TRENDS IN CHILDHOOD ASTHMA: PREVALENCE, HEALTH CARE UTILIZATION, AND MORTALITY

Mark H. Moss

Akinbami LJ, Schoendorf KC. Pediatrics. 2002;110:315–322

Purpose of the Study.

The burden of asthma is larger for pediatric patients than for the rest of the population. The study objective was to assess changes in the burden of asthma among US children by providing a comprehensive description of trends in childhood asthma prevalence, health care utilization, and mortality using national data.

Study Population.

Data from the National Center for Health Statistics included children with asthma 0 to 17 years old from 1980 to the most recent year data were available.

Methods.

Asthma demographic data from the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the Mortality Component of the National Vital Statistics Survey were used to describe trends in childhood asthma. Children were stratified by age group (0–4 years, 5–10 years, and 11–17 years) and by race/ethnicity when possible.

Results.

Childhood asthma prevalence increased from 3.6% to 6.2% (average increase of 4.3% per year) from 1980–1996. A peak prevalence of 7.5% occurred in 1995. The largest increase in prevalence (and associated greater health care use) was in the 0 to 4-year-old age group. Asthma prevalence comparing non-Hispanic blacks and non-Hispanic whites showed a higher prevalence for non-Hispanic blacks by 15% in 1980–1981 and 29% in 1995–1996. Asthma attack prevalence was 5.4% in 1996 and remained plateaued from 1997–2000. Comparison to years before 1997 are precluded by changes in the NHIS design. Asthma office visits grew 3.8% per year from 1989–1999 and hospitalization rates increased 1.4% per year from 1980–1998. Deaths from asthma increased by 3.4% per year from 1980–1998. The greatest mortality occurred in adolescents. Black children were >3 times as likely to be hospitalized and in 1997–1998 were >4 times as likely to die from asthma compared with white children throughout the study.

Conclusions.

The increasing burden in childhood asthma may finally be plateauing. The disparities between black children compared with white children remains quite significant for asthma health care utilization and mortality.

Reviewer’s Comments.

Could the dramatic and concerning increases in childhood asthma seen over the last 2 decades finally be leveling off? Despite this suggested trend, asthma remains the most common chronic disease of childhood. The 1997 redesign of the NHIS makes following asthma trends somewhat difficult but does emphasize the importance of tracking changes in future years. Perhaps most concerning is the continued increase in hospitalizations and racial disparities. Continuing research efforts are being supported to determine the multifactorial causes of asthma inception in a variety of specific populations including inner-city children and high-risk atopic children.

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