Abstracts

Abstract

Trends in Childhood Asthma: Prevalence, Health Care Utilization, and Mortality; Akinbami, L.J., and Schoendork, K.C. Pediatrics 2002; 110:315–322Objective. The objectives of the authors were to use the data from National Health Interview Survey, National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, National Hospital Discharge Survey and Mortality Component, and National Vital Statistic System to compose a comprehensive summary of the trends in childhood asthma, prevalence, health care utilization, and mortality to better evaluate changes in disease burden among U.S. children.Clinical Population. The population included children ages 0–17 years with asthma, who were analyzed using five databases from the National Center for Health Statistics summarized above. Children were surveyed from 1988 to 2000.Clinical Findings. Asthma prevalence increased on an average of 4.3% annually from 1980 to 1996 and from 3.6% to 6.2% over the entire period. The prevalence peaked at 7.5% in 1995. In 1997, asthma attack prevalence was recorded as 5.4%, but alterations in the NHIS design in 1997 to include only physician diagnosed asthma prevents comparison with previous estimates. Asthma attack prevalence remained stable from 1997 to 2000. After a decline between 1980 and 1989, the asthma office visit rate increased by an average of 3.8% per year from 1989 to 1999. The asthma hospitalization rate increased by 1.4% from 1980 to 1998. Children ages 0–4 years have the largest increment in the prevalence and had the greater health care utilization, but adolescents had the highest mortality. The asthma burden was disproportionately higher in black children throughout the period. Racial disparities were most apparent with asthma hospitalizations and mortality. Compared to Caucasian children in 1988 to 1999, black children were more than three times greater likelihood of being hospitalized and more than four times as likely to have mortality from asthma.Conclusions. The conclusions of the authors are that these recent data suggest that the overwhelming burden of childhood asthma may have plateaued recently after several years of increasing, although additional data collection will be necessary to confirm this alteration of the trend. Racial and ethnic disparities remain for asthma care utilization and mortality.Reviewer's Comments. These national statistics combined from five databases indicate that the asthma attack prevalence may have stabilized from 1997 to 2000, but this trend must be cautiously interpreted. The asthma attack prevalence was obtained by questions relating to diagnosis by health care professional rather than by caretaker assessment only.Christopher Randolph, M.D.Waterbury, CT