Asthma Burden. in the C HILDREN S H EALTH I NSURANCE PROGRAM Population. Asthma Control Program Pennsylvania Asthma Surveillance System

Transcription

1 Asthma Burden in the C HILDREN S H EALTH I NSURANCE PROGRAM Population Asthma Control Program Pennsylvania Asthma Surveillance System

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3 TABLE OF CONTENTS Introduction...1 Methodology...2 Summary...3 Figure 1-1: Annual Inpatient Hospitalization s with Asthma as Primary Discharge Diagnosis by Age Group, PA Figure 1-2: Inpatient Hospitalization s with Asthma as Primary Discharge Diagnosis by Age Group and Health District, PA (Combined Data)...4 Figure 1-3: Inpatient Hospitalization s with Asthma as Primary Discharge Diagnosis by Age Group and Five Counties with Highest s, PA (Combined Data)...5 Figure 1-4: Inpatient Hospitalization s with Asthma as Primary Discharge Diagnosis by Month and Age Group, PA (Combined Data)...5 Figure 1-5: Hospitalization s by Day of Week and Age Group, PA (Combined Data)...6 Figure 2-1: Emergency Room Visit s by Age Group, PA Figure 2-2: Emergency Room Visit s by Age Group, PA Figure 2-3: Emergency Room Visit s by Health District, PA Figure 2-4: Emergency Room Visit s by Health District and Age Group, PA (Combined Data)...8 Figure 2-5: Emergency Room Visit s by Month and Age Group, PA (Combined Data)...8

4 TABLE OF CONTENTS continued Figure 2-6: Emergency Room Visit s by Day of Week and Age Group, PA (Combined Data)...9 Figure 3-1: Percentage of CHIP recipients with Asthma Receiving Appropriate Long-Term Control Medications by Year, PA Figure 3-2: Percentage of CHIP recipients with Asthma Receiving Appropriate Long-Term Control Medications by Health District and Year, PA (Combined Data) Table 1: Annual s, Age-Specific s for ER by Age Group and Health District, PA Table 2: Age-Specific s for ER by Age Group and County, PA (Combined Data) Table 2: (continued) Age-Specific s for ER by Age Group and County, PA (Combined Data) Table 3: Percentage of CHIP Recipients with Asthma Receiving Appropriate Long-Term Control Medications by Age Group and County, PA (Combined Data) Table 3: (continued) Percentage of CHIP recipients with Asthma Receiving Appropriate Long-Term Control Medications by Age Group and County, PA (Combined Data) References...16 Glossary of Terms...17 Acknowledgements...18 Disclaimer...18

5 INTRODUCTION Asthma is a disease of the lungs which causes episodes of wheezing, breathlessness, chest tightness and nighttime or early morning coughing. The disease can be controlled by taking preventive medicine and avoiding the triggers that can cause an attack, such as pollen, dust, animal dander, industrial chemicals, viral infections, changes in the weather, exercise, emotional stress, etc. Since 2003, the Bureau of Health Promotion and Risk Reduction of the Pennsylvania Department of Health (PA DOH) has received funding from the Centers for Disease Control and Prevention (CDC) to address the burden of asthma in Pennsylvania. The first Pennsylvania Asthma Burden Report was published in 2006 and is updated every year to describe the burden of asthma in different areas of Pennsylvania. In 2009, PA DOH successfully competed for and was awarded a five-year cooperative agreement. The 2011 Asthma Burden in CHIP Population report describes the burden of asthma among Pennsylvania children (ages 0-18) in the Children s Health Insurance Program (CHIP) population for This report also provides information about hospitalizations, emergency department visits (ER) and percentage of CHIP members taking appropriate control medications by age group and geographical location. PA CHIP provides health insurance to all uninsured children and teens and provides free, low cost and/or at-cost health insurance coverage for Pennsylvania s uninsured children or adolescent residents up to 19 years of age. This program for children is based on income and family size. Approximately 4.7 percent of the children of Pennsylvania were served by CHIP in 2005; the number increased over 40 percent reaching 6.7 percent in However, the number visits almost doubled for the same time period (1,090 in 2005 vs. 2,170 in 2009), and the number of admissions due to asthma among CHIP enrollees increased almost 1.8 times (194 in 2005 vs. 349 in 2009). The 2011 Asthma Burden in CHIP Population report provides information about people with asthma and the burden of asthma in the CHIP population. In addition, it identifies the scope of the problem, develops specific education and intervention strategies to reduce the number of asthma attacks and hospital admissions due to asthma, as well as focuses educational and other issues to lessen the burden of asthma among CHIP members. The Pennsylvania Asthma Control Program will continue monitoring these indicators in order to facilitate the timely development of targeted, disease-based public health education and other intervention strategies designed to reduce the asthma burden in Pennsylvania.

6 METHODOLOGY Asthma CHIP data by age, gender and geographical area was provided to the Asthma Control Program by the Pennsylvania CHIP. The Pennsylvania Asthma Control Program (ACP) requested asthma emergency department visit information and asthma hospitalization data for all patients with ICD-9 code for Asthma ( ) or with ICD-10 code for Asthma (J45) as the primary discharge diagnosis of asthma. CHIP Contractors were asked to submit the specified member level claim/encounter data for identified enrollees with an asthma inpatient admission and ER department visit. The data used in this report are based on medical claims of Pennsylvania CHIP recipients from Jan. 1, 2005 to Dec. 31, 2009 (five years). For some graphs and tables, data were combined for five years in order to increase the sample size and produce more reliable results. The following criteria were chosen in order to define an asthma claim/encounter: At least one emergency department (ED) visit with asthma as the principal diagnosis (ICD-9 code ) during a specified 12 month period. At least one acute inpatient discharge with asthma as principal diagnosis (ICD-9 code ) during a specified 12 month period. Age group was removed from analysis due to small numbers and the assumption that members of this group are no longer considered to be children. However, children 18 years of age were included in the age group. Emergency room (ER) visit rates and inpatient hospitalization rates with asthma as the primary discharge diagnosis were calculated per 1,000 CHIP enrollees. Inpatient hospitalization and ER visit rates reflect the number of admissions, not the number of patients. Data were analyzed using SAS and Excel, with results presented in PowerPoint. Only Pennsylvania CHIP enrollees who were admitted to Pennsylvania hospitals and emergency rooms were included in this report. Both geographic (e.g., county, health district) and demographic (e.g., age group) subpopulation analyses were conducted to identify disparities. However, due to the small size of some groups, descriptive information was limited, and rates for ER visits and hospitalizations due to asthma were not always available for sparsely populated geographical areas.

7 SUMMARY For the entire five-year period, inpatient hospitalization rates with asthma as the primary discharge diagnosis among CHIP recipients was highest in 2006 and 2009 [Figure 1-1]; the highest ER department visits (11.3 per 1,000) occurred in 2009 [Figure 2-1]. During , inpatient hospitalization rates with asthma as the primary discharge diagnosis and ER department visits rates among ages 0-5 years were higher compared to other age groups, respectively. The lowest rates were among children age [Figure 1-1 and Figure 2-1]. For the entire five-year period, inpatient hospitalization rates with asthma as the primary discharge diagnosis and ER department visit rates were significantly higher in the Southeastern Health District compared to other districts [Figure 1-2 and Figure 2-4]. Among five counties with the highest inpatient hospitalization rates with asthma, during , Philadelphia County had the highest rates of admission, followed by Delaware and then Montgomery counties [Figure 1-3]. In , inpatient hospitalization rates with asthma as the primary discharge diagnosis and ER visit rates with asthma in CHIP-enrolled children were highest in September and October, and the lowest rates for all CHIP-enrolled children were in July. Generally, the percentage of CHIP-enrolled children who received appropriate medications has increased between 2005 and Among health districts, the North Central and Northeastern districts had the highest percentage of children taking long-term control medications. The Southeastern Health District accounts for the lowest rates among all districts. Pennsylvania Asthma Control Program will continue to monitor trends in asthma for the following: Inpatient hospitalization rate ER visits rates Percent receiving appropriate long-term meds

8 Figure 1-1: Annual Inpatient Hospitalization s with Asthma as Primary Discharge Diagnosis by Age Group, PA In , inpatient hospitalization rates for CHIP-enrolled children with asthma as the primary discharge diagnosis were higher among age group 0-5 compared to other age groups. The hospitalization rates for the 0-5 age group decreased from 2005 (3.2 per 1,000) to 2007 (2.2) and increased in 2008 (2.5) and 2009 (2.6). During the five-year period, the rates were significantly lower in age group 13-18, compared to other age groups. The highest rates for all children were in 2006 and 2009 (1.8 per 1,000) and lowest in 2007 (1.3). Figure 1-2: Inpatient Hospitalization s with Asthma as Primary Discharge Diagnosis by Age Group and Health District, PA (Combined Data) Overall, in , among all children s age groups, those aged 0-5 years had a significantly higher hospitalization rate per 1,000, compared to other age groups (2.6 vs. 1.8 in age group 6-12; 0.9 in age group 13-18). In Pennsylvania, the lowest hospitalization rate was among children aged (0.9). The highest rates were in the Southeastern Health District, followed by the North Central Health District. The lowest average rate was among children in the South Central Health District (0.6).

9 Figure 1-3: Inpatient Hospitalization s with Asthma as Primary Discharge Diagnosis by Age Group and Five Counties with Highest s, PA (Combined Data) Overall, in , Allegheny, Bucks, Montgomery, Delaware and Philadelphia counties had the highest hospitalization rates of children among the 67 counties in PA. Philadelphia had the highest rates of admission (8.0 per 1,000 in age group 0-5; 5.5 in age group 6-12; and 2.9 in age group 13-18) compared to other counties. The average rates were highest in Philadelphia County (4.8 per 1,000), followed by Delaware (3.4) and then Montgomery (1.8). Figure 1-4: Inpatient Hospitalization s with Asthma as Primary Discharge Diagnosis by Month and Age Group, PA (Combined Data) In , inpatient hospitalization rates with asthma in children ages 0-12 were highest in October, and among age group in May, as well as between the months of September through November. The lowest rates for all children s age groups were in July. Generally, the peaks of asthma admissions for children were seen in May and between the months of September through November. These seasonal dips and rises were likely due to multiple factors, including varying infection rates and pollen counts throughout the year.

10 Figure 1-5: Hospitalization s by Day of Week and Age Group, PA (Combined Data) In , inpatient hospitalization rates of children with asthma in age group 0-5 were highest on Sundays, Tuesdays and Fridays, and among age groups 6-12 and on Mondays. These daily changes are thought to be due to multiple factors, including so called pre-school age and school age factors, compliance with drug treatment and parents work schedule. Figure 2-1: Emergency Room Visit s by Age Group, PA During the five-year period of 2005 through 2009, the rate of asthma emergency room visits per 1,000 CHIP recipients increased (8.0 in 2005 and 11.3 in 2009). For all years and for all age groups, the rates increased, with the exception of 2007 (in the 0-5 and 6-12 age groups).

11 Figure 2-2: Emergency Room Visit s by Age Group, PA There were some findings in the detailed analysis after data was broken down by the four age groups. There was a significant difference between annual rates for age group 0-1, compared to the other age groups, with an exception for The admission rates in age group 0-1 have been decreasing since 2005 (28.8 per 1,000) to 2009 (16.0). On the other hand, ER visit rates have been increasing in age group 2-5 from 9.3 in 2005 to 12.9 in Figure 2-3: Emergency Room Visit s by Health District, PA During , the Southeastern Health District had the highest hospitalization rates, compared to other Health Districts. Generally, rates increased in all Health Districts through the analyzed time period, with the exception of the Northwestern Health District, in which they actually decreased to 6.8 per 1,000 in 2009, compared to 7.9 in 2005.

12 Figure 2-4: Emergency Room Visit s by Health District and Age Group, PA (Combined Data) Overall, during , the highest ER visit rates were in the Southeastern Health District (11.6 per 1,000), followed by the Northeastern Health District (9.7) and then the Southwestern Health District (9.4). The lowest rate among children was in the South Central Health District (6.7). Children aged 0-5 years in the Southeastern Health District had a significantly higher hospitalization rate, compared to other age groups (15.7 vs in age group 6-12; 8.8 in age group 13-18). In Pennsylvania, the highest hospitalization rate was among children aged 0-5 (11.6), followed by age group 6-12 (10.3) and age group with 8.2. Figure 2-5: Emergency Room Visit s by Month and Age Group, PA (Combined Data) In , ER visit rates with asthma in children ages 0-5 were highest in September through December (1.3 per 1,000). Among age group 6-12, the highest rates were in May (1.0), September (1.1) and October (1.1). The same monthly trend was observed in age group 13-18, with a rate of 0.9 for each of the same three months. The lowest rates for all children s age groups were in July. It is thought that these trends are due to multiple factors, including influenza, vaccinations, common colds and allergy seasons.

13 Figure 2-6: Emergency Room Visit s by Day of Week and Age Group, PA (Combined Data) In , ER visit rates with asthma in ages 0-5 were highest on Sundays (1.9 per 1,000) and on Sundays and Mondays (both 1.7 per 1,000) among children ages In age group 13-18, the rate was highest on Mondays (1.3). The lowest rate by day of the week was on Friday for age groups 6-12 (1.0 per 1,000) and (0.7). Among the age group 0-5, the day of the week with the lowest ER visit rate due to asthma was a tie for Wednesday, Thursday and Friday at 1.3 per 1,000. It is believed that these daily changes were due to multiple factors, including so called pre-school age and school age factors, compliance with drug treatment and parents work schedules. Figure 3-1: Percentage of CHIP recipients with Asthma Receiving Appropriate Long-Term Control Medications by Year, PA During , the percentage of children who received appropriate long-term control medications has increased significantly in age group 0-5 from 68.3 percent in 2005 to 90.0 percent in Age groups 6-12 and also displayed an increase in the percentage of children receiving appropriate medications during 2005 through 2008, and then they declined in 2009.

14 Figure 3-2: Percentage of CHIP recipients with Asthma Receiving Appropriate Long-Term Control Medications by Health District and Year, PA (Combined Data) 10 During , the percentage of Pennsylvania children who received appropriate medications was the highest (92 percent) among the age group 6-12, and the lowest was observed for age group 0-5 (80 percent). Among health districts, the North Central and Northeastern districts had the highest percentage of children taking long-term control medications. The Southeastern district accounts for the lowest rates among all age groups.

15 Table 1: Annual s, Age-Specific s for ER by Age Group and Health District, PA HEALTH DISTRICT YEAR AGE. GROUP Southwestern South Central Southeastern Northwestern North Central Northeastern N/D N/D N/D N/D N/D N/D ,0 N/D=Not displayed if count <10

16 Table 2: Age-Specific s for ER by Age Group and County, PA (Combined Data) AGE GROUP AVERAGE/TOTAL COUNTY Adams Allegheny * Armstrong N/D N/D Beaver N/D N/D Bedford N/D N/D N/D N/D N/D N/D Berks Blair Bradford Bucks Butler Cambria N/D N/D Cameron N/D N/D N/D N/D N/D N/D N/D N/D Carbon N/D N/D * Centre N/D N/D 14 6, Chester Clarion N/D N/D N/D N/D N/D N/D Clearfield * Clinton N/D N/D N/D N/D N/D N/D Columbia N/D N/D Crawford N/D N/D Cumberland Dauphin , Delaware * Elk N/D N/D N/D N/D Erie Fayette * Forest N/D N/D N/D N/D N/D N/D N/D N/D Franklin N/D N/D Fulton N/D N/D N/D N/D N/D N/D N/D N/D Green N/D N/D N/D N/D N/D N/D Huntingdon N/D N/D N/D N/D N/D N/D Indana * Jefferson N/D N/D N/D N/D N/D N/D Juniata N/D N/D N/D N/D N/D=Not displayed if count <10

17 Table 2: (continued) Age-Specific s for ER by Age Group and County, PA (Combined Data) COUNTY AGE GROUP AVERAGE/TOTAL Lackawanna N/D N/D Lancaster Lawrence N/D N/D Lebanon * Lehigh * Luzerne Lycoming McKean N/D N/D N/D N/D Mercer N/D N/D Mifflin N/D N/D Monroe * Montgomery Montour N/D N/D N/D N/D N/D N/D N/D N/D Northampton * Northumberland * Perry N/D N/D N/D N/D N/D N/D N/D N/D Philadelphia , , * Pike N/D N/D * Potter N/D N/D N/D N/D N/D N/D N/D N/D Schuylkill Snyder N/D N/D N/D N/D N/D N/D N/D N/D Somerset N/D N/D Sullivan N/D N/D N/D N/D N/D N/D N/D N/D Susquehanna N/D N/D N/D N/D N/D N/D Tioga N/D N/D N/D N/D N/D N/D Union N/D N/D N/D N/D Venango N/D N/D N/D N/D Warren N/D N/D N/D N/D N/D N/D N/D N/D Washington Wayne N/D N/D N/D N/D N/D N/D Westmoreland Wyoming N/D N/D N/D N/D N/D N/D N/D N/D York PA AVERAGE 1, , , , N/D=Not displayed if count <10

18 Table 3: Percentage of CHIP Recipients with Asthma Receiving Appropriate Long-Term Control Medications by Age Group and County, PA (Combined Data) COUNTY AGE GROUP AVERAGE/TOTAL of People Percent (%) of People Percent (%) of People Percent (%) of People Percent (%) Adams N/D N/D Allegheny Armstrong N/D N/D Beaver N/D N/D Bedford N/D N/D Berks N/D N/D Blair N/D N/D Bradford N/D N/D Bucks Butler N/D N/D Cambria N/D N/D Cameron N/D N/D N/D N/D N/D N/D N/D N/D Carbon N/D N/D Centre N/D N/D Chester Clarion N/D N/D Clearfield N/D N/D Clinton N/D N/D N/D N/D Columbia N/D N/D Crawford N/D N/D Cumberland N/D N/D Dauphin N/D N/D Delaware Elk N/D N/D Erie N/D N/D Fayette N/D N/D Forest N/D N/D N/D N/D N/D N/D N/D N/D Franklin N/D N/D Fulton N/D N/D N/D N/D N/D N/D N/D N/D Green N/D N/D N/D N/D Huntingdon N/D N/D Indana N/D N/D Jefferson N/D N/D Juniata N/D N/D N/D=Not displayed if count <10

19 Table 3: (continued) Percentage of CHIP recipients with Asthma Receiving Appropriate Long-Term Control Medications by Age Group and County, PA (Combined Data) COUNTY AGE GROUP AVERAGE/TOTAL Data Source: York Child Health 31 Insurance Program 5.6 (CHIP) N/D=Not PA AVERAGE displayed if count , , , Lackawanna Lancaster Lawrence N/D N/D Lebanon N/D N/D Lehigh Luzerne N/D N/D Lycoming N/D N/D McKean N/D N/D Mercer N/D N/D Mifflin N/D N/D Monroe N/D N/D Montgomery Montour N/D N/D N/D N/D N/D N/D N/D N/D Northampton Northumberland N/D N/D Perry N/D N/D N/D N/D Philadelphia , , Pike N/D N/D Potter N/D N/D N/D N/D N/D N/D N/D N/D Schuylkill Snyder N/D N/D Somerset N/D N/D Sullivan N/D N/D N/D N/D N/D N/D N/D N/D Susquehanna N/D N/D Tioga N/D N/D N/D N/D Union N/D N/D N/D N/D Venango N/D N/D Warren N/D N/D Washington Wayne N/D N/D Westmoreland Wyoming N/D N/D N/D N/D N/D N/D N/D N/D 15 N/D=Not displayed if count <10

20 REFERENCES: 1. Children s Health Insurance Program (CHIP) 2. The Pennsylvania State Data Center (PaSDC) 3. CDC National Center for Health Statistics, Asthma Data and Surveillance National Surveillance for Asthma. United States The 2009 Pennsylvania Asthma Burden Report. 16

21 GLOSSARY OF TERMS: Age-Adjusted : A rate calculated in a manner that allows areas with different age structures to be compared. s are standardized to a control population; in this report, the 2000 U.S. Standard Million Population was used. Confidence Interval (CI): It is common practice among health data users to calculate a standard error of a rate when studying or comparing rates. This statistic defines a rate s variability and can be used to calculate a confidence interval (CI) to determine the actual variance of a rate 95 percent of the time. Emergency Room (ER) Visit : Asthma ER visit rate reflects the number of visits (not the number of patients) per 1,000 CHIP recipients. s were calculated by dividing the number of visits (state, health district, county) by the total number of CHIP recipients for the specified time period. Hospitalization : Inpatient hospitalization rate with asthma as the primary discharge diagnosis reflects the number of admissions (not the number of patients) per 1,000 CHIP recipients. s were calculated by dividing the number of admissions (state, health district, county) by the total number of CHIP recipients for the specified time period. Statistically Significant: In this report, a P-value<0.05 was considered statistically significant. Surveillance: The ongoing systematic collection, analysis and interpretation of health-related data essential to the planning, implementation and evaluation of public health practice. 17

22 ACKNOWLEDGMENTS: This report was prepared by staff of the Asthma Control Program, Bureau of Health Promotion and Risk Reduction, Pennsylvania Department of Health. The Pennsylvania Asthma Control Program extends our appreciation to all members and organizations for their assistance in providing access to asthma data and in reviewing and making recommendations for the publication of Asthma Burden in the Medicaid Population. Centers for Disease Control and Prevention (CDC). Children s Health Insurance Program (CHIP). Pennsylvania Department of Health, Bureau of Health Statistics and Research. Pennsylvania Department of Health, Bureau of Health Promotion and Risk Reduction. Pennsylvania Department of Health, Bureau of Epidemiology For more information regarding data analysis and report compilation, please contact the author of the report: Vadim Drobin, M.D., M.P.H., Asthma Epidemiologist. Pennsylvania Department of Health, Bureau of Epidemiology. Health and Welfare Building, 7th and Forster Streets, Harrisburg, PA Phone: (717) vdrobin@state.pa.us The Asthma Burden in the CHIP Population can be downloaded from the Pennsylvania DOH website: 18 Disclaimer: This report was supported by Cooperative Agreement 5U59EH Addressing Asthma from a Public Health Perspective from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. The Pennsylvania Department of Health (PA DOH) specifically disclaims responsibility for any analyses, interpretations or conclusions made by the user of this report.

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