Population-based trends in asthma in British Columbia: an evolving research agenda
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1 Population-based trends in asthma in British Columbia: an evolving research agenda McLeod C, Boygo T, Demers P, Edeer D, Hertzman C, Kennedy S, Koehoorn M, McGrail K, Tamburic T UW/UBC 19 th Annual Occupational and Environmental Health Conference Semiahmoo WA January 9, 2007
2 Asthma prevalence (%) by province for males, females, and both sexes, for population aged 15-64, 2000/01
3 Asthma in British Columbia Research Questions How much asthma is out there in the preworking age and working age population? How much of this asthma might be workrelated? How does this compare to workers compensated asthma?
4
5 Data and case definition Data Drawn from the medical services payment, hospitalization separation, and workers compensation records for the period of Cases Two or more physician visits in a rolling 12-month window, or one hospitalization or an accepted STD workers compensation claim in any year ICD9 codes: Extrinsic Asthma, Intrinsic Asthma, Unspecified Asthma (493); Red cedar Asthma (495.8)
6 Prevalence and incidence Prevalence Cumulative (once meeting the case definition always considered a prevalent case) Active and inactive (dependent on whether an individual is receiving asthma medical services in a given year) Incidence Restricted to those individuals who had no asthma services in the first five years to minimize the conflating of incidence with finding pre-existing cases
7 Defining work-related asthma Population Attributable Risk (PAR) A measure of the burden of asthma related to occupational exposures Based on a review by the American Thoracic Society of the scientific evidence a PAR of 15% was chosen for this study The overall burden of work-related asthma can be applied by applying the PAR (%) to the overall population burden
8 10-year cumulative asthma prevalence, males and females, by age group, 2000
9 Three-year inactive prevalence and asthma activity in current year, males and females aged 0-14 and 15-64, 2000
10 Active asthma in current year per 1,000 population, males and females, by age group,
11 Incidence per 1,000 children (0-14), males and females, by age group,
12 Incidence per 1,000 working-age adults (15-64), males and females, by age group,
13 Comparison of workers - compensated asthma claims to individuals with work-related asthma, 2001
14 Comparison of workers - compensated asthma claims to individuals with active work-related asthma, 2000
15 Strengths and Limitations Strengths Population-based study Epidemiologically consistent measure of incidence and prevalence Limitations Change in treatment over time No drug data or other respiratory codes Selection-bias in continuously registered cohort
16 Policy Relevance Large amount of work-related adult asthma Focus on occupational regulation and prevention Medical costs externalized from employerfinanced WCB health care to taxpayerfinanced public health care system Impact on compensation policy Changes to what is considered compensable
17 Strengths and Limitations Strengths Population-based study Epidemiologically consistent measure of incidence and prevalence Limitations Change in treatment over time No drug data or other respiratory codes Selection-bias in continuously registered cohort
18 Investigating Asthma in British Columbia Workers: A Pilot Project for Occupational Disease Surveillance Using a newly developed industry of employment variable we will examine whether rates of asthma in the work-aged population vary for those employed in industries with a high risk of work-related asthma compared to industries with little or no risk. Apply a standardized methodology to facilitate comparison across admin data and survey data
19 More Information Full report can be downloaded at:
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