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ICD Code: 493. Asthma



ICD Code: 493. Article Review
Title: Mannino DM et al; "Surveillance for Asthma: United States, 1960-1995." Morbidity and Mortality Weekly Report; V.47; No.SS-1; 4/24/98; p1
      This report summarizes and reviews national data for self-reported asthma prevalence (1980 to 1994), asthma office visits (1975 to 1995), asthma emergency room visits (1992 to 1995), and asthma deaths (1960 to 1995). In addition, the report describes several asthma surveillance programs at the state and local levels that may be useful to other states that are developing asthma surveillance systems.
      MORTALITY: Mortality rates (per 1,000,000 population; age-adjusted to the 1970 U.S. population) with asthma as the underlying cause-of-death diagnosis were reported as follows by the National Center for Health Statistics (NCHS) (1987 to 1989, 1990 to 1992, and 1993 to 1995, respectively): 16.6, 17.1, 17.9. The corresponding rates by race (also age-adjusted) were reported as follows: white, 14.2, 14.6, 15.1; black, 36.1, 35.6, 38.5; other, 17.6, 18.7, 17.7. The corresponding rates by gender (also age-adjusted) were reported as follows (male vs female): 14.7 vs 18.2, 14.8 vs 18.9, 15.1 vs 20.0. The corresponding rates by age group (not age-adjusted) were reported as follows: age 0 to 4 years, 1.5, 2.1, 1.8; age 5 to 14 years, 2.9, 3.0, 3.7; age 15 to 34 years, 4.9, 5.3, 6.3; age 35 to 64 years, 19.0, 18.5, 19.6; age 65 years and older, 85.0, 89.0, 89.8.
      The Underlying Cause of Death dataset from the NCHS was reviewed for 1960 through 1995 to identify all deaths in which asthma was selected as the underlying cause of death. During this period, three different ICD classifications were used to indicate a diagnosis of asthma: ICD-7 (code 241, 1960 to 1967); ICD-8 (Adapted) (ICDA-8) (code 493, 1968 to 1978); and ICD-9 (code 493, 1979 to 1995). The comparability ratio for asthma (ICD-9/ICDA-8) is 1.35, indicating that about 35% more deaths would be attributed to asthma as the underlying cause of death under ICD-9 as compared with ICDA-8. Part of this change was related to classifying "asthmatic bronchitis" as "bronchitis" in ICDA-8 but as "asthma" in ICD-9. The comparability ratio for asthma (ICDA-8/ICD-7) is 0.70, indicating that about 30% fewer deaths would have been assigned to asthma under ICDA-8 compared with ICD-7.
      SELF-REPORTED PREVALENCE: Estimated average annual rates (per 1000 population; age-adjusted to the 1970 U.S. population) of self-reported asthma during the preceding 12 months from the National Health Interview Survey were reported as follows (1987 to 1989, 1990 to 1992, and 1993 to 1994, respectively): 42.9, 46.6, 53.8. The corresponding rates by race (also age-adjusted) were reported as follows: white, 41.1, 44.7, 50.8; black, 51.7, 52.2, 57.8; other, 32.7 (because the relative standard error of the estimate was 30% to 50%, this estimate was considered unreliable), 39.7, 48.6. The corresponding rates by gender (also age-adjusted) were reported as follows (male vs female): 43.0 vs 42.3, 45.3 vs 47.5, 51.1 vs 56.2. The corresponding rates by age group (not age-adjusted) were reported as follows: age 0 to 4 years, 33.9, 46.1, 57.8; age 5 to 14 years, 60.7, 65.9, 74.4; age 15 to 34 years, 40.1, 41.7, 51.8; age 35 to 64 years, 36.8, 42.3, 44.6; age 65 years and older, 42.1, 36.4, 44.6. The self-reported prevalence rate for asthma increased 75% from 1980 to 1994; by 1993 to 1994, an estimated 13.7 million persons reported asthma during the preceding 12 months.
      EMERGENCY ROOM VISITS: Estimated annual rates (per 10,000 population; age-adjusted to the 1970 U.S. population) of emergency room visits for asthma as the first-listed diagnosis from the National Hospital Ambulatory Medical Care Survey were reported as follows (1992, 1993, 1994, and 1995, respectively): 58.8, 66.6, 62.9, 70.7. The corresponding rates by race (also age-adjusted) were reported as follows: white, 46.8, 50.3, 46.1, 48.8; black, 151.9, 197.4, 191.2, 228.9; other (because the relative standard error of each estimate was 30% to 50%, these estimates were considered unreliable), 28.6, 23.7, 21.9, 33.1. The corresponding rates by gender (also age-adjusted) were reported as follows (male vs female): 55.5 vs 61.4, 62.6 vs 69.7, 53.4 vs 65.9, 57.8 vs 82.3. The corresponding rates by age group (not age-adjusted) were reported as follows: age 0 to 4 years, 143.5, 164.3, 145.5, 120.7; age 5 to 14 years, 77.1, 82.8, 80.3, 81.3; age 15 to 34 years, 52.9, 59.0, 62.8, 69.2; age 35 to 64 years, 39.6, 50.7, 41.8, 64.4; age 65 years and older, 27.7, 22.6, 23.5, 29.5. Data for emergency room visits were available for 1992 to 1995. Over this period, the national rate of emergency room visits for asthma did not change significantly. In 1995, there were more than an estimated 1.8 million emergency room visits for asthma. Blacks had consistently higher rates for emergency room visits than whites.
      OFFICE VISITS: Estimated average rates (per 1000 population; age-adjusted to the 1970 U.S. population) of office visits for asthma as the first-listed diagnosis from the National Ambulatory Medical Care Survey were reported as follows (1989, 1990 to 1992, and 1993 to 1995, respectively): 27.0, 34.1, 39.0. The corresponding rates by race (also age-adjusted) were reported as follows: white, 26.2, 34.6, 39.6; black, 29.9, 39.5, 43.8; other, not reported, 17.3, 34.1. The corresponding rates by gender (also age-adjusted) were reported as follows (male vs female): 21.0 vs 32.7, 31.2 vs 36.7, 33.9 vs 43.6. The corresponding rates by age group (not age-adjusted) were reported as follows: age 0 to 4 years, 32.7 (because the relative standard error of the estimate was 30% to 50%, this estimate was considered unreliable), 48.2, 50.3; age 5 to 14 years, 27.0, 49.3, 51.5; age 15 to 34 years, 19.0, 23.9, 22.8; age 35 to 64 years, 31.7, 29.5, 41.7; age 65 years and older, 30.9, 37.0, 44.0.

Search Criteria: Text - Morbidity and Mortality Weekly Report; V.47; No.SS-1; 4/24/98; p1