2005 Missouri State Asthma Plan: Addressing Asthma in Missouri

2005·0.98 MB·English

by  Missouri Department of Health and Senior Services, Division of Chronic Disease Prevention and Health Promotion

ADDRESSING
A S T H M A
IN MISSOURI
2005
MISSOURI ASTHMA COALITION
A D D R E S S I N G A S T H M A I N M I S S O U R I 2 0 0 5
Addressing Asthma in Missouri
The Missouri state asthma plan, Addressing Asthma in Missouri, was
supported by Cooperative Agreement number U59/CCU720866-03
from the Centers for Disease Control and Prevention. Its contents are
solely the responsibility of the authors and do not necessarily represent
official views of the Centers for Disease Control and Prevention.
A D D R E S S I N G A S T H M A I N M I S S O U R I 2 0 0 5
L I S T O F A B B R E V I A T I O N S
BRFSS ................................Behavioral Risk Factor Surveillance System
CDC ..................................Centers for Disease Control and Prevention
ED ...................................................................Emergency Department
HP 2010 ...............................................................Healthy People 2010
MAC ...........................................................Missouri Asthma Coalition
MAPCP ..................Missouri Asthma Prevention and Control Program
MDHSS ................Missouri Department of Health and Senior Services
A C K N O W L E D G E M E N T S
T M
HIS DOCUMENT IS THE RESULT OF COLLABORATIVE EFFORTS BETWEEN THE ISSOURI
A C M A P C P
STHMA OALITION AND THE ISSOURI STHMA REVENTION AND ONTROL ROGRAM
M D H S S .
OF THE ISSOURI EPARTMENT OF EALTH AND ENIOR ERVICES
ADDRESSING ASTHMA IN MISSOURI AUTHORS
Amy Kelsey, MPH, Epidemiology Specialist, Missouri Department of Health and Senior Services,
Office of Surveillance, Evaluation, Planning, and Public Health Information
Peggy Gaddy, RRT, MBA, Program Coordinator, Missouri Department of Health and Senior Services,
Missouri Asthma Prevention and Control Program
T E G D
EXT DITING AND RAPHIC ESIGN
Heather Jacobsen, MPH, Saint Louis University, Health Communication Research Laboratory
Christopher Casey, BFA, Saint Louis University, Health Communication Research Laboratory
S A :
PECIAL CKNOWLEDGEMENTS

Steven Kilfoil, Computer Information Technologist II, Missouri Department of Health and Senior
Services, Office of Information Systems
Michael Dietz, MS, Research Analyst III, Missouri Department of Health and Senior Services, Office
of Surveillance, Evaluation, Planning, and Public Health Information
Nisreen Kabeer, MPH, Epidemiology Specialist, Missouri Department of Health and Senior Services,
Office of Surveillance, Evaluation, Planning, and Public Health Information
Shumei Yun, MD, PhD, Public Health Epidemiologist, Missouri Department of Health and Senior
Services, Office of Surveillance, Evaluation, Planning, and Public Health Information
For additional information, please contact the Missouri Asthma Prevention and Control Program at:
Missouri Department of Health and Senior Services
P.O. Box 570
Jefferson City, Missouri 65102-0570
800-316-0935 or TDD 800-735-2966
E-mail: [email protected]
T A B L E O F C O N T E N T S
Executive Summary
2
Background
3
Asthma in Missouri
4
The Missouri Asthma Coalition
10
Community Objectives
12
Health Care Objectives
16
Environmental Health and Work-Related Asthma Objectives
20
Scientific Objectives
22
Policy Objectives
26
References
27
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E X E C U T I V E S U M M A R Y
Nearly 500,000 Missourians live

with asthma. Each year, nearly 100
Missourians die due to asthma.
A

STHMA IS MORE COMMON
Missouri Asthma Coalition goals, based on
among women (14.0%) than men
(10.9%), and among African Americans objectives outlined in Healthy People 20107:
(16.5%) than Whites (11.6%)1. Based on emergency
department (ED) and hospital data, children are Reduce asthma deaths
disproportionately affected. About 1 in 10 African Reduce hospital ED visits due to asthma
American households have at least one child with
Reduce hospitalizations due to asthma
asthma, compared to 1 in 15 White households.
Reduce the number of school days
Asthma-related hospitalization charges alone total over
missed due to asthma
$50 million each year in Missouri2.
Reduce the number of work days missed

due to asthma
Much of this cost is avoidable. Although there is no
cure, asthma can be controlled with proper medical Reduce activity limitations due to asthma
management and avoidance of certain factors and Reduce disparities in asthma outcomes
behaviors. People with poorly managed asthma suffer among Missourians for all goals listed
from: lower quality of life, reduced activity, missed days
above
of work or school, frequent ED visits or hospitalizations,
and – although rare – death may occur3, 4.
In order to advance these objectives, the MAC is proud
Because asthma can be controlled, a statewide to present the state plan Addressing Asthma in Missouri.
comprehensive public health approach The plan directs efforts toward people
Asthma-related hospitalization
is likely to have significant impact on with asthma, their families, health care
charges alone total over
morbidity and mortality5. With an providers, employers, policymakers,
$50 million
alarming rate of increase in asthma6, it is and communities to control asthma in
crucial that actions are taken to address homes, schools, workplaces, and the
each year
the asthma issue in Missouri. community at-large. Surveillance will
continue to be a priority; data collected
The Missouri Asthma Prevention will be used to measure, monitor,
in Missouri
and Control Program (MAPCP) was and improve plan effectiveness. The
formed with support from a Centers for main goal of the state plan is to reduce
Disease Control and Prevention (CDC) the impact of asthma in Missouri by
grant awarded in 2001. A multidisciplinary group of improving the quality of life for those with asthma and
representatives from government agencies, schools, decreasing direct and indirect economic losses for all
workplaces, nonprofit organizations, the health care Missourians.
industry, and universities joined to create the Missouri
Asthma Coalition (MAC) to address the asthma issue.
2
B A C K G R O U N D
A
It’s all too easy to read about a health problem STHMA IS A SERIOUS chronic disease whose
and forget that it’s a real disease affecting real cause is unknown. However, factors that
people. Throughout this state plan, follow contribute to asthma-related illness are
the story of Kevin, an 8-year-old boy recently well documented. This means that while there is no cure
diagnosed with asthma. Although fictional, for asthma, it can be treated and controlled. Possible
Kevin’s story is typical of many children in consequences for those with poorly managed asthma
Missouri living with asthma. are lower quality of life, reduced activity, missed days of
work or school, frequent ED visits or hospitalizations,
Ever since he was a baby, Kevin seemed to get sick and in rare cases, death3, 4.
more than other kids his age. By the time he was
three he had bronchitis, pneumonia, and a cough Asthma is a major public health problem in Missouri.
that never seemed to go away. His parents took him Nearly 500,000 Missourians live with asthma and
to see the pediatrician whenever he was sick, but nearly 100 die due to asthma complications each
she assured them that there was no reason to worry. year. The rate of asthma is on the rise, with 12.5% of
She said Kevin was exposed to a lot of new germs in adults diagnosed in 2002 compared to only 10.6% in
child care and that it wasn’t uncommon for him to 2000. ED and hospitalization data show that children
have recurring respiratory problems. are disproportionately affected by asthma. Sex and
racial/ethnic disparities also exist. Asthma-related
Around the time Kevin started kindergarten his hospitalization charges total over $50 million every year2.
father lost his job and the family no longer had
health insurance. Although they signed up for It is important to note that public health interventions
Medicaid, Kevin’s pediatrician didn’t accept it. The aimed at people with asthma, their families, health care
family started using the emergency room whenever providers, and communities are likely to significantly
Kevin needed to see a doctor. As a result, Kevin saw impact asthma outcomes because the disease can be
a different doctor each time he was sick and no one controlled3, 4, 5. For this reason, along with the seriousness
noticed that his respiratory symptoms were part of a and costs associated with the disease, asthma needs to be
larger problem. a public health priority in Missouri.
One night, Kevin woke his parents up in the middle
of the night. It was hard to breathe and he was
scared. The family rushed to the emergency room,
where Kevin was given a breathing treatment
to help him breathe better. An observant doctor
noticed that Kevin had been seen several times
before for respiratory problems. He referred them to
an asthma specialist who accepted Medicaid about
an hour away, and even wrote down the address
and phone number for them.
Continue reading Addressing Asthma in Missouri to
see how Kevin’s asthma management is impacted by the
actions of his caregivers, school, and state government.
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A S T H M A I N M I S S O U R I
Healthy People 2010
Table 1: Natlonal Baseline (1998, 1995-1997), Missouri 2001, and Healthy People
2010 National Target Objectives for Asthma-related Deaths, Emergency
Objectives
Department Visits, and Inpatient Hospitalizations.
Age Group Natlonal Missouri Healthy People
Baseline Baseline National
T
HERE ARE CURRENT DATA for Missouri on Target
asthma deaths, emergency department Objectives
(ED) visits, and hospitalizations. Table 1 Year 1998 2001 2010
Asthma- Children under age 5 2.1 * 1.0
compares Missouri’s baseline rates to the national baseline
related Children aged 5t o 14 3.3 * 1.0
rates and the Healthy People 2010 target objectives7.
deaths Adolescents and adults
The Missouri Asthma Coalition (MAC) seeks to progress Rate per million aged 15 to 34 years 5.0 5.4 2.0
toward meeting the HP 2010 objectives related to deaths, Adults aged
35 to 64 years 17.8 15.7 9.0
ED visits, and hospitalizations. If an HP 2010 objective
Adults aged 65
has already been met the MAC seeks to continue to
years and older 86.3 43.8 60.0
improve the outcome. Year 1995-1997 2001 2010
Hospital Children under age 5 150.0 153.8 80.0
emergency Children and adults
According to available figures from 2001, asthma-related
department visits aged 5-64 years 71.1 53.3 50.0
death rates in Missouri exceed both the national baseline due to asthma Adults aged 65
and HP 2010 objective rates for people aged 15 to 34 Rate per 10,000 years and older 29.5 13.7 15.0
Year 1995-1997 2001 2010
years. Missouri’s death rate is below the national average
Hospitalizations Children under age 5 45.6 38.4 25.0
and HP 2010 objective for adults 35 and older. The ED
due to Asthma Children and adults
visit rate for children under age 5 is above the national Rate per 10,000 aged 5-64 years 12.5 12.6 7.7
and HP 2010 rate. Missouri’s ED visit rate for people Adults aged 65
years and older 17.7 11.1 11.0
aged 5 to 64 years is below the national average but above
* Number of deaths too small fur rate calculation
the HP 2010 objective. The ED visit rate in Missouri
for adults 65 years and older is below both the national
average and HP 2010 objective. In Missouri, the asthma
Prevalence: How common is
hospitalization rates for children under age five and adults
65 and older are below the national average but above the asthma?
HP 2010 objective. The hospitalization rate for people 5
to 64 years, however, is above both the national average Based on 2002 Behavioral Risk Factor Surveillance
and the HP 2010 objective. System (BRFSS) data for Missouri, the lifetime prevalence
of asthma among adults 18 years and older is 12.5%,
Other HP 2010 objectives involve days of work missed, compared to the national prevalence of 11.8%. Lifetime
days of school missed, and activity limitation due to prevalence is calculated based on the number of adults
asthma. The MAC seeks to obtain baseline measures for who say that a doctor has told them they have asthma.
these figures to compare Missouri to national averages Lifetime prevalence in Missouri appears to be on the rise.
and the HP 2010 target objectives. In 2000, the adult lifetime asthma prevalence was 10.6%,
and in 2001 it was 12.0%, and in 2002 it was 12.5%.
According to the 2002 data for Missouri adults, females
(14%) have a higher lifetime prevalence of asthma than
males (10.9%). Figure 1 shows lifetime asthma prevalence
by age among adults. People 18 to 24 have the highest
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A S T H M A I N M I S S O U R I
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prevalence, at nearly twice the rate of the Missouri average. In this state plan, all data are reported for African
The lowest prevalence is among adults 65 and older. This Americans and whites of non-Hispanic ethnicity. Also,
rate is almost half of the overall state prevalence. statistics are reported after age-adjustment to the 2000
standard population where appropriate.
Current asthma prevalence is determined based on the
number of adults who report an asthma diagnosis during
their lifetime and who also report that they still have
asthma. This information is found in the Missouri 2002
BRFSS. Figure 2 shows the prevalence of current asthma is
highest among 18-24 year-olds, and is lowest for those 65
years and older.
Figure 3 shows lifetime asthma prevalence by race and
ethnity, and Figure 4 shows current asthma prevalence
by race and ethnicity. Lifetime prevalence among whites
is lower than the Missouri average. African Americans
have higher rates than whites. Prevalence among African
Americans and all other racial/ethnic groups is higher than
the state average and higher than rates for whites1.
5
A S T H M A I N M I S S O U R I
Morbidity: How many ED
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visits and hospitalizations
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are caused by asthma?
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In 2001, 30,777 ED visits (5.6 per 1,000 people) were �
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reported with asthma as the primary cause. The average �� ����
rate from 1993 to 2000 was only 5.2 per 1,000 people; �� �� ���� ���� ���� ������
this was fairly consistent across the years observed. � ��� ��� ������ ������ ������ ������ ������
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the highest rates are for children. This rate is especially ������������ ■ ������ ■ ����
high for children in their first year of life and from 1
to 4 years of age. From ages 1-4, males
visit the ED more than females; however, �����������������������������������������������������������������
females aged 15 and older visit the ED
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more often than males. The overall rate
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shows that more females than males visit �
the ED due to asthma. Figure 6 shows that ��� �� ����
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African Americans (18.6 per 1,000 people) ���� �� ���� ���� ���� ���� ����
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in 2001. These differences remained after ������� ��� ��� ����� ����� ����� ����� ��� ��������
stratification by age. ������������ ■ ���������������� ■ ����� ■ �������
There were 7,106 inpatient hospitalizations
in 2001 (12.7 per 10,000 people) due to asthma. The
average rate from 1993 to 2000 was 13.1 per 1,000
people, which was lower than the 2001 rate, however,
there was great variation among the years observed. Figure
7 shows that this rate is highest for children 14 years
and younger, with the highest rates for children 1 to 4
years of age and in their first year of life. Asthma is the
third leading cause of hospitalization in children under
15. Overall, more females were hospitalized than males;
however, more males under 15 years were hospitalized
than females. African Americans were 3.8 times more
likely to be hospitalized due to asthma complications, and
Figure 8 shows that rates for African Americans are higher
in every age category.

6