Asthma Hospitalization Rates Research Articles

Asthma Prevalence in Athens Inner-city Public Primary Schools

PURPOSE: There is evidence that asthma hospitalization and death rates are disproportionately high in poor urban areas. However, the exact prevalence of asthma in low socioeconomic class areas in Athens, Greece has yet to be established. As part of a study on inner-city school children, we conducted a survey to estimate asthma prevalence.

Regional and racial disparities in asthma hospitalizations in Mississippi

In the United States, asthma hospitalization rates are disproportionately high among blacks compared with other racial/ethnic groups and vary by geographic region. These disparities among asthma hospitalizations might be affected by social, environmental, and health-care access factors. To determine demographic risk factors for asthma hospitalizations in urban versus rural areas of Mississippi. A cross-sectional study using data from the Mississippi Asthma Surveillance System was conducted to compare asthma hospitalizations in the urban Jackson metropolitan statistical area and rural Delta regions of Mississippi from 2003 to 2005. Factors including race, sex, age, and household income that might be associated with multiple hospitalizations for asthma (3 or more during the study period) were assessed using logistic regression. Asthma hospitalization rates were significantly higher among all demographic groups in the rural Delta region compared with the urban Jackson Metropolitan Statistical Area (P < .001). In both regions, hospitalization rates were higher among blacks and females (P < .001). Asthma hospitalization rates were highest among children (0-17 years) and older adults (>or=65 years). In both regions, blacks were more likely to have 3 or more asthma hospitalizations (P < .001). Residents of the Delta had higher odds for multiple hospitalizations controlling for race, sex, age, and household income (P < .05). Blacks with asthma are more likely to have multiple asthma hospitalizations in Mississippi. Higher odds of multiple asthma discharges for Delta residents were not explained by race, sex, age, or income, indicating that other contributing factors (eg, environmental, social, and access to care factors) need further investigation.

Asthma, allergy, and IgE levels in NYC head start children

Among preschool-age children in New York City neighborhoods with high asthma hospitalization rates, we analyzed the associations of total immunoglobulin E (IgE), specific IgE to common indoor allergens, and allergy symptoms with asthma. Parents of children in New York City Head Start programs were asked to complete a questionnaire covering demographic factors, health history (including respiratory conditions), lifestyle, and home environment. Children's serum samples were analyzed for total IgE and specific IgE antibodies to cockroach, dust mite, mouse, and cat allergens by immunoassay. Logistic regression was used to model the association between asthma and IgE, controlling for age, gender, ethnicity/national origin, BMI, parental asthma, smokers in the household, and allergy symptoms (e.g., runny nose, rash). Among 453 participating children (mean age 4.0+/-0.5 years), 150 (33%) met our criteria for asthma. In our multivariable logistic regression models, children with asthma were more likely than other children to be sensitized to each allergen, to be sensitized to any of the four allergens (OR=1.6, 95% CI 1.0-2.6), or to be in the highest quartile of total IgE (OR=3.1, 95% CI 1.5-6.4). Allergy symptoms based on questionnaire responses were independently associated with asthma (OR=3.7, 95% CI 2.3-5.9). Among preschool-aged urban children, asthma was associated with total IgE and sensitization to cat, mouse, cockroach, and dust mite allergens. However, allergy symptoms were more prevalent and more strongly associated with asthma than was any allergen-specific IgE; such symptoms may precede elevated specific IgE or represent a different pathway to asthma.

Asthma Admission Associated with Meteorological Factors in Taiwan

ISEE-0273 Background: The seasonal variation of asthma deserves extensive studies for the association with weather conditions among areas. This study evaluated the risk of hospitalization incidence for asthma associated with weather from 1997 to 2006. Methods: A cohort of 862,842 individuals insured with the National Health Insurance program in Taiwan was identified in 1997. The first hospitalization rates for asthma were measured by month. Relative risks for asthma admissions were estimated in association with information on temperature, barometric pressure, relative humidity, wind speed, accumulated rainfall, and dew point, provided by the Center of Weather Bureau. Results: During the 10-year study period, all the newly admitted asthma cases (N = 12,536) appeared a J-shape association with the diagnosed months. The highest average rate of 16.6 per 100,000 was in March and the lowest rate of 10.2 per 100,000 in August. The multivariate Poisson regression analysis estimated risk for daily asthma incidence revealed a significant inverse association with temperature after controlling for sex, age, year, and other weather variables. Compared with the daily mean temperature of 25–29°C, the relative risk (RR) of the disease increased to 1.23 (95% confidence interval (CI) = 1.04–1.45) when the mean temperature decreased to < 15°C. The risk was also higher when the atmospheric pressure was < 985 hPa (RR = 1.12, 95% CI 1.05–1.19). The risk was also associated with higher humidity. Conclusions: This study demonstrates that the asthma attack risk in Taiwan is elevated when it is colder, with higher atmospheric pressure and higher relative humidity. Key words: asthma, hospital visits, climate change, meteorology, Taiwan.

Physical Activity and Asthma Symptoms among New York City Head Start Children

The coincidence of both an obesity epidemic and an asthma epidemic among children in the United States has suggested that childhood overweight and sedentary lifestyles may be risk factors for asthma development. We therefore conducted a study of those factors among children enrolled in Head Start Centers located in areas of New York City with high asthma hospitalization rates. Data were gathered from 547 children through an intensive home visit, and physical activity was measured on 463 children using the Actiwatch accelerometer. Data on allergy and asthma symptoms and demographic variables were obtained from parents' responses to a questionnaire and complete data were available from 433 children. Overall physical activity was highest in warmer months, among boys, among children whose mothers did not work or attend school, and among children of mothers born in the United States. Activity was also positively associated with the number of rooms in the home. The season in which the activity data were collected modified many of the associations between demographic predictor variables and activity levels. Nearly half the children were above the range considered healthy weight. In cross-sectional analyses, before and after control for demographic correlates of physical activity, asthma symptoms were not associated with physical activity in this age group. Comparing the highest quartile of activity to the lowest, the odds ratio for asthma was 0.91 (95% CI = 0.46, 1.80). However, the novel associations with physical activity that we have observed may be relevant to the obesity epidemic and useful for planning interventions to increase physical activity among preschool children living in cities in the northern United States.

Further confirmation of the relevance of cockroach and dust mite sensitization to inner‐city asthma morbidity

Further confirmation of the relevance of cockroach and dust mite sensitization to inner‐city asthma morbidity

Hospitalizations for asthma in an urban population: 1995–1999

Asthma hospitalizations occur commonly. Many are preventable if asthma is well controlled. Medications and demographic factors affect asthma hospitalization rates. Recent studies suggest that inhaled long-acting beta-agonists (LABAs) may heighten risk of serious asthma exacerbation, particularly in African Americans. To further our understanding of the greater asthma morbidity associated with African American race and to investigate possible risk associated with LABAs. In an ecologic analysis, asthma hospitalization rates in individuals aged 5 to 64 years were determined for Philadelphia zip codes in period 1 (1995-1997) and period 2 (1997-1999) and were studied for associations with asthma drug prescription rates, demographic factors, and numbers and types of asthma care providers. Higher hospitalization rates were found in African Americans vs Caucasians (45.7 vs 7.6 per 10,000) and in 5- to 17-year-olds vs 18- to 34- and 35- to 64-year-olds (30.4 vs 11.9 and 13.7 per 10,000). Hospitalizations were correlated directly with prescriptions for inhaled short-acting beta-agonists (SABAs) in periods 1 (r(s) = 0.61) and 2 (r(s) = 0.60) and inversely with LABA prescriptions in periods 1 (r(s) = -0.56) and 2 (r(s) = -0.66). Higher SABA prescription rates were also correlated with greater proportions of African Americans per zip code in periods 1 (r(s) = 0.58) and 2 (r(s) = 0.53). At all poverty levels, African Americans had higher hospitalization rates than Caucasians. Asthma hospitalization was significantly associated with poverty area residence (relative risk [RR], 2.29) and with African American race (RR, 4.31) and age (RR, 1.15) as individual-level variables (P < .001, Poisson regression). These data do not support the contention that LABA exposure is a major cause of asthma morbidity. Risk of asthma hospitalization is strongly associated with being African American.

Impact of positive and negative beliefs about inhaled corticosteroids on adherence in inner-city asthmatic patients

Daily inhaled corticosteroid (ICS) use is the cornerstone of asthma management, although it is often suboptimal, especially in inner-city populations. To assess the impact of potentially modifiable medication beliefs on adherence with ICS therapy across time. Asthma history, medication beliefs, and ICS therapy adherence were determined in a prospective, observational cohort. Medication beliefs were based on self-regulation and self-efficacy theory. Self-reported adherence with ICS therapy was assessed using the Medication Adherence Reporting Scale, a validated 10-item instrument, at baseline and at 1 and 3 months. Repeated-measures multivariable regression identified beliefs independently associated with adherence across time after adjusting for age, sex, race, and asthma severity. The 261 patients were low-income minorities with high rates of asthma hospitalization, emergency department visits, intubation, and oral corticosteroid use. Adherence with ICS therapy was stable across time, with 70% of patients saying that they used ICS all or most of the time when asymptomatic. Most patients (82%) thought it was important to use ICS when asymptomatic, although 49% worried about side effects and 37% worried about becoming addicted. Although 82% felt confident in using ICS, 7% felt that their regimen was hard to follow. In multivariable analyses, the odds of adherence increased for those who felt that using ICS when asymptomatic was important (odds ratio [OR], 4.15) and for those who were confident in using ICS (OR, 2.23) and decreased by worries about side effects (OR, 0.52) or feeling the regimen was hard to follow (OR, 0.48). Several positive and negative beliefs about ICS were associated with adherence. Eliciting and addressing these potentially modifiable beliefs may help improve adherence and outcomes.

Asthma Hospitalization Rate Tied To Number of Allergens in Home

Asthma Hospitalization Rate Tied To Number of Allergens in Home

Disparities in Pediatric Asthma Hospitalizations

The purpose of this project was to determine to what extent rural children are hospitalized for asthma, an ambulatory care sensitive condition defined by the Agency for Healthcare Research and Quality pediatric quality indicators; to analyze differences in hospitalization rates for asthma by state and by rurality; and to examine the relationships between asthma hospitalization rates and poverty, health insurance, and physician supply. The project used 2001 through 2004 hospital inpatient discharge data for children aged 2 to 17 years from six geographically diverse states in the Healthcare Cost and Utilization Project. County-level poverty, uninsurance estimates, and physician data came from the 2004 Area Resource File. Pediatric Quality Indicator software was used to calculate county-level admission rates for asthma. Multivariate regression models were specified to assess how sensitive hospitalization rates were to characteristics of the children's counties of residence. Pediatric asthma hospitalization rates per 100,000 children aged 2 to 17 years varied by state ranging from 51.1 to 185.9. When comparing all six states, rural children were the most likely to be hospitalized for asthma. However, after controlling for rurality, poverty, uninsurance, and physician supply, uninsurance was the only variable to significantly impact hospitalization rates. These findings indicate that there are significant differences in pediatric asthma hospitalizations rates by and within states, which may best be addressed by targeting public health and healthcare interventions. In addition, the findings support efforts to increase health insurance coverage for children, especially rural children who are less likely to be insured.

Variations and Gaps in Management of Acute Asthma in Ontario Emergency Departments

Variation in hospitalization rates for acute asthma in Ontario may reflect gaps between evidence and current emergency department (ED) management. We investigated ED management of asthma and differences in practice patterns for pediatric (< 20 years old) and adult (> or = 20 years old) patients in Ontario EDs. Patient characteristics and ED management during a 1-year period were assessed by questionnaire and chart abstractions in a stratified sample of 16 Ontario hospitals. Variation between sites was assessed by one-way analysis of variance, Kruskal-Wallis test, or chi(2) test. Reported results are based on the first of 2,671 pediatric (42.0% female) and 2,078 adult (66.7% female) visits with a corresponding questionnaire. Asthma severity, comorbidities, access to care, and prehospital management varied significantly among sites (all p < 0.001). Documentation of peak expiratory flow (27.2% of pediatric [age > or = 7] and 44.3% of adult charts), use of systemic steroids in ED (35.2% pediatric and 33.0% adult charts) and on discharge (31.7% pediatric and 33.2% adult charts), and referrals to asthma services (2.8% pediatric and 2.7% adult charts) varied among sites (all p < 0.001). Admission (%) was directly related to time to receive systemic steroids in ED in adults (r = 0.76; p = 0.004). Repeat ED visits (%) were inversely related to new inhaled steroid prescription on discharge in adults (r = -0.64; p = 0.02). Knowledge translation initiatives are warranted to increase adherence with best practices in emergency management of asthma (such as objective assessment of airflow rates, use of systemic steroids, and referrals) in order to reduce variations in care and improve outcomes of severe acute asthma.

PM10이 소아천식 입원에 미치는 급성 영향 및 건강편익 평가 -서울, 인천, 부산, 울산 4개 도시를 중심으로-

This study assessed the relationships between levels of <TEX>$PM_{10}$</TEX> and hospitalization rates for asthma among children from 2003 to 2005 at four major cities in Korea. In addition, we estimated the reduced number of asthma hospitalization associated with an ambient <TEX>$PM_{10}$</TEX> improvement to the acceptable levels as recommended by the World Health Organization (WHO). The Generalized Additive Model (GAM) was used to estimate the relative risks (RR) of asthma hospitalization associated with changes in <TEX>$PM_{10}$</TEX> The RRs of children's asthma hospitalization for every <TEX>$10{\mu}g/m^3$</TEX> increment in <TEX>$PM_{10}$</TEX> were 1.009(95% CI = 1.004-1.014) in Seoul, 1.013(95% CI = 1.006-1.021) in Incheon, 1.009(95% CI = 1.002-1.016) in Busan, and 1.021(95% CI = 1.005-1.037) in Ulsan. We assessed <TEX>$PM_{10}$</TEX> related health benefits from implementing the WHO's guidelines (24-hour average <TEX>$50{\mu}g/m^3$</TEX>) using the U.S. Environmental Protection Agency's Environmental Benefits Mapping and Analysis Program. The estimated benefits were 439(95% CI = 216-666) reduced asthma hospitalization in Seoul, 720(95% CI = 304-1,151) in Incheon, 260(95% CI = 66-459) in Busan, and 126(95% CI = 30-228) in Ulsan. It was concluded that improving <TEX>$PM_{10}$</TEX> condition to the WHO guideline would make a significant contribution to the reduction in asthma hospitalization among children. Therefore, public health measures are still needed to improve air quality in Korea.

Loose-coupling an air dispersion model and a geographic information system (GIS) for studying air pollution and asthma in the Bronx, New York City

This study developed new procedures to loosely integrate an air dispersion model, AERMOD, and a geographic information system (GIS) package, ArcGIS, to simulate air dispersion from stationary sources in the Bronx, New York City, for five pollutants: PM10, PM2.5, NOx, CO, and SO2. Plume buffers created from the model results were used as proxies of human exposure to the pollution from the sources and they modified the commonly used fixed-distance proximity buffers by considering the realities of air dispersion. The application of the plume buffers confirmed that the higher asthma hospitalization rates were associated with the higher potential exposure to local air pollution. The air dispersion modeling exhibited advantages over proximity analysis and geostatistical methods for environmental health research. The loose integration provides a relatively simple and feasible method for health scientists to take advantage of both air dispersion modeling and GIS by avoiding the need for intensive programming and substantial GIS expertise.

Pediatric Asthma Mortality and Hospitalization Trends Across Asia Pacific: Relationship With Asthma Drug Utilization Patterns

Background: The wide variability in prevalence of childhood asthma across Asia Pacific is well documented, but less is known about its trends in mortality and hospitalization.Objectives: To examine pediatric asthma mortality and hospitalization trends of selected countries across Asia Pacific, and also patterns of asthma drug utilization.Materials and Methods: Mortality and population data were sourced from the World Health Organization's mortality database. Data on hospitalization were obtained by direct inquiry and from government and scientific publications. Drug use for asthma was expressed as a controller-to-reliever (C:R) ratio (ie, units of inhaled corticosteroids/units of short-acting β-agonists, sold in each country). Time-series regression analyses were used to examine temporal patterns and study association between deaths, hospitalizations, and drug use.Results: Japan showed a decreasing trend in pediatric asthma mortality whereas an increase was observed in Thailand. Hospitalizations decreased in Australia and Singapore but increased in Taiwan, Republic of China. C:R ratios increased significantly across the countries.Conclusions: Mixed trends in pediatric asthma mortality and hospitalization rates were observed, which coincided with a uniform increase in C:R ratios. This may reflect importance of other aspects of asthma management besides pharmacotherapy.

Childhood Asthma Surveillance using Administrative Data: Consistency between Medical Billing and Hospital Discharge Diagnoses

The absence of ongoing surveillance for childhood asthma in Montreal, Quebec, prompted the present investigation to assess the validity and practicality of administrative databases as a foundation for surveillance. To explore the consistency between cases of asthma identified through physician billings compared with hospital discharge summaries. Rates of service use for asthma in 1998 among Montreal children aged one, four and eight years were estimated. Correspondence between the two databases (physician billing claims versus medical billing claims) were explored during three different time periods: the first day of hospitalization, during the entire hospital stay, and during the hospital stay plus a one-day margin before admission and after discharge ('hospital stay +/- 1 day'). During 1998, 7.6% of Montreal children consulted a physician for asthma at least once and 0.6% were hospitalized with a principal diagnosis of asthma. There were no contemporaneous physician billings for asthma 'in hospital' during hospital stay +/- 1 day for 22% of hospitalizations in which asthma was the primary diagnosis recorded at discharge. Conversely, among children with a physician billing for asthma 'in hospital', 66% were found to have a contemporaneous in-hospital record of a stay for 'asthma'. Both databases of hospital and medical billing claims are useful for estimating rates of hospitalization for asthma in children. The potential for diagnostic imprecision is of concern, especially if capturing the exact number of uses is more important than establishing patterns of use.

The Gender Disparity in Adult Asthma Hospitalizations Dynamically Relates to Age

Although it is known that women have a higher prevalence of asthma than men, it is not known whether and/or how gender differences in asthma severity are affected by age. Asthma hospitalization rates were compared for men and women in New York State from 1990 through 2006 between the ages of 20 and 84. Female and male hospitalization rates were calculated and characterized for the different age intervals. The ratio between female to male hospitalization rates were compared for different age groups. While males showed an overall linear increase in hospitalization rates with increasing age, women had a steeper increase in hospitalization rates followed by a slowing beginning at the ages between 40–54. The ratio of the female to male hospitalization rates was maximal in this age interval, with a mean ratio of 2.41 compared to 1.97 in other ages. For each year, this female to male ratio was consistently higher for the age range between 40 to 54 than for other ages, and this difference remained when admissions associated obesity, tobacco dependence, and chronic non-asthmatic pulmonary disease were excluded. Differences between the hospitalization rates for men and women vary by age. The gender gap in hospitalization rates appears to be maximal between the ages of 40 and 54. This may reflect age related asthma prevalence and/or severity differences between men and women.

Using county-level public health data to prioritize medical education topics

Medical education topics might be locally prioritized using public health data on health outcomes and risk factors unrelated to quality of care. The Missouri Information for Community Assessment (MICA) supplied preventable hospitalization rates (PHRs) for asthma, chronic obstructive pulmonary disease (COPD), diabetes, heart failure, and hypertension in 114 counties from 1998 to 2002. For each disease, a linear regression model predicted PHR from behavior, access, and disease prevalence data from MICA and other public data sources. For each disease in each county, the residual, unexplained PHR should include effects of local medical practices. Variation in relative priority of diseases between counties was estimated from raw PHR and unexplained PHR. The raw values of the five PHRs varied geographically in different patterns. Regression models explained between 46% and 83% of the variability. The medical education priorities implied by unexplained PHR values differ from priorities inferred from unadjusted PHR or disease prevalence. Patient behavior and poor health care access contribute to PHR but do not fully explain variation in PHR. If county-level unexplained PHR values identify high priority medical education topics, then other measures of importance, notably disease prevalence and PHR, are poor identifiers of high value topics. Although available predictor and outcome variables constrain the current analysis, unexplained variation in health outcome measures might identify educational opportunities. These observations suggest strategies for balancing and evaluating controlled trials of knowledge dissemination efforts and eventually for deploying educational activities.

Canadian Adult Asthma Update 2008 Key Messages: A Focus on Translating Knowledge into Action in Primary Care

Canadian Adult Asthma Update 2008 Key Messages: A Focus on Translating Knowledge into Action in Primary Care

Are We Closing the Disparities Gap?: Small-Area Analysis of Asthma in Chicago

Disparities in asthma outcomes in the Chicago area have been observed between geographic areas and ethnic and socioeconomic groups. As efforts to close this gap have moved beyond the initial characterization of the problem to implementation of concrete programs to address these disparities, objective measures of success are essential. We present a variety of data from the Chicago area to assess whether any improvement in previously reported disparities can be demonstrated. While some process outcomes such as medication usage have improved over time, death from asthma has failed to demonstrate an equivalent improvement. More importantly, the differential in asthma mortality and hospitalization rates between African Americans and European Americans has failed to close in the years following the release of the National Asthma Education and Prevention Program asthma guidelines.

Asthma and infectious respiratory disease in children – correlation to residence near hazardous waste sites

Rates of hospitalization for asthma and respiratory infectious disease in children were modeled as a function of residence: (1) in a zip code containing a hazardous waste site with persistent organic pollutants ('POPs'); (2) in a zip code with a waste site that did not contain POPs ('other'); or (3) in a zip code without any identified waste site ('clean'), as well as other demographic covariates. After adjustment, living in a zip code containing a POPs waste site significantly increased the frequency of hospitalization for asthma and infectious respiratory disease. Living in a zip code with an 'other' waste site also increased hospitalization frequencies for both diseases. The association was strongest for zip codes whose residents were in the lowest quartile of medium family income. This evidence supports the hypothesis that living near a hazardous waste site increases risk of respiratory disease in children.