Epidemiological Analysis for Asthma
in Florida
June 2004
Emily J. Wilson, R.S., M.P.H.
Florida Department of Health
224 SE 24th Street
Gainesville,
FL 32641
(352) 334-7971
BEGIN FULL TEXT REPORT
Asthma At-A-Glance:
Helping Floridians Breathe Easier
The proof is in the numbers. Asthma is emerging as a
public health concern in Florida. So the need for information is critical. Take
a look at our snapshot of the scope of the problem. These fast facts glean
insight from statewide surveys, vital statistic records, and hospital and school
data. Graphs, charts and illustrations are used to capture the information in a
simplified format.
What is Asthma?
Asthma is a disease of the lungs that causes breathing
problems known as attacks or episodes. It is also one of the most common
chronic conditions in our nation and a serious chronic illnesses among
children.
A person with asthma has airways that are abnormally
sensitive to infection, irritants, allergens and exercise. The airway muscles
tighten and the airway lining swells, making the airways very narrow. It is
very hard to breathe when the airways are narrow.
While the cause of asthma and how the airways become
abnormally sensitive is unknown, the condition does tend to be hereditary among
families. In older people, asthma may be confused with other chronic diseases
such as emphysema or chronic bronchitis.
Fast Asthma Facts
Asthma Hospitalization
In 2002, more than 25,000 hospitalizations in
Florida were due to asthma. The average age of patients hospitalized is 37 years
old. They stay an average of 3.6 days, incurring about $11,802 in hospital
charges.
Asthma
Deaths
A total of 232 people died in Florida from
asthma during 2002. Nationally, during the same time period, 4,483 people died
from asthma, according to death certificate records.
Asthma In Florida School Children
During the 2001-2002 school year, a total of
97,386 children had asthma. This represents nearly 40 out of every1,000
children or 4% of the public school children.
Asthma In Florida Adults
More than
10% of Florida adults report having had asthma.
Fast Facts Sources (What is in this Report?)
The first of its kind, this information highlights key asthma facts in
Florida using data from a diverse mix of sources. The four sources used to
provide the data include:
Behavioral Risk Factor Surveillance System (BRFSS)
Vital Statistics (death certificates)
Hospitalization Records
School Health Annual Reports
Behavioral
Risk Factor Surveillance System
The 2002 County Behavioral Risk Factor Surveillance System
(BRFSS) survey was conducted among adults in Florida from September 2002 through
January 2003. As part of the survey, 34,551 adults were randomly selected and
interviewed. Approximately 500 adults were surveyed in each county. Their
responses provided county-level estimates of the prevalence of health behaviors
that contribute to morbidity and mortality. This information is reflected in
this chart.
Asthma Death Rates Adjusted
by Age
Vital
statistics were compiled from death certificates which identified asthma as
the cause of death, using 2002 Florida data. The most recent data for the nation
was gathered in 2001.
Key Findings:
·
In Florida, there were 232 deaths in the year 2002 due to asthma.
·
A total of 4,483 people reportedly died from asthma in the United
States in 2002.
·
Nationally, the age adjusted rate is 1.7, compared to the Florida
rate which is 1.2 per 100,000 people.
Other Data Factors:
·
Based upon age-adjusted death rate per 100,000, which
allows state and national statistics to be fairly compared.
·
Reported in single year rates and include all races and both
sexes.
2000-2002 Florida Asthma
Death Rate by County
Hospitalization Rates
Based upon reports provided by
the Agency for Health Care Administration (ACHA), the upward trend in
hospitalizations caused by asthma has increased steadily.
Data from Veterans Administration or military hospitals were not
included in reviewed reports.
2002 Asthma
Hospitalizations by County
Asthma Among Florida School
Children (School Health Data)
Based on 67 county profiles compiled in the Annual School Health Services
Report, this chart reflects written information provided by parents of children
attending public schools in Florida. Currently, there is no comparative
information available nationally.
This data does not include privately schooled or
home-schooled children.
Comparison of Asthma Rates in
School Districts By County
Data Strengths and Limitations
Collection Techniques & Varied Sources
This analysis uses four sources
and collection systems. By using different sources and collection systems the
data is independently collected from different populations - some adults only,
some children only, some mixed. There could be double counting, for instance a
child reporting asthma at a public school may also be hospitalized. Similarly,
there are some people only counted in one data set. Therefore, it would be
incorrect to either add or subtract the sets of data with one another. The
data sets cannot be compared.
Number of Asthma Deaths Appear Smaller
Deaths from asthma are collected
from death certificates. This data is uniformly collected nationwide through
public health vital statistics and therefore has a reliable national
comparison. The data is collected from a legal document completed by a medical
professional. The numbers of deaths due to asthma is small when looking at a
rate within a population.
Differences between Florida & National
Behavioral Risk Factor Surveillance System
Similar to the vital statistics
data, this is a uniform process from county to county and can be compared to the
state rate. In Florida, there are currently only two questions regarding asthma
on the telephone survey: Have you ever been told by a doctor you have asthma?
and Do you still have asthma? The national model also asks these two
questions but reports them differently. When reported similarly, answering yes
to both questions, Florida's 6.5% is below the national average of 7.5%
Other Data Limitations
All the data is currently available on the Internet and intranet in
CHARTS, but it is not compiled together into an asthma specific report as it is
here.
The data is reported at the county level with no identification so as to
protect patient privacy. This does not allow for an analysis within the county.
The data cannot account for the migration of people in or out of an
area. The data is valid as reported by residence only for the time it was
collected.
Physicians may, at times, mistakenly diagnose asthma as chronic
bronchitis or COPD (Chronic Obstructive Pulmonary Disease).
Hospitalization records are generated from billing data, and as such,
counts visits not patients.
Hospitalization records report primary diagnosis and multiple secondary
diagnoses. Rates of asthma can look different depending upon how wide the net
is cast.
Because asthma is an intermittent illness, people may mistakenly think
they or their children have outgrown the condition and consequently not report
it.
For the school health program, some counties have one nurse per school;
in others one nurse serves 3 or 4 schools. This could translate into
inconsistent reporting and follow through, depending on staff available in the
school health program.
No uniform or mandatory reporting for asthma exists. It is also not a
reportable disease, which means a definitive case definition or definitive
diagnostic test does not exist.
Future Directions
To strengthen asthma prevention efforts, Florida has
submitted a grant proposal to the Centers for Disease Control for funding. If
the proposal is funded:
·
A statewide asthma program will be created at the Florida
Department of Health
·
A statewide asthma coalition will be established
·
A strategic asthma plan will be created for statewide
implementation
·
Health promotion and professional education activities will be
conducted
·
Asthma education and treatment initiatives will be implemented
·
Efforts to build collaborative partnerships between public and
private organizations.
Additional Resources
To find out more about asthma,
you can contact your doctor, health care professional, or gather
additional information from these sources:
Florida Department of Health
Division of Environmental Health
Office of Environmental Public Health Medicine,
850.245.4299
Link to
Asthma
Trigger Fact Sheet
American Lung Association
lungusa.org
National Institutes for Health
http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html
The Asthma and Allergy Foundation of America
http://www.aafa.org/
For Clinicians:
Program Guidelines for the Diagnosis and Management of
Asthma
http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
Action Against Asthma, A Strategic Plan for the Department of Health and Human Services, May 2000
http://aspe.hhs.gov/sp/asthma/overview.htm#f5
