asthma burden 2017hospitalizations from asthma can be prevented. these outcomes are an important...
TRANSCRIPT
Asthma in Wisconsin 2017 1
SCOPE OF THE PROBLEM Over the past decade, Wisconsin has made significant improvements in reducing the asthma burden in
some areas, but in other areas asthma remains unchanged.
ASTHMA PREVALENCE
Asthma Prevalence by State, 2017
In 2017, U.S. adult current asthma prevalence was 9%. In Wisconsin, adult current asthma prevalence was
9.5% putting the state in the 75th percentile nationally.
U.S. Overall: 9.0%
Wisconsin: 9.5%
Significant
Improvements
Slight Improvements No Change
Reducing emergency department (ED) visits
Reducing hospitalizations Reducing mortality rates
Adults with asthma who got a flu shot
Number of schools with asthma action plans on file for all students with asthma
Racial and ethnic disparities in
asthma prevalence,
hospitalization rates, and
mortality rates
ASTHMA IN WISCONSIN 2017
A summary of asthma burden data in Wisconsin describing prevalence, asthma control and
management, health care utilization, and mortality
Asthma in Wisconsin 2017 2
Adult and Child Asthma Prevalence, Wisconsin, 2017
Asthma is a key public health problem. From 2016 to 2017, the prevalence of asthma increased slightly in
Wisconsin. This data translates to about 100,000 Wisconsin children and 400,000 Wisconsin adults with
current asthma.
Asthma Prevalence among Wisconsin Adults by Race and Ethnicity, 2015–2017
Similar to the U.S., Wisconsin’s asthma burden disproportionately falls upon racial and ethnic minority
populations. Non-Hispanic African Americans have an asthma prevalence almost 1.5 times higher than
whites, and American Indians have an asthma prevalence twice that of whites. Because of this difference in
prevalence, you might expect that there would also be higher rates of adverse asthma outcomes (such as
ED visits, hospitalizations, and mortality) among these two populations. In Wisconsin, we see
disproportionately higher rates of asthma health care utilization and mortality among African Americans.
13.2%
9.9%
9.5%
7.4%
Adult
Child
9%
14%
18%
4%
8%
White
African American
American Indian/Alaska Native
Asian/Pacific Islander
Hispanic
Lifetime Prevalence (11.9–14.4%)
Current Prevalence
(8.5–10.6%)
Lifetime Prevalence
(7.6–12.2%)
Current Prevalence
(5.1–9.7%)
Asthma in Wisconsin 2017 3
Asthma Prevalence among Wisconsin Adults by Income, 2015–2017
Asthma disparities also exist by other factors, such as annual household income. Adults in the lowest
income group have over 2.5 times the rate of asthma as those in the highest income group.
Asthma Prevalence among Wisconsin Adults by Sex and Weight Status,
2015–2017
In Wisconsin, obese adults had higher asthma prevalence than both normal and overweight adults, with
dramatically higher prevalence among the morbidly obese.
All Wisconsin Adults
18.7%
12.5%
8.9% 7.5% 7.2%
$<15,000 $15,000 - <$25,000 $25,000 - <$50,000 $50,000 - <$75,000 $75,000+
8.6%
10.1%
15.0%
22.4%
Not Overweight/Obese (BMI<25.0)
Overweight (BMI 25.0-<30.0)
Obese(BMI 30.0-<40.0)
Morbidly Obese
(BMI ≥40.0)
Asthma in Wisconsin 2017 4
When stratified by sex, we see that a significantly higher percent of obese and morbidly obese females
reported having asthma compared to normal weight and overweight females. Men in the morbidly obese
group report significantly higher asthma prevalence compared to men in other weight status groups.
Females
Males
7.9%
7.4%
10.8%
19.6%
Not Overweight/Obese (BMI<25.0)
Overweight (BMI 25.0-<30.0)
Obese(BMI 30.0-<40.0)
Morbidly Obese
(BMI ≥40.0)
7.0%
5.6%
7.4%
15.5%
Not Overweight/Obese (BMI<25.0)
Overweight (BMI 25.0-<30.0)
Obese(BMI 30.0-<40.0)
Morbidly Obese
(BMI ≥40.0)
Asthma in Wisconsin 2017 5
ASTHMA CONTROL
The frequency of asthma symptoms, nighttime awakenings, activity limitations and rescue medication use
among persons with asthma were used to classify asthma control into the following categories: well-
controlled, not well-controlled, and very poorly controlled. Combining the top two categories in the figure
below, we can see that 60% of all adults with asthma reported asthma that was not well-controlled or
very poorly controlled.
Control of Asthma by Income, 2012–2016
Poor asthma control is also associated with a lower income. Among adults with current asthma, those in
the highest income group were more likely to report well-controlled asthma than those in the lower income
groups.
Well-Controlled Not Well-Controlled Very Poorly Controlled
Well-Controlled (40%)
Not Well-Controlled (37%)
Very Poorly Controlled (23%)
31.5
31.7
52.9
34.0
40.2
37.8
34.4
28.1
9.3
<$25,000
$25,000-49,999
≥$50,000
Asthma in Wisconsin 2017 6
ASTHMA MANAGEMENT
Time Since Patient Talked to Doctor about Asthma, among Current
Asthmatics, Wisconsin, 2012–2016
Establishing routine health care visits with a medical provider is an essential part of asthma management.
Nearly one-third of adults with current asthma reported it had been over a year since they discussed
asthma with their doctor.
Percentage of Persistent Asthmatics Who Received a Flu Vaccine by Age
Group among Medicaid Population, 2012–2014 Flu Season
The CDC recommends that all people aged 6 months and older receive a flu vaccine, and it’s especially
important for those with asthma. The Wisconsin Immunization Registry provided flu vaccination data for
Medicaid enrollees with persistent asthma. On average, 44% of Medicaid enrollees with persistent asthma
received a flu vaccination.
67%
17% 7% 8%
< 12 months 1-3 years 3-5 years 5 years or more
Nearly a third of asthmatics haven’t talked to their doctor about
their asthma in over a year.
56%
48%
37%
52%
44%
2-4 years 5-17 years 18-49 years 50-64 years Overall
Asthma in Wisconsin 2017 7
Control of Asthma by School Practices, 2012–2016
The Health Profiles survey is conducted in Wisconsin high schools among school teachers and principals,
and contains some questions on asthma management practices. The 2016 survey revealed that most
schools report using school records to identify and track students with asthma. However, other questions
revealed that there’s still room for improvement on other asthma-related practices. For example, one-third
of health education teachers indicated they would like to receive training on asthma, although only 14%
actually did in the past two years.
Percentages of schools that…
Routinely use school records to identify and track
students with asthma
Provide referrals to health care professionals for
students diagnosed with or suspected to have asthma
Teachers tried to increase student knowledge on
asthma
Lead health education teacher would like to receive
professional development on asthma
Ever used a self-assessment tool to assess asthma
policies, activities, or programs
Provided parents and families with asthma information
Lead health education teacher received professional
development on asthma during past two years
98.6%
48.0%
46.9%
33.5%
25.0%
14.1%
14.1%
Asthma in Wisconsin 2017 8
ASTHMA HEALTH CARE UTILIZATION
With proper medication, symptom management, and avoidance of triggers, most ED visits and
hospitalizations from asthma can be prevented. These outcomes are an important surveillance endpoint
because they help identify populations most in need of asthma management and preventive care.
Asthma Hospitalizations, Milwaukee County and Wisconsin, 2003–2017
Wisconsin has lower rates of asthma hospitalizations than the U.S., but Milwaukee County has rates that
are double that of the overall state rate.
Rates per 10,000 people
Note: U.S. rates not available past 2010.
23.2
6.8
19.8
14.1
11.2
3.6
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
ICD-9 to ICD-10
Transition
Milwaukee
U.S.
Wisconsin
Asthma in Wisconsin 2017 9
Asthma Hospitalizations and ED Visits by Sex and Age Group
Both Sexes
When we look at asthma health care utilization for both males and females, we see that across age
categories, children under five have the highest asthma hospitalization and ED visit rates in Wisconsin
(highlighted below).
† Overall rates are age-adjusted to the 2000 U.S. standard population
11
3
1 2 1
3
6
3 3
6 5 5
8
3 2
4 3 4
0-4 5-14 15-34 35-64 65+ Overall†
77
57
35
21
7
33 41
36
47
33
13
37
59
47 41
27
10
35
0-4 5-14 15-34 35-64 65+ Overall†
Hospitalization Rates by Age Group Per 10,000 people
ED Visit Rates by Age Group Per 10,000 people
Asthma in Wisconsin 2017 10
Females. Females (highlighted below) have more frequent adverse asthma outcomes in adulthood
compare to adolescence.
Males. Males (highlighted below) are more severely impacted by asthma during childhood.
11
3
1 2 1 3
6
3 3
6 5 5
8
3 2
4 3 4
0-4 5-14 15-34 35-64 65+ Overall†
77
57
35
21
7
33 41 36
47
33
13
37
59
47 41
27
10
35
0-4 5-14 15-34 35-64 65+ Overall†
11
3
1 2 1
3
6
3 3
6 5 5
8
3 2
4 3 4
0-4 5-14 15-34 35-64 65+ Overall†
77
57
35
21
7
33 41
36 47
33
13
37
59
47 41
27
10
35
0-4 5-14 15-34 35-64 65+ Overall†
Hospitalization Rates by Age Group Per 10,000 people
ED Visit Rates by Age Group Per 10,000 people
Hospitalization Rates by Age Group Per 10,000 people
ED Visit Rates by Age Group Per 10,000 people
Asthma in Wisconsin 2017 11
Asthma Hospitalization Rates by Race and Ethnicity
In Wisconsin, we see the highest asthma hospitalization rates among non-Hispanic African Americans. This
is a disparity that only seems to be getting worse.
Rates per 10,000 people
0
5
10
15
20
25
30
35
40
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
ICD-9 to ICD-10
Transition
African American
American Indian
Hispanic
Asian White
Asthma in Wisconsin 2017 12
Asthma ED Visit Rates by Wisconsin County, 2015–2017
Certain areas of the state are affected by higher asthma prevalence and rates of asthma health care
utilization. This county-level map shows the rates of asthma ED visit rates during 2015–2017. The darkest
shaded counties had rates that were among the highest in the state.
Milwaukee County and Menominee County, which is primarily composed of members of the Menominee
Tribe, rank at the top for both asthma hospitalizations and ED visits. In addition, Kenosha, Racine, and Rock
counties have had consistently high rates over the past decade.
Overall State Rate:
36.3 per10,000 Population
Asthma in Wisconsin 2017 13
ASTHMA MORTALITY
Age-adjusted mortality rates have declined over the past two decades from 88 to 59 deaths. However,
there are still approximately 70 deaths each year in Wisconsin for which asthma was the underlying cause.
African Americans are almost three times more likely to die from asthma than whites.
Asthma Mortality Rates, Wisconsin, 2000–2017
Rates per 1,000,000 people
0
5
10
15
20
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
African Americans are almost three times more
likely to die from asthma than whites
WISCONSIN ASTHMA PROGRAM
Division of Public Health
Wisconsin Department of Health Services
dhs.wisconsin.gov/asthma | P-02412 (10/2018)
Data Sources: Wisconsin BRFSS Core and BRFSS Asthma Call-Back Surveys
(prevalence); Wisconsin Inpatient and Emergency Department Visit files
(health care utilization); Wisconsin Vital Records (mortality)
Citation: Asthma in Wisconsin 2017. Wisconsin Department of Health
Services, Division of Public Health, Wisconsin Asthma Program.