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ICD Code: 493. Asthma

ICD Code: 493. Article Review
Title: Akinbami LJ et al; "Status of Childhood Asthma in the United States, 1980-2007." Pediatrics; V.123; Suppl 3; 3/09; pS131
      STUDY DESIGN: This report focuses specifically on childhood asthma since 1980; it updates a previous study of trends in childhood asthma, provides new details according to age and race/ethnicity, and adds data on the adoption of asthma control measures. Although estimates of prevalence, health care use, and mortality rates are major indicators of the impact of childhood asthma, symptoms that are not recognized or are not severe enough to warrant emergency care or hospitalization can still affect quality of life. Therefore, this report also addresses the broader context and responses to childhood asthma by reviewing Centers for Disease Control and Prevention (CDC) programs that track symptoms and disease management and that provide timely relevant data to health care professionals, policymakers, and child caretakers at the community level.
      PEDIATRIC PREVALENCE TRENDS: Asthma period prevalence among children 0 to 17 years of age increased from 3.6% in 1980 to a peak of 7.5% in 1995. The annual average increase between 1980 and 1996 was 4.6%. Because the National Health Interview Survey (NHIS) questionnaire was redesigned in 1997, asthma prevalence estimates from 1997 onward are not comparable to earlier estimates. All of the 3 new prevalence estimates (lifetime, current, and attack) show that asthma prevalence remained relatively level from 1997 to 2007.
      The stability of current asthma prevalence noted from 2001 to 2007 probably began in 1997. Prevalence, as estimated in the 2007 NHIS, remains at historically high levels. That is, 9.1% of children (6.7 million) were estimated to have asthma currently, 5.2% of children (3.8 million), or nearly 60% of children with current asthma, had experienced 1 or more asthma attack in the previous year, and 13.1% of children (9.6 million) had been diagnosed as having asthma during their lifetimes. Of this group, 70% were reported to have asthma currently.
      EMERGENCY DEPARTMENT VISITS: Since 1992, when data first became available from the National Hospital Ambulatory Medical Care Survey, the rate of emergency department (ED) visits attributable to asthma among children decreased slightly, by 0.8% per year. In 2006, there were 593,000 visits to EDs attributable to asthma, which represented 2.3% of all ED visits among children 0 to 17 years of age.
      HOSPITALIZATION: Through the 1980s, asthma-related hospitalization rates increased for children 0 to 17 years of age. Trend analysis identified a 2.9% average increase each year from 1980 through 1991 and no statistically significant trend after 1991. In 2006, there were 21 asthma-related hospitalizations per 10,000 children, for a total of 155,000 hospitalizations; this represented about 5.6% of all hospitalizations among children in 2006.
      MORTALITY: In 2005, there were 2.3 asthma-related deaths per 1 million children, for a total of 167 deaths. Trend analysis showed that asthma-related death rates increased by an average of 3.2% per year from 1980 through 1996 and then decreased by an average of 3.9% per year from 1996 through 2005.
      RACIAL DISPARITY: Compared with white children, children of American Indian and Alaska Native descent were 1.3 times more likely and black children were 1.6 times more likely to have current asthma, whereas Asian children had the lowest prevalence. When Hispanic ethnicity was considered in addition to race, Puerto Rican children had the highest prevalence of all groups and were 2.4 times more likely to have current asthma than were non-Hispanic white children, whereas Mexican children had relatively low current asthma prevalence.
      In contrast to patterns for prevalence, non-Hispanic black children’s rate of ambulatory health care use in nonemergency settings was nearly 20% lower than that of non-Hispanic white children. Racial disparities in adverse outcomes (ED visits, hospitalizations, and death) were much larger than disparities in prevalence. Non-Hispanic black children had an ED visit rate 4.1 times higher and a death rate 7.6 times higher than the rates for non-Hispanic white children. For hospitalizations, for which data on Hispanic ethnicity were not available, black children had an asthma-related hospitalization rate 3.0 times higher than that of white children.
      When an at-risk approach was used (rates based on the number of children estimated to have current asthma), racial disparities in adverse outcomes were generally reduced. With accounting for their higher current asthma prevalence, non-Hispanic black children had an ED visit rate 2.6 times higher and a death rate 4.9 times higher than non-Hispanic white children. Hospitalization rates for black children were 2.0 times higher than those for white children (data on Hispanic ethnicity were not available). In contrast, the relative difference between non-Hispanic black and non-Hispanic white children in rates of nonemergency ambulatory care use was accentuated; the at-risk approach-based rate among black children was 50% (vs 20%) lower than that for white children. Examining outcomes for Hispanic children and accounting for differences in asthma prevalence did not change the difference in ED visit rates between Hispanic and non-Hispanic white children (relative risk: 2.0 vs 1.9). Although estimates for Hispanic ethnicity were not reliable for nonemergency ambulatory care data and were not available for hospitalization data, the at-risk analysis for asthma-related death rates among Mexican children versus non-Hispanic white children yielded a higher relative risk than did the population-based analysis (relative risk: 1.5 vs 1.1).
      DISCUSSION: Analysis of the current burden of childhood asthma yields a mixture of positive and negative findings. Prevalence trends have plateaued and asthma-related death rates have decreased. Major steps have been made to increase the quality, quantity, and geographic availability of asthma surveillance data. However, although innovative approaches and broad public health programs have focused on minimizing the impact of asthma, the disease burden remains high. Even after controlling for their higher asthma prevalence, minority children have much greater rates of adverse outcomes. Given that the primary causes of developing asthma are only partially understood, research, prevention, and intervention efforts aimed at reducing the burden of childhood asthma remain as important as ever.

Search Criteria: Text - Pediatrics; V.123; Suppl 3; 3/09; pS131