Focus Area 24 Respiratory Diseases Progress Review

1. Focus Area 24Respiratory DiseasesProgress Review Edward J. SondikNational Center for Health Statistics May 22, 2008

2. Respiratory Diseases Asthma Facts • Prevalence (2006) • Children -- 9.4% • Adults -- 7.3% • Asthma was responsible for (2005): • 12,823,000 physician office visits • 1,770,000 emergency department visits • 489,000 hospitalizations • 3,884 deaths Chronic Obstructive Pulmonary Disease (COPD) Facts • COPD is under-diagnosed • Diagnosed prevalence -- 12 million U.S. adults (2006) • NHANES III data estimated that 24 million U.S. adults had evidence of impaired lung function (1988-94) • COPD was responsible for (2006): • 17,528,000 physician and hospital outpatient visits • 1,998,000 emergency department visits • 661,000 hospitalizations • Fourth leading cause of death -- 122,000 deaths (2004)

3. Target met Improving Little or no change* Getting worse Baseline only Highlighted Objectives Asthma 24-1 a-e Deaths from asthma 24-2 a-c Hospitalizations for asthma 24-3 a-c Hospital emergency department visits for asthma 24-6 Patient education—among persons with asthma 24-7 a-f Appropriate asthma care Chronic Obstructive Pulmonary Disease 24-10 Deaths from chronic obstructive pulmonary disease *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant.

4. Asthma Mortality Decreasedesired Death rate per million population 2010 Targets 1999 2005 Under 5 years 5-14 years 15-34 years 35-64 years 65 years and over I = 95% confidence interval. Note: Data are for ICD-10 codes J45-J46. SOURCE: National Vital Statistics System, CDC, NCHS. Obj. 24-1 a-e

5. Asthma Mortality, Adults 65 Years and Over Decrease desired Death rate per million population 120 Hispanic Black 80 Asian White 40 2010 Target: 47.0 0 1999 2000 2001 2002 2003 2004 2005 Note: Data are for ICD-10 codes J45-J46. The categories black and white exclude persons of Hispanic origin. Asian includes other Pacific Islander. Persons of Hispanic origin may be any race. Only one race could be recorded prior to 2003. For 2003 and later years, one or more races could be recorded. Data by single race categories are for persons for whom only one racial group was recorded. SOURCE: National Vital Statistics System, CDC, NCHS Obj. 24-1 e

6. Asthma Hospitalizations Decrease desired Hospitalizations per 10,000 population 2010 Targets 1998 2006 Asthma Hospitalizations, 2006 Under 5 years 5-64 years 65 years and over I = 95% confidence interval.Note: Hospital discharges with a principal diagnosis of asthma (ICD-9-CM code 493). Data for 24-2 b & c are age adjusted to the 2000 standard population. SOURCE: National Hospital Discharge Survey, CDC, NCHS Obj. 24-2 a-c

7. Asthma Hospitalizations, Children Under 5 Years Decrease desired Hospitalizations per 10,000 population 1998 2006 2010 Target: 25.0 Total Black White Male Female I = 95% confidence interval. Note: Hospital discharges with a principal diagnosis of asthma (ICD-9-CM code 493). The race categories black and white include persons of Hispanic or non-Hispanic origin. Only one race category could be recorded prior to 1999. For 1999 and later years, one or more races could be recorded. The categories black and white include persons for whom only one racial group was recorded. SOURCE: National Hospital Discharge Survey, CDC, NCHS Obj. 24-2 a

8. Asthma Hospitalizations, Adults 65 Years and Over Decrease desired Hospitalizations per 10,000 population 1998 2006 2010 Target: 11.0 Total Black White Male Female I = 95% confidence interval.Note: Hospital discharges with a principal diagnosis of asthma (ICD-9-CM code 493). Data are age adjusted to the 2000 standard population. The race categories black and white include persons of Hispanic or non-Hispanic origin. Only one race category could be recorded prior to 1999. For 1999 and later years, one or more races could be recorded. The categories black and white include persons for whom only one racial group was recorded. SOURCE: National Hospital Discharge Survey, CDC, NCHS Obj. 24-2 c

9. Asthma Emergency Department Visits Decrease desired 2010 Targets 1995-97 2004-06 Visits per 10,000 population Under 5 years 5-64 years 65 years and over I = 95% confidence interval.Note: Visits to an emergency department with a first-listed diagnosis of asthma (ICD-9-CM code 493). SOURCE: National Hospital Ambulatory Medical Care Survey, CDC, NCHS Obj. 24-3 a-c

10. Asthma Emergency Department Visits, Ages 5-64 years Decrease desired 1995-97 2004-06 Visits per 10,000 population 2010 Target: 50.0 Black Male Total Female White I = 95% confidence interval.Note: Visits to an emergency department with a first-listed diagnosis of asthma (ICD-9-CM code 493).The race categories black and white include persons of Hispanic or non-Hispanic origin. Only one race category could be recorded prior to 1999. For 1999 and later years, one or more races could be recorded. The categories black and white include persons for whom only one racial group was recorded. SOURCE: National Hospital Ambulatory Medical Care Survey, CDC, NCHS Obj. 24-3 b

11. Asthma Patient Education *Have you ever taken a course or class on how to manage your asthma yourself? Increase desired 1998 2003 Percent 2010 Target: 30.0 Total Poor Near Poor Middle/ High Income I = 95% confidence interval. Note: Data are for persons aged 18 years and older. Data are age adjusted to the 2000 standard population. Poor is below the Federal poverty level. Near poor is 100-199% of the Federal poverty level. Middle/high income is 200% or more of the Federal poverty level. SOURCE: National Health Interview Survey, CDC, NCHS Obj. 24-6

12. Appropriate Asthma Care, 2003 2010 Targets Increase desired Proper-use instructions with prescribed inhalers (24-7b) Preventive medication regimens* (24-7d) Long term management care after hospitalization due to asthma (24-7e) Education on early signs, symptoms, and responses to asthma episodes (24-7c) Advice to reduce exposure to environmental risk factors** (24-7f) 2002 Written asthma plan from health care provider (24-7a) 2002 Percent I = 95% confidence interval. *People who take medicine everyday to protect their lungs and keep them from having attacks (includes both oral medicine and inhalers and NOT inhalers for quick relief). **Persons who report having been advised to change things at home, school, or work to improve their asthma. Note: Data are age adjusted to the 2000 standard population. SOURCE: National Health Interview Survey, CDC, NCHS Obj. 24-7 a-f

13. Advice to Reduce Exposure to Environmental Risk Factors* 2010 Target: 50 2002 2003 Increase desired Total White Black Hispanic Female Male Poor Near poor Middle/ High Percent I = 95% confidence interval.*Persons who report having been advised to change things at home, school, or work to improve their asthma. Note: Data are age adjusted to the 2000 standard population. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. Poor is below the Federal poverty level. Near poor is 100-199% of the Federal poverty level. Middle/high income is 200% or more of the Federal poverty level. SOURCE: National Health Interview Survey, CDC, NCHS Obj. 24-7 f

14. COPD Mortality Rate per 100,000 population Percent Decrease desired Current Cigarette Smoking, Adults 18 Years and Over COPD Mortality, Adults 45 Years and Over Male Male Female Female 2010 Target: 62.3 Note: COPD data are for ICD-10 codes J40-J44. Current smokers are those who ever smoked 100 cigarettes in lifetime and now smoke everyday or some days. Data are age adjusted to the 2000 standard population. SOURCE: National Vital Statistics Survey, CDC, NCHS Obj. 24-10

15. COPD Mortality, Adults 45 Years and Over Decrease desired Death rate per 100,000 population 1999 2005 2010 Target: 62.3 American Indian Total White Black Hispanic Asian I = 95% confidence interval. Note: Data are for ICD-10 codes J40-J44. Data are age adjusted to the 2000 standard population. American Indian includes Alaska Native. Asian includes other Pacific Islander. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Only one race could be recorded prior to 2003. For 2003 and later years, one or more races could be recorded. Data by single race categories are for persons for whom only one racial group was recorded. SOURCE: National Vital Statistics Survey, CDC, NCHS Obj. 24-10

16. Chronic Obstructive Pulmonary Disease Death Rates, 2003-2005 2010 Target: 62.3 Rates per 100,000 population Rates are unreliable 46.7 – 104.6 137.7 – 157.3 123.8 – 137.6 157.4 – 250.9 104.7 – 123.7 Note: Data are for ICD-10 codes J40-J44. Data are for ages 45 year and older and are age-adjusted to the 2000 standard population.Legend represents quintiles of the rates. Rates are calculated by health service area.Rates are per 100,000 population. SOURCE: National Vital Statistics System—Mortality, CDC, NCHS. Obj. 24-10

17. Chronic Obstructive Pulmonary Disease Death Rates, 2003-2005 2010 Target: 62.3 Rates per 100,000 population Rates are unreliable 46.7 – 104.6 137.7 – 157.3 123.8 – 137.6 157.4 – 250.9 104.7 – 123.7 Note: Data are for ICD-10 codes J40-J44. Data are for ages 45 year and older and are age-adjusted to the 2000 standard population.Legend represents quintiles of the rates. Rates are calculated by health service area.Rates are per 100,000 population. SOURCE: National Vital Statistics System—Mortality, CDC, NCHS. Obj. 24-10

18. Adults With Sleep Apnea Symptoms†who Seek Medical Care, 2005-2006 Told doctor have trouble sleeping‡ Total Female Adults, 20 years and over Male 20-39 years with symptoms† (31.3%) 40-59 years 60 + years Percent I = 95% confidence interval. † People who (snore 5 or more nights per week) OR (snort, gasp, or stop breathing 5 or more nights per week) OR (feel excessively sleepy during the day 16-30 times per month AND usually sleep 7 or more hours per night). ‡ People who have ever told a doctor or other health professional that they have trouble sleeping. Note: Data are for adults ages 20 years and over. Data are age adjusted to the 2000 standard population. SOURCE: National Health and Nutrition Examination Survey, CDC, NCHS

19. Adults With Sleep Apnea Symptoms†who Seek Medical Care, 2005-2006 Told doctor have trouble sleeping‡ Diagnosed Sleep Apnea Total Female Male 20-39 years 40-59 years 60 + years Percent I = 95% confidence interval. † People who (snore 5 or more nights per week) OR (snort, gasp, or stop breathing 5 or more nights per week) OR (feel excessively sleepy during the day 16-30 times per month AND usually sleep 7 or more hours per night). ‡ People who have ever told a doctor or other health professional that they have trouble sleeping. Note: Data are for adults ages 20 years and over. Data are age adjusted to the 2000 standard population. SOURCE: National Health and Nutrition Examination Survey, CDC, NCHS

20. No data Target met Improving Little or no change* Getting worse Baseline only Progress Toward 2010 Targets Asthma 24-1 a-e Deaths from asthma 24-2 a-c Hospitalizations for asthma 24-3 a-c Hospital emergency department visits for asthma 24-4 Activity limitations—among persons with asthma 24-5 School or work days lost—among persons with asthma, due to asthma 24-6 Patient education—among persons with asthma 24-7 a-f Appropriate asthma care 24-8 State-based asthma surveillance systems Chronic Obstructive Pulmonary Disease 24-9 Activity limitations due to chronic lung and breathing problems 24-10 Deaths from chronic obstructive pulmonary disease Sleep Problems 24-11 a, b Medical management of persons with symptoms of obstructive sleep apnea 24-12 Motor vehicle crash deaths caused by excessive sleepiness *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant.

21. Summary • Most objectives are either moving towards or show little or no change with respect to their Healthy People 2010 targets • Asthma mortality has decreased for most age groups (16.6% decrease in number of deaths from 1999 to 2005) • Asthma hospitalizations for older adults in 65+ age group have increased • Asthma emergency department visits have changed very little • COPD mortality for ages 45+ has decreased (4.1% decrease in age adjusted rates 1999 to 2005) • American Indian or Alaska Native: 14.2% decrease • Hispanic: 14.7% decrease • Asian or Pacific Islander: 19.7% decrease

22. Acknowledgements • Lesley Agress • Health Statistician • CDC/National Center for Health Statistics • LKA7@cdc.gov • Contributors: • Christopher Barrett, HHS/ODPHP • Thomas Croxton, NIH/NHLBI • Ellis Davis, HHS/ODPHP • Rob Fulwood, NIH/ NHLBI • Paul Garbe, CDC/NCEH • Peter Gergen, NIH/NIAID • Jeanette Guyton-Krishnan, NIH/NHLBI • Elizabeth Jackson, CDC/NCHS • Bill Jirles, NIH/NIEHS • Jeanne Moorman, CDC/NCEH • Zakia Nelson, CDC/NCHS • Jeff Pearcy, CDC/NCHS • Daniel Rotrosen, NIH/NIAID • Diana Schmidt, NIH/NHLBI • Virginia Taggart, NIH/NHLBI

23. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm