Asthma in Minnesota Slide Set Asthma Program Minnesota Department of Health June 2010

Introduction This slide set provides a cross-section of recent data on asthma in Minnesota and has been developed as a resource for our partners in the asthma community. If you extract slides from this presentation, please reference the MDH Asthma Program. For technical assistance, please contact us at health.asthma@state.mn.us. This slide set provides a cross-section of recent data on asthma in Minnesota and has been developed as a resource for our partners in the asthma community. If you extract slides from this presentation, please reference the MDH Asthma Program. For technical assistance, please contact us at health.asthma@state.mn.us.

Contents Background Asthma Prevalence Asthma Self-Management Education Asthma Hospitalizations & Emergency Department Visits Asthma Mortality Summary The MDH Asthma Program tracks different aspects of asthma – including the prevalence of asthma, rates of asthma hospitalizations and emergency room visits, quality of life and asthma mortality – in order to better understand the burden of asthma across the state.

Background

What is asthma? Asthma is a chronic respiratory disease Symptoms include wheezing, chest tightness and coughing Triggers of asthma episodes can include respiratory infections, allergens, cigarette smoke, air pollution, and exercise Cause of asthma is unknown Asthma is a chronic disease of the respiratory system that includes episodes of tightening of the muscles around the airways in the lungs (bronchoconstriction), swelling of the bronchial tubes and increased mucus production due to inflammation of the airways. Symptoms of asthma can include wheezing, chest tightness and coughing. A variety of factors can trigger an asthma attack (also known as an asthma episode or an asthma exacerbation), including viral respiratory infections, allergens (like pollen and dust mites), irritants (like cigarette smoke, wood smoke and air pollution) and exercise. What causes asthma to develop in an individual in the first place is unknown.

Asthma Prevalence Asthma prevalence is a measure of the proportion of people in a certain population (e.g., state) who have asthma.

Minnesota Adults and Asthma Approximately 1 in 13 Minnesota adults has asthma Adults in the Twin Cities metro area are more likely than adults in Greater Minnesota to have asthma The percentage of adults with asthma has increased since 2000 as it has nationally Due to new cases and/or increased awareness and diagnosis According to data from 2008, approximately 1 in 13 (7.8%) of Minnesota adults (age 18 and older) currently have asthma. That translates to approx. 310,000 adults in Minnesota. Adults in the Twin Cities are more likely than adults in Greater Minnesota to have asthma. The percentage of Minnesota adults who report having asthma has increased since 2000. This trend has been seen nationally as well. It is unclear whether this increase is due entirely to an increase in new cases and/or increased awareness of asthma leading to increased diagnosis of the disease. This information comes from the Behavioral Risk Factor Surveillance System (BRFSS), a joint state/Centers for Disease Control and Prevention (CDC) telephone survey about risk factors for chronic disease. The BRFSS survey is completed annually among a random sample of non-institutionalized adults age 18 and older residing in Minnesota. www.cdc.gov/brfss Source: Behavioral Risk Factor Surveillance System

Asthma Prevalence, Minnesota and U.S. Adults, 2008 The question “Has a doctor or nurse ever told you that you had asthma?” is used to estimate the percentage of people with a history of asthma (lifetime asthma prevalence). The follow-up question “Do you still have asthma?” is used to estimate the percentage of people with current asthma. Source: Behavioral Risk Factor Surveillance System

Current Asthma Prevalence, Minnesota and U.S. Adults, 2000-2008 The prevalence of current asthma among adults in Minnesota increased through the mid-2000s, but has stabilized over the past few years; a similar pattern has been observed at the national level. Source: Behavioral Risk Factor Surveillance System

Current Asthma Prevalence by Residence, Minnesota Adults, 2000-2008 Residents of the 7-county Twin Cities metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington counties) are consistently more likely to report having asthma than residents of Greater Minnesota. In 2008, 8.8% of adults living in the Twin Cities Metropolitan area and 6.8% of adults living in Greater Minnesota reported having asthma. Source: Behavioral Risk Factor Surveillance System

Current Asthma Prevalence by Sex, 2000-2008 Women are more likely than men to report that they currently have asthma. In 2008, the prevalence of asthma among Minnesota women was 9.2%, which is lower than that for US women (10.7%). The prevalence of asthma among Minnesota men in 2008 was 6.3%, slightly lower than that for US men (6.7%). Source: Behavioral Risk Factor Surveillance System

Current Asthma Prevalence by Age, 2000-2008 Between 2000 and 2008, there have been no clear trends in adult asthma prevalence by age group in Minnesota. Some of the year-to-year variation may be due to the relatively small numbers of respondents in each age group. In 2008, 7.8% of 18-44 year olds, 9.1% of 45-64 year olds, and 4.7% of adults 65 and older reported having asthma. Source: Behavioral Risk Factor Surveillance System

Minnesota Children and Asthma Approximately 1 in 16 Minnesota children (age 0-17) currently has asthma Asthma prevalence stable since 2003 when it was first measured Nationally, asthma rates increased dramatically through the mid-1990s, but have stabilized in recent years According to 2007 data from the National Survey of Children’s Health, 1 in 16 or 6.0% of Minnesota children (age 0-17) currently have asthma. That translates to approximately 76,000 Minnesota children. The percentage of children with asthma in Minnesota has been stable since 2003 when it was first measured by the Behavioral Risk Factor Surveillance System. Nationally, the percentage of children with asthma increased dramatically through the mid-1990s, but appears to have stabilized in recent years. Sources: National Survey of Children’s Health Behavioral Risk Factor Surveillance System

Asthma Self-Management Education A key component of asthma care is self-management education. According to the Expert Panel Report 3 (EPR-3) Guidelines for the Diagnosis and Management of Asthma, released in 2007 by the National Asthma Education and Prevention Program (NAEPP), this involves teaching people with asthma how to monitor their level of asthma control, how to take medications correctly (e.g., inhaler technique) and how to avoid environmental triggers, as well as developing and providing a written asthma action plan for each person with asthma.

Asthma Self-Management Education Among Minnesotans with Current Asthma Adults Children Taught to recognize early signs of an asthma episode 63.2% 78.2% Taught how to respond to an asthma episode 77.4% 73.1% Taught how to monitor peak flow 47.6% 50.7% Ever given an asthma action plan 34.2% 51.4% Taken a class on asthma management 7.7% * Shown how to use inhaler by a health professional 97.3% 87.1% Health professional observed inhaler use 75.8% 84.3% This slide shows the proportion of Minnesota adults and children with current asthma who have received asthma self-management education. Of note, only a third of adults with asthma have ever received an asthma action plan (AAP), while half of children have ever been given an AAP. Very few adults or children with asthma have ever taken a class on asthma management. *Estimate is unreliable due to its high relative standard error (≥30%) and is not shown. In this case, only a very small number of parents reported that their children had taken a class on asthma management. MN Asthma Callback Survey Self-Management Education questions: Has a doctor or other health professional ever taught you (your child) how to recognize early signs or symptoms of an asthma episode? Has a doctor or other health professional ever taught you (your child) what to do during an asthma episode or attack? Has a doctor or other health professional ever taught you (your child) how to use a peak flow meter to adjust your daily medications? Has a doctor or other health professional ever given you (your child) an asthma action plan? Have you (Has your child) ever taken a course or class on how to manage your (his/her) asthma? Have you (Has your child) ever used a prescription inhaler? AND Did a health professional show you (your child) how to use the inhaler? Did a doctor or other health professional watch you (your child) use the inhaler? *Estimate is unreliable due to relative standard error ≥30% Source: Minnesota Asthma Callback Survey, 2005

Emergency Department Visits and Hospitalizations for Asthma The goal of asthma management is to decrease the likelihood of asthma exacerbations, which in turn should decrease the need for an Emergency Department (ED) visit or hospitalization. Thus, factors that are associated with asthma exacerbations, such as respiratory infections, are also risk factors for ED visits and hospitalizations.

Asthma Emergency Department Visit Rates by Age and Sex, Minnesota, 2008 Emergency Department (ED) visits for asthma are an indication that asthma may not be under control. They may also indicate the lack of a primary health care provider (i.e., going to ED for primary care). Boys are more likely than girls to have an asthma-related emergency dept visit through the teenage years, after which, women are more likely than men to go to the ED for asthma. This graph shows only those ED visits for asthma that did not result in a hospitalization. Source: Minnesota Hospital Association

Asthma Hospitalization Rates by Age and Sex, Minnesota, 2008 Asthma hospitalizations are an indicator of the severity of the asthma exacerbation (even people with so-called mild asthma can experience severe exacerbations that require hospitalization) and barriers to regular asthma care (e.g., lack of health insurance). Hospitalizations for asthma are theoretically preventable with appropriate and timely asthma care. Asthma hospitalization rates are highest among children under the age of 5, with rate for boys nearly double that for girls. Rates are higher for males than females until the late teenage years at which point rates are higher in females than males. Source: Minnesota Hospital Association

Asthma Hospitalization Rates, Minnesota, 1998-2008 2008 MN rate = 7.6 per 10,000 2009 CDC target = 7.9 per 10,000 population The Centers for Disease Control and Prevention (CDC) set a goal for state asthma programs of decreasing asthma hospitalization rates by 16% between 2000 and 2009. Asthma hospitalization rates have been decreasing in Minnesota, and in 2008, we met the target. This graph illustrates the data lag with hospital discharge data – we won’t know how we did in 2009 until late 2010 or early 2011. Overall, asthma hospitalization rates in Minnesota have been decreasing since 1999. Source: Minnesota Hospital Association

Asthma Hospitalization Rates by Age Group and Region, 1998-2008 Despite the statewide decline in asthma hospitalization rates, there are some differences in trends for Twin Cities metro area and Greater Minnesota adults and children. Children in the 7-county Twin Cities metropolitan area (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington counties) have consistently had the highest rates of asthma hospitalizations in the state; although, their rates decreased dramatically between 1998 and 2008 (orange line). Hospitalization rates for adults in the Twin Cities are also declining (light blue line), while rates for adults in Greater Minnesota (pink line) have remained relatively stable. Hospitalization rates for children in Greater Minnesota (dark blue line) rose through the mid-2000’s but have since declined. Source: Minnesota Hospital Association

Seasonal Variations in Asthma Hospitalizations, Minnesota, 2008 The highest rates of asthma hospitalizations are seen in the Fall, with a smaller peak in the Spring. The lowest rates are always seen in June-August. The seasonal patterns are most pronounced in young people. A major cause of the fall increase in asthma hospitalizations is thought to be increasing rates of respiratory infections associated with children going back to school. The fall pollen season may be another contributor, as could the decreased use of controller medication by children over the summer. Source: Minnesota Hospital Association

Asthma Mortality Fortunately asthma deaths are relatively rare in Minnesota; although they still do occur. Asthma deaths should be preventable with timely and proper diagnosis and appropriate care. Known risk factors for asthma deaths include poor asthma control and asthma severity.

Asthma Mortality by Age, Minnesota, 2003-2008 The largest proportion of asthma deaths occur among Minnesota residents who are 65 and older. However, distinguishing asthma from other chronic respiratory conditions is difficult in this age group. An MDH Asthma Program review of deaths that had been attributed to asthma among Minnesota residents age 55 and older found that the majority of deaths were not in fact due to asthma. Difficulties in distinguishing asthma from other respiratory conditions, plus inconsistent reporting on the death certificates contributed to the inaccurate coding. Thus, it is likely that the true number of asthma deaths among seniors is lower than previously thought. Source: Minnesota Center for Health Statistics

Age-Adjusted Asthma Mortality Rates, Minnesota, 1999-2008 Asthma mortality rates have decreased dramatically since 1999 with the largest decreases among those 65 and older. This decrease is not completely explained by the coding issues described in the notes for the previous slide. Source: Minnesota Center for Health Statistics

Summary Many of the measures of the burden of asthma have improved since the 2005 Asthma in Minnesota report However, there is still much work to be done to improve quality of life for adults and children with asthma in Minnesota In summary, many of the measures of the burden of asthma in Minnesota have improved since the 2005 Asthma in Minnesota report. However there is still much work to be done to improve the quality of life for adults and children in Minnesota who have asthma.

For more information Asthma in Minnesota 2008 Epidemiology Report Available at: www.health.state.mn.us/asthma/Research.html