A healthier and safer Indiana A STHMA I N I NDIANA Amy Brandt, MPHChronic Respiratory Disease Epidemiologist Indiana State Department of Health C HRONIC.

A healthier and safer Indiana

ASTHMA IN INDIANA

Amy Brandt, MPH—Chronic Respiratory Disease Epidemiologist

Indiana State Department of Health

CHRONIC RESPIRATORY DISEASE SECTIONAUGUST 2013

Description of presentation

This slide set provides a cross-section of data on asthma in Indiana and is intended to be a resource for those working on asthma in the state.

If you extract slides from this presentation, please use citations and footnotes on the slides. Also, please reference the Indiana State Department of Health Chronic Respiratory Disease Section. For technical assistance, please contact [email protected].

Understanding asthma data

Prevalence Annual or average annual number of total cases of asthma.

Mortality Annual or average annual number of deaths from asthma.

Hospitalization Rates Age-adjusted rate of hospitalizations with a primary diagnosis of asthma per

10,000 people. Emergency Department (ED) Rates

Age-adjusted rate of ED visits with a primary diagnosis of asthma per 10,000 people.

Age-adjusted Rates Removes the impact of different age distributions between populations and

allows for direct comparisons of those populations. Age-specific Rates

Rate in a specific, defined age group. Numerator and denominator refer to the same age group.

Understanding asthma data—confidence intervals and statistical significance

Confidence intervals (CIs) are used to describe the range of that variation Most typically, 95% CIs are calculated, which provide a range of values in

which if one repeated a study 100 times, 95 of the intervals would include the true rate.

When 95% CIs do not overlap, the two areas are statistically significantly different at the P<.05 level i.e., the difference between the two rates is more than that expected by

random variation.

Most common data sources

Indiana Behavioral Risk Factor Surveillance System (BRFSS) www.in.gov/isdh/22860.htm

Centers for Disease Control and Prevention (CDC) BRFSS www.cdc.gov/brfss

BRFSS Asthma Call-Back Survey (ACBS) http://www.cdc.gov/brfss/acbs/index.htm

Indiana Hospital Discharge Database http://www.state.in.us/isdh/20624.htm

Indiana Vital Records Information: www.in.gov/isdh/23574.htm Data: www.in.gov/isdh/19096.htm

Background

What is asthma?

Chronic disease of the airways that may cause:• Wheezing• Breathlessness• Chest tightness• Nighttime or early morning coughing

Triggers of asthma episodes can include respiratory infections, allergens, cigarette smoke, air pollution, and exercise.

Episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible with treatment.

Prevalence

Summary slide for adult asthma

Approximately 1 in 11 (9.1%) Indiana adults (18+ years) are currently diagnosed with asthma.

Adult females in Indiana are more likely than males to have asthma.

An asthma diagnosis is more likely in adults with an annual household income < $15,000 compared to household incomes ≥ $15,000.

Prevalence of asthma among adults (18+ years) , Indiana and United States, 2012

Lifetime asthma determined from response to question “…ever told you had asthma?”Current asthma determined from response to question “Do you still have asthma?”Source: CDC and ISDH DAT. (2013). Behavioral Risk Factor Surveillance System Prevalence Data, 2012.

13.0

9.1

13.3

8.9

0

3

6

9

12

15

Lifetime asthma Current asthma

Pe

rce

nt

Indiana United States

Prevalence of lifetime asthma among adults (18+ years) , Indiana, 2000–2010, 2011–2012*

*Starting in 2011 prevalence estimates were determined using a new, more precise methodology, including the addition of cell phone respondents and new weighting techniques; therefore, estimates made in 2011 or later should not be compared to earlier prevalence estimates.

Source: CDC and ISDH DAT. (2013). Behavioral Risk Factor Surveillance System Prevalence Data, 2000–2012.

11.2

14.213.0*

0

2

4

6

8

10

12

14

16

18

20

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nt

Year

Prevalence of lifetime asthma among adults (18+ years) by sex, Indiana, 2000–2010, 2011–2012*



9.8

11.610.8

12.4

16.7

15.0

0

2

4

6

8

10

12

14

16

18

20

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nt

Year

Males Females

Prevalence of current asthma among adults (18+ years) , Indiana, 2000–2010, 2011–2012*



8.1

9.5 9.1

0

2

4

6

8

10

12

14

16

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nt

Year

Prevalence of current asthma among adults (18+ years) by sex, Indiana, 2000–2010, 2011–2012*



5.8

7.26.9

10.211.7

11.1

0

2

4

6

8

10

12

14

16

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pe

rce

nt

Year

Males Females

Prevalence* of current asthma among adults (18+ years) by age group, Indiana, 2012

*Prevalence rates are presented with 95% confidence intervals.Source: CDC and ISDH DAT. (2013). Behavioral Risk Factor Surveillance System Prevalence Data, 2012.

6.7

8.89.7 9.5

10.8

8.7

0

2

4

6

8

10

12

14

18–24 25–34 35–44 45–54 55–64 65+

Pe

rce

nt

Prevalence* of current asthma among adults (18+ years) by gender, Indiana, 2012


6.9

11.1

0

2

4

6

8

10

12

14

Male Female

Pe

rce

nt

Prevalence* of current asthma among adults (18+ years) by race and ethnicity, Indiana, 2012 (NH=Non-Hispanic)


8.7

13.716.3

0

5

10

15

20

25

White NH Black NH Multiracial NH

Pe

rce

nt

Prevalence* of current asthma among adults (18+ years) by household income, Indiana, 2012


17.1

11.08.4 7.1 7.0

0

5

10

15

20

25

Pe

rce

nt

Prevalence* of current asthma among adults (18+ years) by educational attainment, Indiana, 2012


11.09.4 8.9

7.5

0

2

4

6

8

10

12

14

16

Less than HS HS or GED Some post-HS College graduate

Pe

rce

nt

Prevalence* of current asthma among adults (18+ years) by sex and age group, Indiana, 2012


5.97.4 6.3 6.3

8.0 7.57.59.6

13.0 12.7 13.5

9.5

0

2

4

6

8

10

12

14

16

18

18–24 25–34 35–44 45–54 55–64 65+

Pe

rce

nt

Male Female

Summary slide for child asthma

Approximately 1 in 10 (9.5%) Indiana children (ages 0-17) are currently diagnosed with asthma.

Asthma prevalence variation over the years can partially be explained by changes in sample size.

White children have a significantly lower prevalence rate than black children.

Indiana did not collect child data in 2012.

Prevalence of asthma among children (0-17 years) , Indiana and United States,* 2011

*National estimates are based on the 16 states who collected cell phone and landline data.Lifetime asthma determined from response to question “…ever told you had asthma?”Current asthma determined from response to question “Do you still have asthma?”Source: CDC and ISDH DAT. (2012). Behavioral Risk Factor Surveillance System Prevalence Data, 2011.

13.2

9.5

13.6

8.7

0

3

6

9

12

15

Lifetime asthma Current asthma

Pe

rce

nt

Indiana United States

Prevalence of lifetime asthma among children (0-17 years) , Indiana, 2005–2010, 2011*

*The 2011 prevalence estimate was determined using a new, more precise methodology, including the addition of cell phone respondents and new weighting techniques; therefore, the 2011 estimate should not be compared to earlier prevalence estimates.

Source: CDC and ISDH DAT. (2011). Behavioral Risk Factor Surveillance System Prevalence Data, 2000-2011.

13.7 13.413.2*

0

2

4

6

8

10

12

14

16

18

20

2005 2006 2007 2008 2009 2010 2011

Pe

rce

nt

Year

Prevalence of current asthma among children (0-17 years) , Indiana, 2005–2010, 2011*

*The 2011 prevalence estimate was determined using a new, more precise methodology, including the addition of cell phone respondents and new weighting techniques; therefore, the 2011 estimate should not be compared to earlier prevalence estimates.

Source: CDC and ISDH DAT. (2011). Behavioral Risk Factor Surveillance System Prevalence Data, 2000-2011.

9.6

8.89.5*

0

2

4

6

8

10

12

14

16

18

20

2005 2006 2007 2008 2009 2010 2011

Pe

rce

nt

Year

Prevalence*of current asthma among children (0-17 years) by age group, Indiana, 2011


7.1

12.3 11.9

7.4

0

2

4

6

8

10

12

14

16

18

0–4 5–9 10–14 15–17

Pe

rce

nt

Prevalence* of current asthma among children (0-17 years) by sex, Indiana, 2011


6.1

11.2

0

2

4

6

8

10

12

14

16

Male Female

Pe

rce

nt

Prevalence* of current asthma among children (0-17 years) by race and ethnicity, Indiana, 2011 (NH=Non-Hispanic)


7.6

21.8

9.7

0

5

10

15

20

25

30

35

White NH Black NH Hispanic

Pe

rce

nt

Asthma Management and Education

Asthma self-management education among Hoosiers with current asthma

1. CDC and ISDH DAT. (2013). Behavioral Risk Factor Surveillance System Adult Asthma Call-back Survey, 2011.2. CDC and ISDH DAT. (2012). Behavioral Risk Factor Surveillance System Child Multi-year Asthma Call-back Survey,

2006-2010.

Has a health care professional . . . Adults1 Children2

shown you how to use an inhaler? 94.6% 95.3%taught you what to do during an asthma episode or attack?

83.9% 85.4%

watched you use an inhaler? 81.7% 82.7%taught you how to recognize early signs or symptoms of an asthma episode?

70.4% 81.8%

taught you how to use a peak flow meter to adjust daily medications?

42.9% 39.7%

given you an asthma action plan? 33.7% 47.7%

Have you . . .

ever taken a course to manage asthma 9.9% 18.3%

Barriers facing Hoosiers with current asthma

1. CDC and ISDH DAT. (2013). Behavioral Risk Factor Surveillance System Adult Asthma Call-back Survey, 2011.2. CDC and ISDH DAT. (2012). Behavioral Risk Factor Surveillance System Child Multi-year Asthma Call-back Survey,

2006-2010.

Adults1 Children2

Uninsured 18.2% 4.1%Unable to see primary care doctor for asthma because of the cost

16.5% 6.9%

Unable to see specialist because of the cost 8.0% 5.0%

Unable to buy medications because of the cost 26.0% 11.9%Missed at least 1 day of work/school in the past 12 months due to asthma

40.4% 44.7%

Limited usual activities a lot within the past 12 months due to asthma

12.5% 4.2%

Had 0 asthma symptom-free days during the past 2 weeks 29.8% 11.6%

36.8

44.6

18.6

0 10 20 30 40 50 60Percent

Asthma control among adults (18+ years)*, Indiana, 2011

*Percents are presented with 95% confidence intervals.Source: CDC and ISDH DAT. (2013). Behavioral Risk Factor Surveillance System Adult Asthma Call-back Survey, 2011.

Very poorly controlled

Not well controlled

Well controlled

18.3

54.7

27.0

0 10 20 30 40 50 60 70Percent

Asthma control among children (0–17 years)*, Indiana, 2006–2010

*Percents are presented with 95% confidence intervals.Source: CDC and ISDH DAT. (2012). Behavioral Risk Factor Surveillance System Child Multi-year Asthma Call-back

Survey, 2006-2010.

Very poorly controlled

Not well controlled

Well controlled

Emergency Department Visits for Asthma

Asthma* ED visit rates,** Indiana, 2004–2011

*Primary diagnosis asthma emergency department visits. **Age-adjusted rates per 10,000 population.Source: Indiana State Department of Health. (2012). Indiana Hospital Discharge Data Files, 2004-2011.

37.3

47.2 45.348.1

54.058.8

52.8

47.1

0

10

20

30

40

50

60

70

2004 2005 2006 2007 2008 2009 2010 2011

Ra

te p

er

10

,00

0

Asthma* ED visit rates** by age and sex, Indiana, 2011

*Primary diagnosis asthma emergency department visits. **Age-specific rates per 10,000 population. Source: Indiana State Department of Health. (2012). Indiana Hospital Discharge Data Files, 2011.

0

20

40

60

80

100

120

140

0–4 5–9 10–14 15–17 18–19 20–24 25–34 35–44 45–54 55–64 65+

Ra

te p

er

10

,00

0

Female Male

0

2

4

6

8

10

12

14

16

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

Ra

te p

er

10

,00

0

0–9 10–17 18+

Asthma* ED visit rates** by month and age, Indiana, 2009–2011

*Primary diagnosis asthma emergency department visits. **Age-specific rates per 10,000 population. Source: Indiana State Department of Health. (2012). Indiana Hospital Discharge Data Files, 2009–2011.

2009 2010 2011

Hospitalizations

Asthma* hospitalization rates,** Indiana, 2002–2011

*Primary diagnosis asthma hospitalizations. **Age-adjusted rates per 10,000 population.Source: Indiana State Department of Health. (2012). Indiana Hospital Discharge Data Files, 2002-2011.

12.8

14.8

12.413.1

11.7 11.4

13.113.9

12.7 12.6

0

2

4

6

8

10

12

14

16

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Ra

te p

er

10

,00

0

Asthma* hospitalization rates** by age and sex, Indiana, 2011

*Primary diagnosis asthma hospitalizations. **Age-specific rates per 10,000 population. Source: Indiana State Department of Health. (2012). Indiana Hospital Discharge Data Files, 2011.

0

5

10

15

20

25

30

35

40

0–4 5–9 10–14 15–17 18–19 20–24 25–34 35–44 45–54 55–64 65+

Ra

te p

er

10

,00

0

Female Male

Asthma* hospitalization rates** by month and age, Indiana, 2009–2011

*Primary diagnosis asthma hospitalizations. **Age-specific rates per 10,000 population. Source: Indiana State Department of Health. (2012). Indiana Hospital Discharge Data Files, 2009–2011.

2009 2010 2011

0

0.5

1

1.5

2

2.5

3

3.5

4

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

Ra

te p

er

10

,00

0

0–9 10–17 18+

Asthma Mortality

Age-adjusted asthma mortality rates*, Indiana, 1999–2011

*Rate per 100,000 population.Source: ISDH Data Analysis Team. Death Reports (Mortality), 1999-2011.

1.76

1.04

0

0.5

1

1.5

2

0

20

40

60

80

100

120

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Ra

te p

er

10

0,0

00

Nu

mb

er

of

vis

its

Number of Deaths Age-adjusted rate per 100,000

Asthma mortality by age, Indiana, 2006–2011

Source: ISDH Data Analysis Team. Death Reports (Mortality), 2006-2011.

0–4 yrs2.5%

5–17 yrs4.9% 18–24 yrs

4.2%

25–44 yrs16.2%

45–64 yrs29.4%

65 and older42.8%

Summary and highlights

In Indiana, 9.1% of adults and 9.5% of children currently have asthma.

Improvements in asthma self-management can help decrease asthma exacerbations such as hospitalizations and ED visits.

A higher priority could be placed on ensuring adults with asthma are getting access to care.

For more information

ISDH Asthma Program website http://www.in.gov/isdh/24965.htm

Most current Indiana data http://www.in.gov/isdh/17279.htm

Data request form http://www.in.gov/isdh/files/Asthma_ISDH_Data_Request_Form.docx

Indiana INdicators: health-related indicators for the state and by county http://indianaindicators.org/

Contact Information

Amy BrandtChronic Respiratory Disease Epidemiologist

Indiana State Department of [email protected]

(317) 233-7793

For more asthma data, visit the Asthma Program’s Data and Reports webpage at http://www.in.gov/isdh/17279.htm.

A healthier and safer Indiana A STHMA I N I NDIANA Amy Brandt, MPHChronic Respiratory Disease Epidemiologist Indiana State Department of Health C HRONIC.

Documents

ageadjusted rates

agespecific rates rate

primary diagnosis of

defined age group

mortality annual

safer indiana

true rate

crosssection of data