"Asthma is one of the most common chronic conditions in the United States." (1) It is a chronic lung condition characterized by sudden, acute narrowing of the breathing passages resulting in an inability to take in enough oxygen, which causes lung damage and can be fatal. A condition that affects persons of all ages, the cause of asthma have been linked to family traits, infections, allergies, poverty, stress and environmental factors such as ozone and particulate levels outside and cigarette smoke and odors inside (7). Several studies have shown that asthma morbidity and mortality are significantly decreased with medical management and improved patient education when compared with traditional episodic care (4, 5).

"National statistics indicate that asthma prevalence and mortality have increased in recent years, despite numerous advancements in the diagnosis and treatment of asthma" (1). The Centers for Disease Control and Prevention estimates that the self-reported prevalence rate for asthma increased 75% from 1980-1994. The greatest increases were found in the younger age groups (0-4 year age group- 160% and the 5-15 years age group - 74%).

Nationally, during the 20-year period from 1975-1995, the estimated rate of office visits almost doubled, from 21.4 per 1,000 in 1975 to 39.0 per 1,000 in 1993-1995. The estimated rate of emergency room visits for asthma rose from 5.9 per 1,000 in 1992 to 7.1 per 1,000 in 1995 (1).

In 1985, the direct (medical care) cost of asthma for the United States was estimated at $2.4 billion (1990 dollars), and the indirect costs (lost wages, decreased productivity, etc.) were estimated at $2.1 billion. By 1990, the national cost of asthma-related medical care had risen to $3.6 billion, and the indirect costs had risen to $2.6 billion (5).

Local and Comparative Data

The Partnership for Health Care Information has compiled local data in an effort to identify asthma trends, comparative data in incidence of hospital asthma care, and costs for asthma care.

In a comparative study of hospitalization rates for asthma in Vanderburgh (Evansville) and Allen (Ft. Wayne) counties, Vanderburgh County showed a consistently higher hospitalization rate across all age groups. The most significant differences were found in the younger age groups. In 1996, Vanderburgh County had a hospitalization rate of 51.7 per 10,000 versus 32.2 per 10,000 in Allen County for the 0-3 age group; for the 4-8 year old group Vanderburgh County's rate was 35.2 while Allen County's rate was 10.5; and the 9-13 year group showed 40.2 for Vanderburgh County and 8.3 for Allen County. These differences continue in 1997. It cannot be determined if these differences exist because of a higher incidence of asthma in Vanderburgh County or because of differences in treatment.

One finding of interest in this data is the consistent trend of males utilizing services for asthma more often than females in the younger years (0-13 years) and females utilizing services more often in the adult years (18-65+). This is consistent with national data (1,2). The reason(s) for this difference is unclear. Perhaps asthma develops later in females than in males (6); perhaps adult women have a different response to asthma symptoms (8), or it may be due to comparatively smaller airways in adult women than adult men (9).

The total emergency room visits and total hospital admissions in Vanderburgh County for the years 1995-1997 showed only minor variations.

The direct cost of asthma is significant. Total hospital claims for Vanderburgh county residents for the year September 1996 through August 1997 were $1,565,355 (3). A comparison of the hospital charges for Vanderburgh County and Allen County show charges were generally less per patient in Vanderburgh County than in Allen County. The only exception was in 1996 when the average per patient charge in the 65+ age group was $2,000.00 more in Vanderburgh County than in Allen County. It should also be noted that this is a small population and a single complicated case can greatly affect the group average.

The Dartmouth Atlas of Health Care 1998 (10) has calculated the per thousand enrollees hospitalization rates for Adult Bronchitis and Asthma among non-HMO Medicare enrollees in selected hospital referral regions (HRR) for the years 1994-95. These rates are adjusted for differences in age, sex, and race composition of the area's population. While these rates are not directly comparable to the data collected by the Partnership for Health Care Information, the data shows interesting difference in hospitalization rates among other US cities. For instance, Evansville HRR has a per thousand hospitalization rate of 4.7; Paducah HRR rate is 4.4; Louisville HRR, 3.5; and Owensboro HRR, 3.4. The rate for the United States as a whole is 2.4 per thousand, with a range from 0.7 in Tacoma, WA HRR, and Napa, CA HRR, to 7.8 in Monroe, LA HRR.
 
 

        1. Centers for Disease Control and Prevention (April 24, 1998). Morbidity and Mortality Weekly Report. Surveillance for Asthma - United States, 1960-1995. Available at: ftp://ftp.cdc.gov/pub/Publications/MMWR/SS/SS4701.pdf.

        2. Christensen, D. (1998, February 5). Medical Tribune. Asthma said to take harsher toll on women. Available at: http://www.medtrib.com/issues/1998/5feb98/fp3.htm

        3. Community Health Audit (1997). Personal correspondence from C. Meese.

        4. Detwiller, D.A., Boston, L.M., and Verhulst, S.J. (1994). Evaluation of an educational program for asthmatic children ages 4-8 and their parents. Respiratory Care, 39:3, 204-212.

        5. Managing Asthma Care. Business and Health, special issue, 1995.

        6. Estrogen: It's Link With Asthma. Delicious!, December, 1996. Available at: http://www.delicious-online.com/health/articles/pmsd1296gen.html

        7. 4-Step Asthma Control Program, 1997. Available at: http://www.asthmacontrol.com/4step.html

        8. Osborne, M. (1998). Asthma. Debilitating effects worse in women. Women's Health Weekly, March 9, 1998. Available at: http://www.mewsfile.com/protect/nwhic(Search Database for "Asthma")

        9. Asthma & Women: Worrisome Trend (July 19, 1995). Rx Women Weekly Report. Available at http://uttm.com/rx_women/reports/july_1995/july19.html

        10. The Center for the Evaluative Clinical Sciences. Dartmouth Medical School (1998). The Dartmouth Atlas of Health Care 1998. Chicago: American Hospital Publishing.