2012 Asthma Summit Greenville SC, Aug. 9, 2012

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1 Burden of In South Carolina 2012 Asthma Summit Greenville SC, Aug. 9, 2012 Khosrow Heidari, M.A., M.S., M.S. State Chronic Disease Epidemiologist Director of Chronic Disease Epidemiology & Evaluation, Bureau of Community Health and Chronic Disease Prevention

2 Mortality Rate due to Asthma (Age Adjusted per 100,000 Population) Black Other SC Total White Source: DHEC SCAN

3 Number of Asthma Deaths White Black Other Source: DHEC SCAN

4 Rate per 10,000 population Figure 24-2a.2. Rate of hospitalizations for asthma: children under age 5 years by Race, SC, White Black Other HP Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

5 Rate per 10,000 population Figure 24-2b.2. Rate of hospitalization for asthma in children and adults (5-64) by Race, SC, White Black Other HP Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

6 Rate per 10,000 population Figure 24-2c.2. Rate of hospitalizations for asthma: adults age 65 years and older SC, White Black Other HP

7 Rate per 10,000 population Figure 24-3a.2. Rate of emergency room visits: children under age 5 years SC, White Black Other HP Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

8 Rate per 10,000 population 120 Figure 24-3b.2. Rate of emergency room visits due to asthma for children and adults (5-64) SC, White Black Other HP Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

9 Rate per 10,000 population Figure 24-3c.2. Rate of emergency room visits: adults age 65 years or older by Race, SC, White Black Other HP Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

10 Age-adjusted rate per 100, Figure Rate of deaths from COPD among adults 45 and Older by Race, SC, White Black HP Data source: DHEC Biostatistics Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

11 Morbidity

12 SC 2011 Percent Distribution of Asthma Related ED & Hospitalization Charges of Pediatric Patients Total Charges $30.1 Million Medicaid 59.8% Medicare 0.1% Data source: Hospital Discharge Database, ORS Self Pay 7.1% HMO 3.7% Other Gov. (Champus, State, County) 2.8% Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC Commercial Ins. 25.5% Indigent/ Charitable Organization 0.9%

13 SC 2011 Percent Distribution of Asthma Related ED & Hospitalization Charges of Adult Patients Total Charges $117.6 Million Medicare 39.6% Medicaid 12.9% Self Pay 15.0% Commercial Ins. 23.5% HMO 3.3% Data source: Hospital Discharge Database, ORS Other Gov. (Champus, State, County) 1.2% Indigent/ Charitable Organization 4.3% Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC Worker s Compensation 0.2%

14 < Number of Visits Asthma Hospital & ER Visits* by Age and Gender, South Carolina, Male Female

15 Asthma ED Visit Rates (3-Yr Av.) Oconee Greenville Cherokee York Pickens Spartanburg Union Chester Lancaster Marlboro Anderson Chesterfield Laurens Fairfield Kershaw Dillon Abbeville Newberry Darlington Lee Marion Greenwood Saluda Richland Florence McCormick Lexington Sumter Horry Edgefield Aiken Calhoun Clarendon Williamsburg Georgetown Orangeburg Rate per 10,000 population Barnwell Bamberg Allendale Hampton Jasper Berkeley Dorchester Colleton Charleston Beaufort Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

16 Asthma ED + Hospital Visit Rates (3-Yr Av.) Oconee Greenville Cherokee York Pickens Spartanburg Union Chester Lancaster Marlboro Anderson Chesterfield Laurens Fairfield Kershaw Dillon Abbeville Newberry Darlington Lee Marion Greenwood Saluda Richland Florence McCormick Lexington Sumter Horry Edgefield Aiken Calhoun Clarendon Williamsburg Georgetown Orangeburg Rate per 10,000 population Barnwell Bamberg Allendale Hampton Jasper Berkeley Dorchester Colleton Charleston Beaufort Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

17 Relative Risk of Asthma Morbidity: African American to White ED Average rate White African Rate- American Ratio Union McCormick

18 Asthma ED Visit Rate/ Ratio (AA/W) Oconee Greenville Cherokee York Pickens Spartanburg Union Chester Lancaster Marlboro Anderson Chesterfield Laurens Fairfield Kershaw Dillon Abbeville Newberry Darlington Lee Marion Greenwood Saluda Richland Florence McCormick Lexington Sumter Horry Edgefield Aiken Calhoun Clarendon Williamsburg Georgetown Orangeburg Rate Ratio Barnwell Bamberg Allendale Hampton Jasper Berkeley Dorchester Colleton Charleston Beaufort 4+ Correlation Between and Rate Ratio is 0.94 Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

19 Asthma Hospitalization Rate/ Ratio (AA/W) Oconee Greenville Cherokee York Pickens Spartanburg Union Chester Lancaster Marlboro Anderson Chesterfield Laurens Fairfield Kershaw Dillon Abbeville Newberry Darlington Lee Marion Greenwood Saluda Richland Florence McCormick Lexington Sumter Horry Edgefield Aiken Calhoun Clarendon Williamsburg Georgetown Orangeburg Rate Ratio Barnwell Bamberg Allendale Hampton Jasper Berkeley Dorchester Colleton Charleston Beaufort 4+ Correlation Between and Rate Ratio is 0.78 Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

20 Asthma ED & IP Visit Rate/ Ratio (AA/W) Oconee Greenville Cherokee York Pickens Spartanburg Union Chester Lancaster Marlboro Anderson Chesterfield Laurens Fairfield Kershaw Dillon Abbeville Newberry Darlington Lee Marion Greenwood Saluda Richland Florence McCormick Lexington Sumter Horry Edgefield Aiken Calhoun Clarendon Williamsburg Georgetown Orangeburg Rate Ratio Barnwell Bamberg Allendale Hampton Jasper Berkeley Dorchester Colleton Charleston Beaufort 4+ Correlation Between and Rate Ratio is 0.95 Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

21 Leading Causes of Hospitalization, Children Under 18, South Carolina, 2010 Asthma & Bronchitis 3,338 Pneumonia & Pleurisy 1,961 Perinatal Digestive Disorders Nutritional Disorders Cellulitis Otitis Media & Uri Seizures 1,364 1,118 1, Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

22 Relative Risk of Asthma Morbidity: African American to White Rate-Ratio Among 0-19 Year Old

23 Asthma ED Visit Rate/ Ratio (AA/W) Oconee 0-19 Year Old Greenville Cherokee York Pickens Spartanburg Union Chester Lancaster Marlboro Anderson Chesterfield Laurens Fairfield Kershaw Dillon Abbeville Newberry Darlington Lee Marion Greenwood Saluda Richland Florence McCormick Lexington Sumter Horry Edgefield Aiken Calhoun Clarendon Williamsburg Georgetown Orangeburg Rate Ratio Barnwell Allendale Bamberg Hampton Jasper Colleton Dorchester Beaufort Charleston Berkeley 4+ Correlation Between and Rate Ratio is 0.81 Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

24 Asthma Hospitalization Rate/ Ratio (AA/W) Oconee 0-19 Year Old Greenville Cherokee York Pickens Spartanburg Union Chester Lancaster Marlboro Anderson Chesterfield Laurens Fairfield Kershaw Dillon Abbeville Newberry Darlington Lee Marion Greenwood Saluda Richland Florence McCormick Lexington Sumter Horry Edgefield Aiken Calhoun Clarendon Williamsburg Georgetown Orangeburg Rate Ratio Barnwell Bamberg Allendale Hampton Jasper Berkeley Dorchester Colleton Charleston Beaufort 4+ Correlation Between and Rate Ratio is 0.88 Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

25 Asthma ED & IP Visit Rate/ Ratio (AA/W) Oconee 0-19 Year Old Greenville Cherokee York Pickens Spartanburg Union Chester Lancaster Marlboro Anderson Chesterfield Laurens Fairfield Kershaw Dillon Abbeville Newberry Darlington Lee Marion Greenwood Saluda Richland Florence McCormick Lexington Sumter Horry Edgefield Aiken Calhoun Clarendon Williamsburg Georgetown Orangeburg Rate Ratio Barnwell Bamberg Allendale Hampton Jasper Berkeley Dorchester Colleton Charleston Beaufort 4+ Correlation Between and Rate Ratio is 0.83 Data source: Hospital Discharge Database, ORS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

26 South Carolina Asthma prevalence

27 Adults Self reported current asthma Prevalence Rate (%) BRFSS 2003

28 Adults Self Reported Current Asthma Prevalence Rate (%) BRFSS 2010 Vermont Rhode Island Michigan New Hampshire Massachusetts Kentucky District of Columbia Arizona Maine Delaware Alaska Pennsylvania Wyoming New York New Mexico Washington Ohio Oregon Oklahoma Indiana Hawaii Nevada Illinois Connecticut Colorado Utah Montana Nationwide (States and DC) Missouri Idaho New Jersey Kansas Virginia Maryland Wisconsin South Carolina Florida Alabama Nebraska Iowa Georgia Arkansas California Minnesota South Dakota North Carolina Texas North Dakota West Virginia Mississippi Louisiana Tennessee

29 Adult Self-Reported Lifetime Asthma Prevalence SC Rate (Percent) BRFSS

30 Adult Self-Reported Current Asthma Prevalence SC Rate (Percent) BRFSS

31 % Adult Self-Reported Lifetime Asthma Prevalence Rate (Percent) by Income: US BRFSS Income < $15K $15-$25K $25-$35K $35-$50K >$50K US SC

32 2010 Percent of Adults with Asthma Greenville Cherokee Lifetime prevalence Pickens Spartanburg York Oconee Anderson Laurens Union Newberry Chester Fairfield Lancaster Kershaw Chesterfield Darlington Marlboro Dillon Abbeville Greenwood Lee Marion McCormick Saluda Lexington Richland Sumter Florence Horry Edgefield Aiken Calhoun Clarendon Williamsburg Orangeburg Georgetown Percent (SC %) Barnwell Bamberg Allendale Hampton Jasper Berkeley Dorchester Colleton Charleston Beaufort Data source: SC BRFSS Generated by Office of Chronic Disease Epidemiology and Evaluation, SC DHEC

33 Rate per 10,000 persons Children (<5) Monthly Asthma Rate Hospital and ED discharges J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N

34 Rate per 10,000 persons Children (5-9) Monthly Asthma Rate Hospital and ED discharges J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N

35 Rate per 10,000 persons Children (10-14) Monthly Asthma Rate Hospital and ED discharges J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N

36 Rate per 10,000 persons Children (15-19) Monthly Asthma Rate Hospital and ED discharges J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N J M M J S N

37 Conclusions Currently about 293,200 adults and 90,005 children suffer from asthma in South Carolina. B between10% and 14.3% of middle school students suffer from asthma. Between 18.9% and 25.4% of middle school students have ever been told that they have asthma (2011).

38 Conclusions (continue) 9.2%-13.7% of high school students suffer from asthma, compared to 11.9% nationwide. 20.8% % of high school students have ever been told that they have asthma, compared to 23% nationwide (2011). 67 South Carolinians died from asthma in 2010 (1.4 per 100,000 population age-adjusted rate).

39 Conclusions (continue) 1.2% (5,975) of ALL hospitalizations were for asthma. Thirty percent of all those hospitalizations were among children. Of those high school students who were asthmatic, 24.4% are current smokers, which is more than the statewide percentage for high school students of 22.4% (not significantly different).

40 Conclusions (continue) 74.4% of high school students with asthma were exposed to second hand smoke in a room or car within the past week. Disproportionate number African American in SC have been seen in the ER or hospitalized due to asthma Use of ER and hospitals follows a specific seasonal patterns.

41 Thanks!

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