rates of Hospitalization due to Asthma by Sex
and Year, All Ages, Michigan, 1990-2003
Uses 1990-2003 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 Age
Group, All Ages, Michigan, 2001-2003
Uses 2002 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
48
Rates of Hospitalization due to Asthma by Age
Group and Year, All Ages, Michigan, 1990-2003
Uses 1990-2003 MI population estimates. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
49
Rates of Hospitalization due to Asthma by Race,
All Ages, Michigan, 2001-2003
Uses 2002 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
50
Rates of Hospitalization due to Asthma by Race
and Year, All Ages, Michigan, 1990-2003
Uses 1990-2003 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
51
Rates of Hospitalization due to Asthma by Sex,
Age Group, and Race, All Ages, Michigan, 2001-2003
Uses 2002 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
52
Rates of Asthma Hospitalization by Race and
Income, All Ages, Michigan, 2000-2002
Rate per 10,000
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.
53
Rates of Hospitalization due to Asthma by Age
Group and Month of Admission, All Ages, Michigan,
2001-2003
Uses 2002 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
54
Average Length of Stay for a Hospitalization due
to Asthma by Year, All Ages, Michigan, 1990-2003
Data Source Michigan Inpatient Database, Bureau
of Epidemiology, MDCH.
55
Average Length of Stay for a Hospitalization due
to Asthma by Age Group and Year, All Ages,
Michigan, 1990-2003
Data Source Michigan Inpatient Database, Bureau
of Epidemiology, MDCH.
56
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
57
Rates of Hospitalization due to Asthma by County
of Residence, All Ages, Michigan, 2001-2003
State of Michigan Rate 15.6 (15.4, 15.7)
Uses 2002 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.
58
Rates of Hospitalization due to Asthma for
Children lt18 Years by County of Residence,
Michigan, 2001-2003
State of Michigan Rate 23.0 (22.7, 23.4)
Uses 2002 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.
59
Rates of Hospitalization due to Asthma for
Adults ?18 Years by County of Residence,
Michigan, 2001-2003
State of Michigan Rate 13.0 (12.8, 13.1)
Uses 2002 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.
60
Rates of Hospitalization due to Asthma by County
of Residence for White Persons, All Ages,
Michigan, 2001-2003
State of Michigan Rate 10.6 (10.4, 10.7)
Uses 2002 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.
61
Rates of Hospitalization due to Asthma by County
of Residence for Black Persons, All Ages,
Michigan, 2001-2003
State of Michigan Rate 43.4 (42.8, 44.1)
Uses 2002 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.
62
Asthma Mortality
63
Rates of Mortality due to Asthma by Sex, All
Ages, Michigan, 2001-2003
Uses 2002 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 Sex and
Year, All Ages, Michigan, 1990-2003
Uses 1990-2003 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 Age Group,
All Ages, Michigan, 2001-2003

Uses 2002 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.
66
Rates of Mortality due to Asthma by Age Group
and Year, Michigan, 1990-2003
Uses 1990-2003 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
67
Rates of Mortality due to Asthma by Race, All
Ages, Michigan, 2001-2003
Uses 2002 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
68
Rates of Mortality due to Asthma by Race and
Year, All Ages, Michigan, 1990-2003
Uses 1990-2003 MI population estimates and age
adjusted to the 2000 US standard population. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
69
Rates of Mortality due to Asthma by Sex and Age
Group and Year, All Ages, Michigan, 2001-2003

Uses 2002 MI population estimates and age
adjusted to the 2000 US standard
population. Number of deaths lt5, there were 0
deaths among females, age 0-4 years. Data Source
Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
70
Rates of Mortality due to Asthma by Race and Age
Group and Year, All Ages, Michigan, 2001-2003

Uses 2002 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.
71
The Healthy People 2010 Objectives for Asthma

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

72
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)

73
Rates of Hospitalization due to Asthma Compared
to Healthy People 2010 Target for Objective 1-9a,
Children lt 18 Years, Michigan, 1990-2003
Uses 1990-2003 MI population estimates. Data
Source Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
74
Rates of Mortality due to Asthma Compared to
Healthy People 2010 Target for Objective 24.1,
Age gt14 Years, Michigan, 1990-2003
15 to 34
35 to 64
65 and Older
Rate per 1,000,000
Michigan HP 2010 Target
Uses 1990-2003 MI population estimates. Data
Source Michigan Resident Death Files, Bureau of
Epidemiology, MDCH.
75
Rates of Hospitalization due to Asthma by Race
Compared to Healthy People 2010 Target for
Objective 24-2, All Ages, Michigan, 1990-2003
0 to 4
5 to 64
65 and Older
Black White HP 2010 Target
Uses 1990-2003 MI population estimates. Age-adj
usted to the 2000 US standard population. 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 0 to 4 Years, Michigan,
2001-2003
State of Michigan Rate 48.7 (47.7, 49.7) HP
2010 Target Rate 25 per 10,000
Uses 2002 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
77
County Level Attainment of the Healthy People
2010 Target for Rate of Asthma Hospitalization
for Objective 24-2, Age 5 to 64 Years, Michigan,
2001-2003
State of Michigan Rate 12.3 (12.1, 12.4) HP
2010 Target Rate 7.7 per 10,000
Uses 2002 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
78
County Level Attainment of the Healthy People
2010 Target for Rate of Asthma Hospitalization
for Objective 24-2, Age 65 Years and Over,
Michigan, 2001-2003
State of Michigan Rate 18.4 (18.0, 18.9) HP
2010 Target Rate 11 per 10,000
Uses 2002 MI population estimates. Data Source
Michigan Inpatient Database, Bureau of
Epidemiology, MDCH.
79
Data Summary

• 233,900 children and 629,100 adults currently
  have asthma in Michigan.
• 55 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.
• 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 over 4 times
  the rate for whites.

80
Data Summary Cont.

• Rates of asthma hospitalization are higher in low
  income areas than high income areas.
• Asthma causes 153 deaths each year in Michigan.
• Mortality rates are significantly higher among
  blacks than whites.
• In all age groups, some counties of Michigan have
  asthma hospitalization rates equal to or lower
  than the Healthy People 2010 targets.
• In recent years, Michigan has met the Healthy
  People 2010 target for asthma mortality among
  those age 65 years and older.

81
For more information
Visit the Asthma Initiative of Michigan Website
www.GetAsthmaHelp.org
Call Toll Free
1.866.EZLUNGS
1.866.395.8647
82
Acknowledgements

• The Asthma Epidemiology and Surveillance
  Workgroup of the Michigan Asthma Advisory
  Committee
• This project is supported by Cooperative
  Agreement Number U59/CCU517742 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.

83
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