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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.

Next Stop: Cleaner Air by swanksalot via Flickr and a Creative COmmons licenseAsthma, 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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1 Comments:

Anonymous Lead Poisoning said...

Oh wow, I had no idea that the amount of money spent on lead poisoning was so huge - more parents should be checking out what their kids are touching and interacting with.

May 10, 2011 at 9:41 PM  

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
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
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.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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