Characteristics of Asthma Visits to Physician Offices in the United States: 2012–2015 National Ambulatory Medical Care Survey

September 20, 2019

Questions for Lead Author Lara Akinbami, Health Statistician, of “Characteristics of Asthma Visits to Physician Offices in the United States: 2012–2015 National Ambulatory Medical Care Survey.”

Q: Why did you decide to do a report on asthma visits to physician offices?

LK: Asthma is a common chronic condition in the United States: in 2016 8.3% of the population had asthma.  Each year, there are nearly 2 million emergency department visits, over 300,000 hospitalizations and more than 3.500 deaths in the United States due to asthma.

These adverse outcomes arise when episodic asthma attacks become severe.  A key part of preventing these adverse asthma outcomes is the prevention of attacks, and early recognition and management of symptoms.  Physicians in non-emergent community settings have a key role in partnering with people with asthma in identifying and monitoring symptoms, and developing a plan to avoid things that trigger attacks, and providing a medication plan to reduce symptoms when they do arise.  There are evidence-based national asthma guidelines that provide recommendations on how to best manage asthma that are directed toward care in physician offices (https://www.ncbi.nlm.nih.gov/books/NBK7232/).  Furthermore, asthma is now increasingly recognized as a risk factor for chronic obstructive pulmonary disease, the fourth leading cause of death in the US, and diagnosis and management of asthma is as an important part of monitoring lung health through the lifespan.

For all these reasons, assessing trends in visits to physician offices is useful in tracking the characteristics of asthma patients, the reasons asthma patients seek care (routine monitoring or acute care), and the services provided in these visits.  These help answer questions that can direct interventions, for example, “Are certain groups less likely to seek care in office settings?” Or “Are guideline recommendations being followed?”


Q: How did the data vary by age, sex and race?

LK: Asthma visit rates tend to reflect the prevalence of asthma in the population, but with some notable exceptions.  Asthma prevalence is higher in children than in adults, and children have higher asthma physician office visit rates than adults.  However, although asthma prevalence peaks in mid-childhood, we see high rates of asthma visits among children 0-4 years of age.  This is because these very young children have smaller airways.  They are more likely to show symptoms with any conditions that further narrows the airways, such as respiratory infections.

Another interesting pattern is that asthma prevalence is higher among boys than girls, in contrast to among adults in whom women have higher asthma prevalence than men.  Asthma visit rates also reflect this pattern with boys having higher visit rates than girls, and women having higher visit rates than men.  However, once the differences in prevalence are accounted for by looking at just people who have asthma, boys with asthma have similar asthma visit rates as girls with asthma, and the same is true for men and women with asthma.  The one exception is that very young boys ages 0-4 yeas with asthma still have higher rates of asthma visits than 0-4 year old girls with asthma.

By race and Hispanic origin, asthma visit rates are similar between groups with no differences seen between asthma visits rates for non-Hispanic white, non-Hispanic black and Hispanic persons.  Asthma visit rates were lower for persons of non-Hispanic other race.  However, this pattern does not reflect asthma prevalence which is higher for non-Hispanic black persons than non-Hispanic white and Hispanic persons.


Q: Is this the first time you have published a report on this topic?

LK: The Centers for Disease Control and Prevention publishes regular asthma surveillance reports on asthma that provide analysis of trends and estimates of the most recent data for asthma prevalence, health care utilization and death.  The CDC also provides a web page with the most recent asthma data: https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm.  However, this report is only the second since 1996 to analyze asthma visits to physician offices in depth, including the degree to which services in asthma visits reflect recommendations in the national asthma guidelines.  These guidelines were originally released in 1991 with the most recent update in 2007.  When findings of this report which analyzed data from 2012-2015 is compared to the 1996 report that analyzed data from 1993-1994, we found that despite an increase in asthma prevalence over this period, the annual average number of asthma visits declined from 11 million in 1993-1994 to 10.2 million in 2012-2015.  Medications in 2012-2015 included newer medications that target airway inflammation.  A similar percentage of asthma visits were seen by primary care physicians as opposed to asthma specialists, 65% in 1993-1994 and 60% in 2012-2015.  However, there was less progress in increasing the implementation of national asthma guidelines than would be expected given the effort to increase uptake of key recommendations such as providing an asthma action plan and documenting asthma severity and control.


Q: Was there a specific finding in your report that surprised you?

LK: Given the emphasis on the importance of assessing and documenting asthma control, only 40.9% of asthma visits to physician offices had a level of asthma control documented.  The distribution between levels of asthma control was expected with 29.1% of patients with well controlled asthma, 10.5% with not well controlled asthma and 1.3% of patients with very poorly controlled asthma.  However, that 59.1% of asthma patients had no level of control documented was surprising given the concerted efforts to have asthma control assessed and documented.  These efforts included quality of care measurements, physician continuing education, a Guideline Implementation Report (https://www.nhlbi.nih.gov/files/docs/guidelines/gip_rpt.pdf), and local quality improvement projects.


Q: What is the take home message for this report?

LK: Asthma is a common chronic condition and a common reason for physician office visits.  Given its high burden in morbidity, health care use, and mortality, it is important to assess the content of asthma physician office visits given that physicians are the on the “front line” of asthma care and provide the majority of asthma care.  Rates for asthma visits to physician offices started to decline before total office visit rates declined.  Asthma education, objective monitoring (pulmonary function  testing) and level of asthma control were documented in a minority of visits.  Quick-acting relief medication remained the most frequently mentioned medication class.  Additional research can explore the underlying reasons for trends, and future policy can target low implementation rates of guideline recommendations.


QuickStats: Percentage of Adults Aged 18–64 Years Who Had an Influenza Vaccination† in the Past 12 Months, by Sex and Current Asthma Status

January 18, 2019

In 2017, adults aged 18–64 years with current asthma were more likely to have had an influenza vaccination in the past 12 months (47.9%) than those without asthma (36.4%).

Regardless of asthma status, women were more likely than men to have had an influenza vaccination in the past 12 months.

Women aged 18–64 years with current asthma (51.3%) were more likely to have had an influenza vaccination than men with current asthma in this age group (41.6%).

Among adults aged 18–64 years without asthma, women also were more likely to have had an influenza vaccination (40.0%) than were men (32.8%).

Source: National Health Interview Survey, 2017.

https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a7.htm


Early Release of Selected Estimates Based on Data From the January–September 2016 National Health Interview Survey

February 23, 2017
Tainya C. Clarke, Ph.D., M.P.H., Health Statistician

Tainya C. Clarke, Ph.D., M.P.H., Health Statistician

Questions for Tainya C. Clarke, Ph.D., M.P.H., Health Statistician and Lead Author on the “Early Release of Selected Estimates Based on Data From the January–September 2016 National Health Interview Survey.”

Q: What health measures does this report look at?

TC: The measures covered in this report are lack of health insurance coverage and type of coverage, having a usual place to go for medical care, obtaining needed medical care, receipt of influenza vaccination, receipt of pneumococcal vaccination, obesity, leisure–time physical activity, current cigarette smoking, alcohol consumption, human immunodeficiency virus (HIV) testing, general health status, personal care needs, serious psychological distress, diagnosed diabetes, and asthma episodes and current asthma. Three of these measures (lack of health insurance coverage, leisure-time physical activity, and current cigarette smoking) are directly related to Healthy People 2020 Leading Health Indicators.


Q: How do you collect your data for these surveys?

TC: The data is collected by household interview surveys that are fielded continuously throughout the year by the National Center for Health Statistics (NCHS). Interviews are conducted in respondents’ homes. Health and socio-demographic information is collected on each member of all families residing within a sampled household. Within each family, additional information is collected from one randomly selected adult (the “sample adult”) aged 18 years or older and one randomly selected child (the “sample child”) aged 17 years or younger. NHIS data is collected at one point in time so we cannot determine causation. Data presented in this report are quarterly data and are preliminary.


Q: What are some of the findings that you would highlight in this early release report?

TC: Here are some findings from the early release report:

• The percentage of persons of all ages who had a usual place to go for medical care decreased, from 87.9% in 2003 to 85.4% in 2010, and then increased to 88.3% in January–September 2016.

• The percentage of persons who failed to obtain needed medical care due to cost increased, from 4.3% in 1999 to 6.9% in 2009 and 2010, and then decreased to 4.4% in January–September 2016.

• The percentage of adults aged 65 and over who had ever received a pneumococcal vaccination increased from 63.5% in 2015 to 67.3% in January–September 2016.

• The prevalence of obesity among U.S. adults aged 20 and over increased, from 19.4% in 1997 to 30.6% in January–September 2016.

• In the third quarter of 2016, 52.8% of U.S. adults aged 18 and over met the 2008 federal physical activity guidelines for aerobic activity (based on leisure-time activity). This was higher than the third quarter of 2015 estimate of 49.5%.

• The prevalence of current cigarette smoking among U.S. adults declined, from 24.7% in 1997 to 15.3% in 2015 and remained low through the third quarter of 2016 (15.9%).
• During January–September 2016, men were more likely to have had at least 1 heavy alcohol drinking day (31.6%) in the past year compared with women (18.6%).

• The prevalence of diagnosed diabetes among adults aged 18 and over increased, from 5.1% in 1997 to 9.2% in 2010, and has since remained stable through January–September 2016.


Q: What do the findings in this report tell us about the health of the country overall?

TC: Since 2010, the percentage of uninsured persons has decreased by almost 50% (16.0% vs 8.8%) and the percentage of persons who failed to obtain needed medical care due to cost has also shown a significant decline during the same time period (6.9% to 4.4%). These two indicators demonstrate increased access to healthcare from 2010 to September 2016.


Q: Are there any trends in this report that Americans should be concerned about?

TC: Although in the 3rd quarter of 2016, 52.8% of U.S. adults met the 2008 federal physical activity guidelines for aerobic activity; obesity is an epidemic that has seen a steady increase since 1997 and now affects just under one third (30.6%) of U.S. adults.


Current Asthma Prevalence by Weight Status Among Adults: United States, 2001–2014

March 16, 2016

Asthma is a common chronic airway disorder characterized by periods of airflow obstruction known as asthma attacks. Symptom frequency can range from intermittent to constant, and attack severity can vary from mild to life threatening.

Several studies have shown that among adults, obesity is associated with an increased risk of asthma diagnosis, more frequent asthma-related health care use, and greater symptom or severity burden.

In a new NCHS report, current asthma prevalence is examined by weight status among U.S. adults aged 20 and over.

Findings:

  • In 2011–2014, current asthma prevalence was 8.8% among adults. It was higher among adults with obesity (11.1%) compared with adults in normal weight (7.1%) and overweight (7.8%) categories.
  • Women with obesity had higher current asthma prevalence (14.6%) than those in normal weight (7.9%) and overweight (9.1%) categories. Current asthma prevalence did not differ significantly by weight status for men.
  • Current asthma prevalence was highest among adults with obesity for all race and Hispanic origin groups and age groups.
  • Overall current asthma prevalence among adults increased from 2001–2002 (7.1%) to 2013–2014 (9.2%). By weight status, prevalence increased among overweight adults but not among adults in the obese or normal weight categories.

 


Asthma Awareness Month

May 7, 2014

Illustration of person using asthma inhaler.May is Asthma Awareness Month and it’s important to recognize one of the most common lifelong chronic diseases.

Asthma is a common chronic airway disorder characterized by periods of reversible airflow obstruction known as asthma attacks.  Airflow is obstructed by inflammation and airway hyperreactivity (contraction of the small muscles surrounding the airways) in reaction to certain exposures.  Exposures include exercise, infection, allergens (e.g., pollen), occupational exposures (e.g., chemicals), and airborne irritants (e.g., environmental tobacco smoke).

Symptoms may include wheezing, coughing, shortness of breath, and chest tightness. It is not clear how to prevent asthma from developing and there is no cure. Yet the means to control and prevent exacerbations in persons who have asthma are well established in evidence-based clinical guidelines.

3,404 people died of asthma in 2010, according to the most recent national data.

In 2010, 439,000 people were discharged from the hospital with asthma as first-listed diagnosis and the average length of stay was over 3 days.

Asthma prevalence (the percentage of people who have ever been diagnosed with asthma and still have asthma) increased from 7.3% in 2001 to 8.4% in 2010.  Also, an estimated 25.7 million people had asthma: 18.7 million adults and 7 million children and adolescents.

Children and adolescents had higher asthma prevalence (9.5%) than adults (7.7%) for the period 2008–2010. Females had higher asthma prevalence than males (9.2% compared with 7%).

However, data from the National Health Interview Survey show that asthma prevalence in the U.S. dropped sharply during the first nine months of 2013.

For more information on asthma:

http://www.cdc.gov/asthma/

http://www.cdc.gov/asthma/pdfs/kids_fast_facts.pdf

http://www.cdc.gov/nchs/data/databriefs/db94.pdf

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6017a4.htm?s_cid=mm6017a4_w

http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf

 

 

 


A brief look at asthma

November 5, 2008

Two weeks ago, NCHS released a report concerning the prevalence of food allergies in children. In this report, the authors reported that “children with food allergy are two to four times more likely to have other related conditions such as asthma and other allergies, compared with children without food allergies.” According to the report, about 3 million children have food allergies. However, statistics show that asthma affects almost 7 million children, and asthma rates more than doubled between the 1980s and 1990s. The cause of the condition, like food allergies, is still relatively uknown (Advance Data 381).

For more Asthma statistics, click here.

 
 

 


America’s Children: Key National Indicators of Well-Being

July 19, 2007

Last Friday we released the 10th anniversary edition of America’s Children, a product of the Federal Interagency Forum on Child and Family Statistics.

The Federal Interagency Forum on Child and Family Statistics (Forum) is a collection of 22 Federal government agencies involved in research and activities related to children and families. The Forum was founded in 1994 and formally established in April 1997 under Executive Order No. 13045. The mission of the Forum is to foster coordination and collaboration and to enhance and improve consistency in the collection and reporting of Federal data on children and families. The Forum also aims to improve the reporting and dissemination of information on the status of children and families.

Quite a bit of media interest was generated (here | here) on the subject of teen sexual behavior but there was much more to the report. The full report is available here and our overview of the data on health indicators which we contributed to is below the fold.

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