Small-area estimation on current asthma prevalence among adults in Massachusetts using BRFSS survey data

Background: Asthma is a significant public health problem in the United States, affecting over 25 million people. The adult asthma prevalence in Massachusetts (MA), among the highest in the U.S, increased from 8.5% in 2000 to 10.7% in 2011. However, municipality-level asthma prevalence estimates for adults are not usually available. Using model based approaches, estimates of adult asthma using MA BRFSS data were computed for 351 MA municipalities. These estimates can be used to guide the allocation of scarce public health resources.

Methods: We developed a multilevel, mixed-effect logistic regression model to estimate and compare municipality level of asthma prevalence among adults using pooled 2008, 2009 and 2010 MA BRFSS survey data, other related administrative data, and 2010 American Community Survey population estimates. The analytic sample included more than 52,000 respondents with an average age of 54 years, 63% women, 17% racial/ethnic minorities, 63% college educated, and 66% household income less than $75,000. Municipality-level estimates were derived based on the model and according to socio-demographic composition and municipality characteristics.

Results: The three-year average annual state asthma prevalence estimate is 10.8%. The municipality-level prevalence estimates ranged from 8.4% to 17.2%. Urban and poor neighborhood municipalities had higher prevalence rates.

Discussion: The results will by used by MDPH and its partners to identify high prevalence municipality and prioritize municipality-based interventions in order to improve the quality of life for residents with asthma and to reduce disparities in asthma outcomes between distinct population groups.