Thursday, May 5, 2011
QD: News Every Day--Asthma rates rising amid falling budgets to treat it
Asthma and other environmentally included diseases such as lead poisoning are rising, even as the government is cutting programs to reduce incidence rates.
Asthma, in particular, is rising even as cigarette smoking is declining, leading public health officials to look at other environmental causes, such as traffic pollution.
According to a Centers for Disease Control and Prevention report, asthma's prevalence increased from 7.3% (20.3 million persons) in 2001 to 8.2% (24.6 million persons) in 2009, a 12.3% increase. Its prevalence among children was 9.6% and among adults was 7.7%.
To create its report, the CDC analyzed asthma data from the 2001-2009 National Health Interview Survey and from the 2001, 2005, and 2009 state-based Behavioral Risk Factor Surveillance System.
Researchers concluded that lack of insurance played a role. Not surprisingly, more asthmatic patients without insurance than with it could not afford prescriptions (40.3% versus 11.5%), and fewer without insurance consulted a primary-care physician (58.8% versus 85.6%) or a specialist (19.5% versus 36.9%).
Asthma is prevalent:
--One in 12 people (about 25 million, or 8% of the population) had asthma in 2009, compared with 1 in 14 (about 20 million, or 7%) in 2001.
--More than half (53%) had an asthma attack in 2008. Asthma was linked to 3,447 deaths (about 9 per day) in 2007--185 children and 3,262 adults.
--About 1 in 10 children (10%) had asthma and 1 in 12 adults (8%) had asthma in 2009. Women were more likely than men and boys more likely than girls to have asthma.
--About 1 in 9 (11%) non-Hispanic blacks of all ages and about 1 in 6 (17%) of non-Hispanic black children had asthma in 2009, the highest rate among racial/ethnic groups.
--The greatest rise in asthma rates was among black children (almost a 50% increase) from 2001 through 2009.
Asthma is costly:
--Asthma cost the U.S. about $3,300 per person with asthma each year from 2002 to 2007 in medical expenses, missed school and work days, and early deaths. Asthma costs in the U.S. grew from about $53 billion in 2002 to about $56 billion in 2007, about a 6% increase.
--Medical expenses associated with asthma increased from $48.6 billion in 2002 to $50.1 billion in 2007.
--More than half (59%) of children and one-third (33%) of adults who had an asthma attack missed school or work because of asthma in 2008. On average, in 2008 children missed 4 days of school and adults missed 5 days of work because of asthma. Also, 26% (3.2 million people) reported emergency department or urgent care center visits and 7% (850,183 people) reported a hospital admission--meaning on nearly one in seven people with asthma had an asthma attack that required urgent outpatient care.
But, asthma is manageable:
--While inhaled corticosteroids and avoiding asthma triggers prevent attacks, in 2008 less than half of people with asthma reported being taught how to avoid them. Almost half (48%) of adults who were taught how to avoid triggers did not follow most of this advice.
--Among persons with asthma, 34.2% reported being given a written asthma action plan, and 68.1% had been taught the appropriate response to symptoms of an asthma attack.
Health care providers can:
--Determine the severity of asthma and monitor how much control the patient has over it;
--Make an asthma action plan for patients;
--Teach them how to use inhaled corticosteroids and other prescribed medicines correctly and how to avoid asthma triggers such as tobacco smoke, mold, pet dander, and outdoor air pollution; and
--Prescribe inhaled corticosteroids for all patients with persistent asthma. (Only about one third of children or adults were using them at the time of the survey.)
The environment is getting tougher, not only for pollution but for politics, as well. Public health organizations will write their protests to Congress about the President's budget, which proposes merging the CDC's National Asthma Control Program with the Healthy Homes/Lead Poisoning Prevention Program, cutting both budgets by more than half and reducing the number of states funded by the National Asthma Control Program from 36 to 15.
But cutting that budget may result in spending more down the line elsewhere, even if it's not federal spending. Overall, environmental illness in children adds $76.6 billion to annual health care costs, compared to $54.9 billion in 1997 reports Health Affairs.
The new study focused on the cost of lead poisoning, childhood cancer and chronic conditions, including asthma, intellectual disability, autism and attention deficit disorder--conditions linked to environmental toxins and pollution.
Researchers used recent data to estimate the number of environmentally induced conditions in children and then calculated the annual cost for direct medical care and indirect costs, such as lost productivity resulting from parents caring for sick children.
In comparing the two studies, researchers found that diminished exposure to lead and reductions in costs for asthma care were offset by diseases newly identified as environmentally induced, including attention deficit disorder, and the added burden of mercury exposure.
Other findings include:
--Lead poisoning cost $50.9 billion;
--Autism cost $7.9 billion;
--Intellectual disability cost $5.4 billion;
--Mercury exposure cost $5.1 billion;
--Attention deficit hyperactivity disorder cost $5 billion;
--Asthma cost $2.2 billion; and
--Childhood cancer cost $95 million.
Several papers in the latest issue of Health Affairs call for further reductions in lead-based paint hazards to protect children from lead poisoning, which can severely affect mental and physical development, and tighter air quality standards to curb mercury emissions, as well as reduce particulates that can trigger asthma (especially in school zones), and testing new and existing substances to ensure they pose no risk to human health.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Suneel Dhand, MD, ACP Member
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