 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Carlos Arturo Camargo, MD, DrPH and Jennifer A. Emond, MS. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Clinics Building 397, Boston, MA 02114, (617) 726-5276, ccamargo@partners.org
OBJECTIVE: To describe recent trends in U.S. emergency department (ED) visits for asthma, with particular emphasis on racial disparities. METHODS: Data were obtained from the 1992-2000 National Hospital Ambulatory Medical Care Survey. Analyses included all visits with a primary diagnosis of asthma (ICD-9 code 493). National estimates were obtained using assigned patient visit weights. 95% CI were calculated using the relative standard error of the estimate. Rates were calculated using population data from the US Census Bureau, with all rates reported per 1,000 US population. Regression was used for trend analysis. RESULTS: From 1992-2000, there were an estimated total of 16,343,000 ED visits for asthma, representing 1.9% of all ED visits. The population rate was 6.8 (95% CI, 6.3-7.4) ED visits per year per 1,000 Americans. The total absolute number of ED visits rose steadily between 1992-1998 (1,467,000 to 2,034,000, p for trend < 0.01), leveled off at 1,997,000 in 1999, and then decreased to 1,835,000 in 2000 (p < 0.01). ED visit rates followed a similar pattern. Overall, the asthma visit rate was highest for age <10 years (13.4; 95% CI, 11.8-15.1). Asthma visit rates were a little higher among women (7.3, 6.6-8.0) than men (6.3, 5.6-6.9), but were more than 3x higher among blacks (18.9, 16.5-21.3) than whites (5.2, 4.7-5.6). The black:white ratio has lessened in recent years, with a ratio of 3.9 in 1992-93, a peak of 4.8 in 1994-95, and then a low of 2.3 in 2000. Indeed, the recent decline in ED asthma visits was explained by a drop in ED asthma visit rates by black men (20.3 in 1998-99 to 16.1 in 2000) and black women (18.1 to 11.6). For this same comparison (1998-99 vs. 2000), rates were stable among white men (5.1 to 4.8) and actually increased among white women (6.5 to 7.2). By region, overall rates were higher in the Northeast (9.5, 8.1-10.9) than other regions: Midwest 7.7, South 5.9, and West 5.0. 65% of asthma visits were coded as urgent/emergent, and 12% resulted in hospitalization. Systemic corticosteroids were prescribed in only 46% of patients. CONCLUSION: ED visits for asthma remain common but recent trends indicate improvement. Although blacks continue to bear a disproportionate share of the asthma burden, progress has been made. Reductions in racial disparities are an overarching goal of Healthy People 2010 and this analysis suggests that recent/ongoing efforts are improving this longstanding national problem.
Learning Objectives:
Keywords: Asthma, African American
Related Web page: www.emnet-usa.org
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.