Asthma Surveillance Programs in Public Health Departments -- United States

Although asthma affects more than 14 million persons in the United States (1,2), there have been no nationally coordinated efforts to assist state health departments in developing asthma surveillance programs. To characterize asthma surveillance and control programs in public health departments in the United States, during March and April 1996, the Council of State and Territorial Epidemiologists and CDC conducted a survey of state and territorial epidemiologists. This report presents the results of that survey, which indicate that most states lack the funding and data necessary to develop asthma surveillance programs.

Questionnaires were sent to the 54 state and territorial epidemiologists who were asked to identify the appropriate person to respond to questions about asthma programs in the state. Responses were received from 48 states and three territories. Of the 51 respondents, 43 reported no state- or territorial-level asthma-control program. Based on a priority ranking scale with five items suggesting reasons states might not have an asthma-control program, the two most important reasons included lack of funds and shortage of staff. In an open-ended response, 10 states reported that asthma was not a public health priority in their state. However, 37 (86%) of the 43 states/territories expressed an interest in starting an asthma-control program.

Potential data available for characterizing asthma included hospital discharge records (42 {82%}), emergency department visits (16 {31%}), use of public or private health-care services for asthma care (10 {20%}), first-time visitors to a health-care provider (four {8%}), and survey data about the quality of life for persons with asthma (four {8%}). Only Wisconsin maintained a surveillance system to monitor trends in asthma.

Of the 42 states/territories with hospital discharge data, 14 previously had analyzed the data for asthma morbidity. Reasons for inability to use hospital discharge data included restricted access to the data because of legislative constraints and incompatible data formats.

Although no state or territory maintains an asthma-control program, 26 state health departments have been associated with efforts to control asthma in selected communities in their state, including environmental control measures (22), public education (14), patient education (14), education of health-care providers (12), and legislation (five).

Reported by: HA Anderson, MD, WR Forrester, MPA, DM Perrotta, PhD, Council of State and Territorial Epidemiologists, Atlanta. Air Pollution and Respiratory Health Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: During 1985-1990, the estimated medical costs of asthma care in the United States increased from $4.5 billion to $6.2 billion, and in 1985 these costs represented approximately 1% of total U.S. health-care costs (3). In the United States, asthma is the most common chronic disease of childhood and affects approximately 5 million children aged less than 18 years; asthma is the fourth leading cause of disability in children (4). Rates for asthma prevalence, hospitalization, and death are highest among children residing in inner cities, and important risk factors for asthma-related mortality include being poor or black (1,5,6).

National health objectives for the year 2000 regarding asthma prevention are to establish and monitor state-based plans to define and track sentinel respiratory diseases triggered by environmental factors, reduce hospitalizations, reduce the proportion of persons with activity limitations, and increase the proportion of persons with asthma that get formal patient education (objectives 11.16, 11.1, 17.4, and 17.14b) (7).

The findings in this report indicate that states lack the funding, staff, and data necessary to develop asthma surveillance programs. Although 84% of respondents reported the availability of hospital discharge data, most state and territorial health departments have not used the data because of barriers to its access such as negotiating its use with a private entity, legal barriers, or incompatible data systems. Other potential sources for obtaining state-specific data about asthma include adding state-specific questions about asthma to the Behavioral Risk Factor Surveillance System, designating asthma a performance measure in the Health Plan and Employer Data and Information Set (HEDIS), and monitoring Medicaid data over time.

Despite the need for state-specific data and the need to develop surveillance systems to monitor trends in asthma, approximately half of the responding health departments have been associated with efforts to reduce the impact of asthma in selected communities in their state. State and territorial health departments need to determine the local burden of asthma and should explore approaches for eliminating barriers that prevent the use of existing data. Collaboration between CDC and other federal agencies, managed-care organizations, academic institutions, and states and territories to design and implement comprehensive community-based asthma surveillance systems will better characterize the burden of asthma in the United States and will enable states to target areas where asthma-prevention programs should be implemented.

References

1. CDC. Asthma mortality and hospitalization among children and young adults -- United States, 1980-1993. MMWR 1996;45:350-3.

2. Adams PF, Marano MA. Current estimates from the National Health Interview Survey, 1994. Vital Health Stat 1995;10:94.

3. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med 1992;326:862-6.

4. CDC. Disabilities among children aged less than or equal to 17 years -- United States, 1991-1992. MMWR 1995;44:609-13.

5. CDC. Asthma -- United States, 1982-1992. MMWR 1995;43:952-5.

6. Weiss KB, Wagener DK. Changing patterns of asthma mortality. JAMA 1990;264:1683-7.

7. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50213.

   
   

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