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Asthma disparities in Indiana.

Asthma is a common chronic disease affecting more than half a million Hoosiers. The Indiana State Department of Health's Asthma Program recently released a report on asthma in Indiana and found certain populations had a greater burden of asthma.

The Asthma Program report found blacks, children, females, and persons with an annual household income less than $15,000 per year carried a disproportionate amount of the asthma burden with higher prevalence rates, hospitalizations, emergency department visits, and deaths. Several factors that may contribute to these disparities include genetic differences, poverty, environmental exposures, and lack of patient education.

The Asthma Program report, which analyzed data primarily from 2005, found adult men had an asthma prevalence of 6.0 percent, while adult women had an asthma prevalence of 10.3 percent. Adult women had higher asthma hospitalization and emergency department (ED) visit rates than men; however, hospitalization and ED rates were higher for males 14 years of age or younger when compared to females of the same age. Females also had higher asthma mortality rates than males.

Though the prevalence of current asthma was not significantly different between blacks and whites, the asthma ED and hospitalization rates for Blacks were approximately three times higher than Whites. Additionally, the asthma mortality rate for blacks was nearly five times higher.

Children had the highest asthma ED rates and third highest asthma hospitalization rates when compared to all other age groups. Additionally, asthma prevalence was highest among those with an annual household income of less than $15,000 per year.

Individuals in the above mentioned demographic groups should receive special care to help them better understand asthma control since they tend to use the health care system for asthma treatment more often. This may include extra time to evaluate environmental triggers, assessing proper inhaler use during each visit, monitoring use of controller and quick-relief medications, and determining barriers to asthma control (i.e. cost, low health literacy, absence of an Asthma Action Plan, etc.).

Most adults and children with asthma should receive an influenza shot every year. Those adults, who also smoke should be referred to the Indiana Tobacco Quitline at 1-800-QUIT-NOW. While these steps are important for all people with asthma, they are critical for populations disproportionately affected.

In August of 2007, the National Heart, Lung, and Blood Institute updated their Guidelines on the Diagnosis and Management of Asthma, which more clearly defined how to assess asthma severity and control.

Asthma severity measures disease intensity when the patient is not on long-term control therapy, and asthma control measures the extent to which symptoms of disease are minimized and guides decisions on maintaining or adjusting therapy. Severity and control also each involve two domains: current impairment and future risk.

Additionally, the guidelines have tailored disease assessment and treatment plans to three age groups: 4 years of age and younger; 5 to 11 years of age, and 12 years of age and older. These help direct treatment, however, asthma varies widely among patients and does require individualized therapy.

Despite advances in treatment, the guidelines conclude even long-term control medications do not improve the underlying severity of the disease. A copy of the guidelines and a summary can be found at: asthma /index. htm.

By following the National Heart, Lung, and Blood Institute guidelines, Hoosiers can help reduce asthma disparities and the overall burden of asthma in Indiana. Until more research is completed to determine which factors are contributing to these disparities in Indiana, it is important for individuals with asthma to know the disease can be controlled. All people with asthma deserve to lead active, healthy lives.

For more information on asthma or to access the full report on the Burden of Asthma in Indiana contact the Indiana State Department of Health Asthma Program at (317) 233-1325 or www.
Adult     Hospitalization *   ED visits *   Mortality *   per
Asthma    Prevalence          per 10,000    per 10,000    1,000,000

Females   10.30%              16.4          43.9          16.4
Males     6.00%               9.4           34.3          8.1
Blacks    9.20%               27.6          94.7          55
Whites    8.20%               10.6          28.3          9.8

Source: The Burden of Asthma in Indiana: Second Edition, January

* Hospitalization, ED visit, and mortality rates include adults
and children.
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Publication:ISNA Bulletin
Date:May 1, 2008
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