1

ASTHMA

BURDEN REPORT, GEORGIA,

2015

2

Acknowledgements

Georgia Department of Public Health Brenda Fitzgerald, MD

Commissioner, State Health Officer

Health Protection J. Patrick O’Neal, MD

Director

Epidemiology Program Cherie L. Drenzek, DVM, MS

State Epidemiologist

Chronic Disease, Healthy Behaviors and Injury Rana Bayakly, MPH

Epidemiology Section Chief Epidemiologist

Behavioral Surveillance Madhavi Vajani, MPH

Team Lead

Health Promotion and Disease Prevention Section Jean O’Connor, JD, DrPH

Director

Georgia Asthma Control Program Francesca Lopez, MSPH, AE-C

Program Manager

For more information on asthma surveillance in Georgia, please contact:

Asthma Epidemiologist

Chronic Disease, Healthy Behaviors, and Injury Epidemiology Section

Georgia Department of Public Health

2 Peachtree Street, 14th Floor

Atlanta, GA 30303-3142

(404) 463-4628

http://dph.georgia.gov/asthma-surveillance

This publication is supported by the Cooperative Agreement numbers U59EH000520 and

5U580000021-03 from the Centers for Disease Control and Prevention (CDC). Its contents are

solely the responsibility of the authors and do not necessarily represent the official view of the

CDC.

Suggested citation: Annor F., Bayakly A., Vajani M., Drenzek, C., Lopez F., O’Connor J.

Georgia Asthma Burden Report. Georgia Department of Public Health, Health Protection,

Epidemiology, Chronic Disease, Healthy Behaviors and Injury Epidemiology Section, May

2015.

3

Table of Contents

Acknowledgements ....................................................................................................................................... 2

Georgia Counties and Public Health Districts .............................................................................................. 4

PART A – ASTHMA IN CHILDREN ......................................................................................................... 5

Key Findings: ............................................................................................................................................ 5

A1. Emergency Room Visits .................................................................................................................... 6

A1.1. Overall trends of asthma ER visits between 2010 and 2012, Georgia ........................................ 6

A1.2. Disparities in Asthma ER Visits among Georgia Children aged 0-17 Years .............................. 8

A1.3. Multiple Asthma ER Visits among Georgia Children aged 0-17 Years ................................... 13

A2. Hospitalizations ................................................................................................................................ 15

A2.1 Overall asthma hospitalizations among Georgia children .......................................................... 15

A2.2. Disparities in asthma hospitalizations among children ............................................................. 16

A2.3. Repeat Asthma Hospitalizations among Georgia Children aged 0-17 years ............................ 19

PART B – ASTHMA IN ADULTS ............................................................................................................ 20

Key Findings: .......................................................................................................................................... 20

B1. Asthma ER Visits ............................................................................................................................. 21

B1.1 Overall asthma ER visit trends among Georgia Adults 18 years and older ............................... 21

B1.2. Disparities in Adult Asthma ER visits ...................................................................................... 23

B1.3. Repeat Asthma ER Visits among Adults................................................................................... 24

B2. Asthma Hospitalizations among Adults ........................................................................................... 28

B2.1. Overall trend of asthma hospitalizations among Georgia adults ............................................... 28

............................................................................................................................................................ 30

PART C – ASTHMA MORTALITY ......................................................................................................... 32

C1.1. Overall age-adjusted asthma mortality rate in Georgia between 2001 and 2011 ...................... 33

C1.2. Age-adjusted asthma mortality rates by race ............................................................................. 34

Data Sources: .............................................................................................................................................. 37

Methods and Technical Notes ..................................................................................................................... 38

4

Georgia Counties and Public Health Districts

1-1: Northwest

Bartow

Catoosa

Chattooga

Dade

Floyd

Gordon

Haralson

Paulding

Polk

Walker

1-2: North

Georgia Cherokee

Fannin

Gilmer

Murray

Pickens

Whitefield

2-0: North

Banks

Dowson

Forsyth

Franklin

Habersham

Hall

Hart

Lumpkin

Rabun

Stephens

Towns

Union

White

3-1: Cobb/Douglas

Cobb

Douglas

3-2: Fulton

Fulton 3-3: Clayton

County

Clayton

3-4: East Metro

Gwinnett

Newton

Rockdale

3-5: DeKalb

DeKalb 4-0: LaGrange

Butts

Carroll

Coweta

Fayette

Henry

Lamar

Meriwether

Pike

Spalding

Troup

Upson

7-0: West Central

Chattahoochee

Clay

Crisp

Dooly

Harris

Macon

Marion

Muscogee

Quitman

Randolph

Schley

Stewart

Sumter

Talbot

Taylor

Webster

8-1: South

Ben Hill

Berrien

Brooks

Cook

Echols

Irwin

Lanier

Lowndes

Tift

Turner

9-2: Coastal

Bryan

Camden

Chatham

Effingham

Glynn

Liberty

Long

McIntosh

8-2: Southwest Baker

Calhoun

Colquitt

Decatur

Dougherty

Early

Grady

Lee

Miller

Mitchell

Seminole

Terrell

Thomas

Worth

9-1: Southeast

Appling

Atkinson

Bacon

Brantley

Bulloch

Candler

Charlton

Clinch

Coffee

Evans

Jeff Davis

Pierce

Tattnall

Toombs

Ware

Wayne

5-2: North

Central

Baldwin

Bibb

Crawford

Hancock

Houston

Jasper

Jones

Monroe

Peach

Putnam

Twiggs

Washington

Wilkinson

5-1: South

Central

Bleckley

Dodge

Johnson

Laurens

Montgomery

Pulaski

Telfair

Treutlen

Wheeler

Wilcox

10-0:

Northeast

Barrow

Clarke

Elbert

Greene

Jackson

Madison

Morgan

Oconee

Oglethorpe

Walton

6-0: East Central

Burke

Columbia

Emanuel

Glascock

Jefferson

Jenkins

Lincoln

McDuffie

Richmond

Screven

Taliaferro

Warren

Wilkes

5

PART A – ASTHMA IN CHILDREN

Asthma Emergency Room Visits and Hospitalizations among Georgia Children 0-17 years

Key Findings: An average of 27,000 asthma emergency room (ER) visits occurred annually among Georgia

children aged 0-17 years during 2010-2012, an average rate of 1083/100,000 population.

Three notable seasonal peaks were observed in the number of asthma emergency room visits

among Georgia children - during spring, early fall and late fall seasons.

The rate of asthma ER visits among Georgia children was highest among 0-4 year olds, blacks

and boys.

The rate of asthma ER visits among Georgia children was highest in the metro Atlanta and

Augusta areas.

The total charges for asthma ER visits among Georgia children increased from $33.6 million in

2010 to $44.2 million in 2012.

Among Georgia children who had an asthma ER visit in 2012, 16% had repeat visits during the

calendar year.

On average, 3,000 asthma hospitalizations occurred annually among Georgia children during

2010-2012.

Among Georgia children, the highest rate of asthma hospitalizations occurred among 0-4 year

olds, blacks and boys.

About 7% of children who were hospitalized for asthma during 2012 had repeat asthma

hospitalizations during the calendar year.

6

A1. Emergency Room Visits

A1.1. Overall trends of asthma ER visits between 2010 and 2012, Georgia

Between 2010 and 2012, there was an average of 27,000 asthma Emergency Room (ER) visits

annually among Georgia children aged 0-17 years.

In Georgia during 2010-2012:

There were three notable periods in each calendar year when the number of asthma ER

visits was highest among children- during spring, early fall and late fall seasons (Fig

A1.1).

o The number of asthma ER visits among children increased in early February and

remained high until late May.

o Then the number of visits dropped in early June to reach the lowest level for the

year and remained low until early August.

o After the first week in August, the number of visits increased to reach the highest

peak in late August.

o In early September, the number of visits dropped from the August peak but

remained fairly high until the end of November compared to the number of visits

observed in June (Fig A1.1).

The number of asthma ER visits among children was highest during the weekend period-

Saturdays to Mondays (Fig A1.2).

The total charges for asthma ER visits among Georgia children aged 0-17 years increased

from about $33.6 million in 2010 to $44.2 million in 2012 (Fig A1.3). The median charge

per asthma ER visit also shifted upward from $984 in 2010 to $1,175 in 2012.

7

17.3

15.8

14.5 13.7

12.1 12.1

14.6

17.4

16.0

14.5

12.9 12.8 12.3

14.3

17.6

16.3

14.3 13.4

12.4 12.5 13.5

0

5

10

15

20

Sun Mon Tue Wed Thu Fri Sat

Pe

rce

nt

Ast

hm

a ER

Vis

its

Day of the Week

Fig A1.2. Asthma ER Visits among Georgia Children 0-17 Years, by Day of the Week, 2010-2012

2010 2011 2012

33.6

38.1

44.2

20

30

40

50

2010 2011 2012

Tota

l Ch

arge

s in

Mill

ion

s, U

S D

olla

rs

Year

Fig A1.3. Total Charges for Asthma ER Visits among Georgia Children, by Year, 2010-2012

8

1,426

1,240

785

491

1,434

1,268

785

470

1,514 1,466

886

555

0

500

1000

1500

2000

0-4yrs 5-9yrs 10-14yr 15-17yrs

Rat

e p

er

10

0,0

00

Age Categories

Fig A1.4. Age-Specific Rate (per 100,000) of Asthma ER Visits among Children 0-17 years in Georgia, 2010-2012

2010 2011 2012

A1.2. Disparities in Asthma ER Visits among Georgia Children aged 0-17 Years

The rate of asthma ER visits among Georgia children was not randomly distributed. Children

with specific demographic characteristics and in specified geographic locations had higher

asthma ER visit rates than others. The overall asthma ER visit rate was highest among younger

children (under 5 years), boys, blacks, and children living in urban areas.

In Georgia during 2010-2012:

The average age-specific asthma ER visits rates per 100,000 were: 1,434 for children

aged 0-4 year olds; 1,325 for 5-9 year olds; 818 for 10-14 year olds; and 505 for 15-17

year olds (Fig A1.4).

Boys (1,316/100,000) had higher asthma ER visits rate than girls (839/100,000) (Fig

A1.5).

The rate of asthma ER visits was four times higher for black children (2,050/100,000)

than for white children (502/100,000), and eight times higher for black children than for

Asian children (272/100,000) (Fig A1.6).

Children living in non-rural counties (1,122/100,000) had higher asthma ER visit rates

than those living in rural counties (887/100,000) (Fig A1.7).

The rate of asthma ER visits was higher among children residing in the following

Georgia Public Health Districts (PHD); DeKalb, Fulton, East Central, and Clayton (Map

A1.1).

9

1260 1266 1421

809 814 894

0

500

1000

1500

2000

2010 2011 2012

Rat

e p

er

10

0,0

00

Year

Fig A1.5. Rate of Asthma ER Visits among Children 0-17 years, by Gender, 2010-2012

Male Female

1984 2020 2144

483 476 547 236 255 324 143 134 414

0

500

1000

1500

2000

2500

2010 2011 2012

Rat

e p

er

10

0,0

00

Year

Fig A1.6. Rate of Asthma ER Visits among Children 0-17 years in Georgia, by Race, 2010-2012

Black White Asian AA, PI

Note: AA= American Indians or Alaska Natives, PI= Pacific Islanders Asian is a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent

including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

10

869 847 947

1074 1084 1207

0

500

1000

1500

2000

2010 2011 2012

Rat

e p

er

10

0,0

00

Year

Fig A1.7. Rate of Asthma ER Visits among Children 0-17 years in Georgia, by Rural/non-Rural Status, 2010-2012

Rural Non-Rural

Non-Rural County: Any county with 35,000 or more total population per the 2000 Census.

Rural County: Any county with less than 35,000 total populations per the 2000 Census.

11

Map A1.1 – Rate of Asthma ER Visits among Georgia Children Aged 0-17 years, by Public

Health Districts, 2010-2012

12

Map A1.2 – Rate of Asthma ER Visits among Georgia Children Aged 0-17 years, by

County of Residence, 2010-2012

13

16.9 15.4 14.3

18.8

14.4

0.0

10.0

20.0

30.0

40.0

Males Females 0-4 yrs 5-11 yrs 12-17 yrs

Pe

rce

nt

Sex

Fig A1.8. Percent of Children 0-17 years who had more than one Asthma ER Visits, by Sex and Age, Georgia 2012

Age

A1.3. Multiple Asthma ER Visits among Georgia Children aged 0-17 Years

Having more than one (or repeat) asthma ER visit within a calendar year may be an indication of

uncontrolled asthma.

In Georgia during 2012:

About 23,620 children aged 0-17 years had a total of 29,035 asthma ER visits.

Of the children who had asthma ER visits, 3,854, representing about 16%, had a repeat

asthma ER visits during the 2012 calendar year.

Of those who had repeat asthma ER visits, 40% had 2 visits, 14% had three visits, 6%

had four visits, and the remaining 39% had five or more visits during 2012.

Among children 0-17 years, repeat asthma ER visits was more common in male, black,

aged 5-11 years, and Medicaid, Medicare or Peachcare health insurers.

o While 17% of boys had repeat asthma ER visits, 15% of girls did.

o While 18% of African-American children had repeat asthma ER visits, 13.0% of

white children did.

o Whereas 18% of children aged 5-11 years had repeat asthma ER visits in 2012, 14%

of children aged 0-4 years and 12-17 years each did.

o Whereas 18% of Medicare, Medicaid, and Peachcare-insured children had repeat

asthma ER visits, the number of repeat visits was lower among children covered by

other payor types during 2012.

14

13.2

18.0

14.3

17.9 17.8

11.9

15.6 17.5

0.0

10.0

20.0

30.0

40.0

Whites Black Others Medicaid Medicare Private Self-Pay Peachcare

Pe

rce

nt

Race

Fig A1.9. Percent of Children 0-17 who had more than one Asthma ER Visits, by Race and Payor Type, Georgia, 2012

Insurance Type

15

$5,000

$5,500

$6,000

$6,500

$7,000

$7,500

$8,000

2010 2011 2012

Me

dia

n T

ota

l Ch

arge

s

Year

Fig A2.1. Median Charges for Asthma Hospitalizations among Georgia Children, by Year, 2010-2012

A2. Hospitalizations

A2.1 Overall asthma hospitalizations among Georgia children

Between 2010 and 2012, there were total of 8,987 hospitalizations among Georgia

children aged 0-17 years, representing an overall hospitalization rate of 120 per 100,000.

Specifically, there were: 2,965 (119/100,000) hospitalizations in 2010; 2,947

(118/100,000) hospitalizations in 2011; and 3,075 (123/100,000) hospitalizations in 2012.

Two-thousand, seven hundred and fifty (2,750) children were hospitalized for asthma in

Georgia during 2010, while 2,695 children and 2,881children were hospitalized for

asthma during 2011 and 2012 respectively.

Children hospitalized for asthma in Georgia during 2012 spent an average of 2.2 days in

the hospital.

The total charges for asthma hospitalizations among children 0-17 years were

approximately $26.7 million, $27.4 million and $40 million for 2010, 2011 and 2012

respectively.

The median total charges for asthma hospital admissions among children 0-17 years

shifted upward from $6,678 in 2010 to $7,757 in 2012 (Fig A2.1).

16

146.0

91.0

78.0

191.0

208.0

143.0

64.0

23.0

144.0

91.0

72.0

191.0 205.0

145.0

61.0

26.0

152.0

94.0 83.0

182.0

200.0

166.0

64.0

27.0

0

50

100

150

200

250

Boys Girls White Black 0-4yrs 5-9yrs 10-14yrs 15-17yrs

Rat

e p

er

10

0,0

00

Race

Fig A2.2. Rate of Asthma Hospitalizations among Children 0-17 years, by Sex, Race, and Age, Georgia 2010-2012

2010 2011 2012

Sex Age

A2.2. Disparities in asthma hospitalizations among children

In Georgia during 2010-2012:

The rate of asthma hospitalizations was higher among boys (average rate of 147/100,000)

than girls (mean rate of 92/100,000) (Fig A2.2).

The rate of asthma hospitalizations was higher among blacks and children 0-4 years of

age (Fig A2.2).

The South Central and DeKalb PHDs had the highest rates of asthma ER visits during

2010-2012 (Maps A2.1).

17

Map A2.1. Rate of Asthma Hospitalizations among Georgia Children Aged 0-17 years, by

Public Health District, 2010-2012

18

Map A2.2. Rate of Asthma Hospitalizations among Georgia Children Aged 0-17 years, by

County of Residence, 2010-2012

19

5.5 6.2

5.3

6.5

3.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Males Females Whites Black Others

Pe

rce

nt

Race

Fig A2.3. Percent Repeat Asthma Hospitalizations among Children 0-17 years, by Sex and Race, Georgia 2012

5.3

6.5

4.6

6.6

4.7

2.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

0-4 yrs 5-11 yrs 12-17 yrs Medicaid Private Self-Pay

Pe

rce

nt

Insurance Type

Fig A2.4. Distribution of Repeat Asthma Hospitalizations among Children 0-17 years, by Age and Insurance type, Georgia 2012

Age

A2.3. Repeat Asthma Hospitalizations among Georgia Children aged 0-17 years

In Georgia during 2012, 2,881 children aged 0-17 years were hospitalized 3,075 times for asthma

during the calendar year.

About 7% (194) of the children hospitalized for asthma in 2012 were hospitalized two or

more times for asthma during the calendar year (repeat).

A repeat asthma hospitalization was higher among girls, black children, Medicaid-insured

and children 5-11 years of age (Figs A2.3 and A2.4).

Sex

20

PART B – ASTHMA IN ADULTS

Asthma Emergency Room Visits and Hospitalizations among Georgia Adults 18 years and

older

Key Findings:

Between 2010 and 2012, a total of 86,167 asthma-related ER visits occurred among

Georgia adults, an average of 28,700 visits per year and at an average rate of 392/100,000

population.

Total charges from adult asthma ER visits increased during 2010-2012, from $49.5

million in 2010 to $60.0 million in 2011 and to $68.1 million in 2012.

Among Georgia adults, the number of asthma-related ER visits was highest among blacks

and females.

Among adults who visited the ER for asthma in 2012, approximately 18% had two or

more ER visits within the year.

Between 2010 and 2012, there were total of 21,946 asthma-related hospitalizations

among adults 18 years and older with asthma listed as the principal diagnosis: 7,436 in

2010; 7,344 in 2011; and 7,166 in 2012.

The rate of asthma hospitalizations among adults was highest among blacks, women, and

those aged 65 years and older.

Of Georgia adults hospitalized for asthma in 2012, about 13% were hospitalized two or

more times during the calendar year.

21

0

40

80

120

160

Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12

Nu

mb

er

of

Dai

ly E

R v

isit

s

Date

Fig B1.1. Daily Asthma ER Visits among Georgia Adults Aged 18 + Years, 2010-2012

2012 2011 2010

B1. Asthma ER Visits

B1.1 Overall asthma ER visit trends among Georgia Adults 18 years and older

In Georgia during 2010-2012, there were three notable periods in each year when the

number of asthma ER visits was high among adults- during April to early May, in mid-

September, and during November through to December (Fig B1.1).

The daily ER visit trend in adults seems to mimic that of children but the peaks were

lower than those observed in children.

The number of daily asthma ER visits among Georgia adults was higher during Sundays

and Mondays (Fig B1.2).

In Georgia during 2010 to 2012, the estimated total charges for asthma ER visits among

adults 18 years and older was $173.6 million; $49.5 for 2010, $60.0 million for 2011, and

$68.1 million for 2012.

The median total charges per adult asthma ER visit shifted upward between 2010 and

2012; from $1,344 in 2010 to $1,491 in 2012 (Fig B1.3).

22

15.3 15.3 14.4 14.5

13.8 13.5 13.3

15.4 15.3 14.8 14.2 13.6 13.1 13.7

15.18 15.5 14.61 14.21 13.63 13.48 13.4

0

5

10

15

20

Sun Mon Tue Wed Thu Fri Sat

Day of the Week

Fig B1.2. Percent Asthma ER Visits among Georgia Adults, 18+ Years, by Day of the Week, 2010-2012

2012 2011 2010

1000

1100

1200

1300

1400

1500

2010 2011 2012

Tota

l Ch

arge

s in

US

Do

llars

Year

Fig B1.3. Median Total Charges Per Visit, Adult Asthma ER Visits, Georgia 2010-2012

.

23

423 320

532

223

882

0

200

400

600

800

1000

Total Males Females White Black

Rat

e p

er

10

0,0

00

Race

Fig B1.4. Rate of Asthma ER Visits among Adults, by Sex and Race, Georgia 2012

573 564 479

438

300

204

0

200

400

600

800

1000

18-24yrs 25-34yrs 35-44yrs 45-54yrs 55-64yrs 65+ yrs

Rat

e p

er

10

0,0

00

Age

Fig B1.5. Rate of Asthma ER Visits among Adults, by Age, Georgia 2012

B1.2. Disparities in Adult Asthma ER visits

The total asthma ER visit rate among adults 18 years and older during 2012 was

430/100,000.

The rate was higher among females (532/100,000) than males (320/100,000), which is in

contrast to the results from children when comparing boys to girls (Fig B1.4).

The rate was almost four times higher among blacks (882/100,000) than whites

(223/100,000). (Fig B1.4).

The rate of asthma ER visits decreased with increasing age among adults (Fig B1.5).

Sex

24

B1.3. Repeat Asthma ER Visits among Adults

In Georgia during 2012:

Approximately 23,300 adults had 31,929 asthma ER visits.

Of adults who visited the ER for asthma, 19,212 (82.5%) had one visit in the calendar

year while the remaining 4,079 (17.5%) had two or more asthma ER visits.

Of those who had repeat asthma ER visits, 39.2% had two visits, 20.5% had three visits,

and 13.1% had four visits, while the remaining 27.6% had five or more visits during the

calendar year (Fig B1.6).

Having repeat asthma ER visits was more common among males, blacks and those 25-34

years of age (Fig B1.8).

Having repeat asthma ER visits was higher among the Medicaid population and those

who indicated as self-paying (Fig B1.9).

One Visit, 82.5%

Repeat, 17.5%

2 Visits, 39.2%

3 Visits, 20.5%

4 Visits, 13.1%

5 or More Visits, 27.6%

Fig B1.6. Percent of Adults with Repeat Asthma ER Visits and the Number of Times

they visited the ER, Georgia, 2012

25

16.3

19.9 18.9 18.5

15.6

10.4

20.4

14.7 13.6

20.1

0.0

5.0

10.0

15.0

20.0

25.0

18-24 25-34 35-44 45-54 55-64 65+ Medicaid Medicare Private Self-Pay

Pe

rce

nt

Insurance Type

Fig B1.8. Percent Repeat Asthma ER Visits among Adults, by Age and Insurance Source, Georgia, 2012

Sex

Age

26

Map B1.1 – Rate of Asthma ER Visits among Georgia Adults 18+ years, by Public Health

District, 2010-2012

27

Map B1.2 – Rate of Asthma ER Visits among Georgia Adults 18+ years, by County of

residence, 2010-2012

28

97

51

139

73

152

66

0

50

100

150

200

250

Total Males Females Whites Black Other

Rat

e p

er

10

0,0

00

Race

Fig B2.1. Rate of Asthma Hospitalizations among Adults, by Sex and Race, Georgia, 2012

B2. Asthma Hospitalizations among Adults

B2.1. Overall trend of asthma hospitalizations among Georgia adults

Between 2010 and 2012, there were a total of 21,946 hospitalizations among adults aged

18 years and older with asthma listed as the principal diagnosis: 7,436 in 2010; 7,344 in

2011; and 7,166 in 2012.

The rate of asthma hospitalizations among adults during; 2010 was 103/100,000, in 2011,

it was 100/100,000, and in 2012, it was 97/100,000.

The asthma hospitalization rate was higher among males, blacks, adults aged 65 years

and older, and residents of rural counties (Fig B2.1 and B2.2).

The rate of asthma hospitalizations among adults was higher in the North Central,

Southwest and Southeast Public Health Districts (Map B2.1).

Sex

29

29

48

70

123 135

176

0

50

100

150

200

18-24 25-34 35-44 45-54 55-64 65+

Rat

e p

er

10

0,0

00

Age

Fig B2.2. Rate of Asthma Hospitalizations among Adults, by Age, Georgia, 2012

Non-Rural County: Any county with 35,000 or more total population per the 2000 Census.

Rural County: Any county with less than 35,000 total populations per the 2000 Census.

30

Map B2.1. Rate of Asthma Hospitalizations (per 100,000) among Georgia Adults Aged 18

years and older, by Public Health District, 2010-2012

31

Map B2.2. Rate of Asthma Hospitalizations (per 100,000) among Georgia Adults Aged 18+

years, by County of Residence, Georgia 2010-2012

32

PART C – ASTHMA MORTALITY

Key findings

Between 2001 and 2011, there were 1,145 asthma-related deaths in Georgia, representing

an age-adjusted asthma mortality rate of 13.0 per 1,000,000 deaths.

Overall, the age-adjusted asthma mortality rate significantly declined between 2001 and

2011 in Georgia.

The age-adjusted asthma mortality rate was significantly higher among blacks than

whites and among females than in males.

33

13 6

16 12

21

0

10

20

30

40

50

Total White Males Black Males WhiteFemales

BlackFemales

Rat

e p

er

1,0

00

,00

0

Sex and Race

Fig C1.1. Age-Adjusted Asthma Mortality Rate, by Race and Sex, 2001-2011

C1.1. Overall age-adjusted asthma mortality rate in Georgia between 2001 and 2011

Between 2001 and 2011, there were 1,145 asthma deaths (60 in children and 1,085 in

adults) in Georgia, representing an age-adjusted asthma mortality rate of 13 per

1,000,000 deaths.

Among children, the annual number of asthma deaths ranged between 1 (in 2004) and 9

(2002 and 2006).

Among adults, the annual number of asthma deaths in Georgia ranged between 79 (in

2009) and 121 (2001).

The age-adjusted asthma mortality rate was significantly higher among females

(14.0/1,000,000; 95% CI=13.0-15.0) than males (10.0/1,000,000; 95% 9.0-10.9).

The overall age-adjusted asthma mortality rate decreased from 18.0 per 1,000,000 in

2001 to 10.0 per 1,000,000 in 2011.

Between 2001 and 2011, the age-adjusted asthma mortality rate for females declined

from 23.0/1,000,000 (95% CI=18.3-27.7) to 10.0 per 1,000,000 (95% CI=7.2-12.8) in

2011. The rate decline was statistically significant.

Among males, the age-adjusted asthma mortality rate remained fairly stable during this

period.

34

0

10

20

30

40

50

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Age

-ad

just

ed

rat

e p

er

1,0

00

,00

0

Year

Fig C1.2. Age-Adjusted Asthma Mortality Rate, by Sex, Georgia 2001-2011

Total Males Females

C1.2. Age-adjusted asthma mortality rates by race

Between 2001 and 2011in Georgia, there were 570 deaths from asthma among whites and

555 asthma deaths among blacks, representing an age-adjusted rate of 9/1,000,000 (95%

CI= 8.3-9.7) and 23.0/1,000,000 (95% CI=21.1-24.9), respectively (Fig C1.3).

The age-adjusted asthma mortality rate among blacks was significantly higher than

whites.

Between 2001 and 2011, the age-adjusted asthma mortality rate for both blacks and

whites significantly decreased. Among whites, the age-adjusted asthma mortality rate of

7/1,000,000 (95% CI=4.9-9.1) in 2011was significantly lower than the age-adjusted

asthma mortality rate of 15.0/1,000,000 (95% CI=11.6-18.3) in 2001. Among blacks, the

age-adjusted asthma mortality rate significantly declined between 2004 (33.0/1,000,000;

95% CI=24.9-41.1) and 2008 (15.0/1,000,000; 95% CI=10.2-19.8).

35

13 9

23

0

10

20

30

40

50

Total White Black

Rat

e p

er

1,0

00

,00

0

Race

Fig C1.3. Age-Adjusted Asthma Mortiality Rate, by Race, Georgia, 2001-2011

0

10

20

30

40

50

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Rat

e p

er

1,0

00

,00

0

Year

Fig C1.4. Age-Adjusted Asthma Mortality Rates, by Race, Georgia, 2001-2011

Total White Black

36

Asthma age-adjusted mortality rates by Health District, 2001-2011

The overall age-adjusted asthma mortality rates during the period from 2001 to 2011

was highest for residents in the Southwest Public District (8-2) at 21 deaths per

100,000, while the lowest overall age-adjusted rate was seen in the North Georgia

Health District (1-2) at a rate of 6 deaths per 1,000,000.

Map C1. Asthma Mortality Rate (per 1, 000,000 deaths), by Health Districts, Georgia 2001-2011

37

Data Sources:

Emergency Room (ER) Visit Data

Emergency room (ER) visit data in this report are based on ER visit data by Georgia residents

who were seen in the ER with asthma as the primary diagnosis. The ICD-9 codes (493.0-493.9)

used to select ER visits. Data included in this report were based on ER visits at non-federal acute

care hospitals in Georgia. Rates were age-adjusted to the 2000 US standard population via the

direct method. ER visit charges may differ from costs. Charges are based on the total charges

reported by the hospital. The amount a hospital is reimbursed is usually less than what is

charged.

Hospital Inpatient Discharge Data

Hospitalization data in this report are based on hospital discharge data for Georgia residents who

were hospitalized for asthma as the primary cause. The ICD-9 codes (493.0-493.9) used to select

hospitalizations due to asthma. We only included information reported by non-federal acute care

hospitals in Georgia. Rates were age-adjusted to the 2000 US standard population via the direct

method. Hospitalization charges may differ from costs. Charges are based on the total charges

reported by the hospital. The amount a hospital is reimbursed is usually less than what is

charged.

Georgia Vital Records Death Data

Mortality data are based on deaths of Georgia residents whose underlying cause of death was

asthma. Deaths from 2001-2011 with ICD-10 codes J45-J46 were selected. Death rates were age-

adjusted to the 2000 US standard population via the direct method.

38

Methods and Technical Notes

Age-Adjusted Rates

A weighted average of the age-specific rates (death, ER visits, or hospitalizations) where the

weights are the proportions of persons in the corresponding age groups of a standard population.

The calculation of an Age-Adjusted Rate uses the year 2000 U.S. standard million.

Using age-adjusted rates controls for differences in age structure between population at different

geographic locations or at a specified time so that observed differences in rates across areas over

time is not due solely to differences in the proportion of people in different age groups in

different areas.

Age-Specific Rates

[Number of death, hospitalizations, or ER visits in a specific age group / Population of same age

group] * 100,000.

Statistical significance

In this report, a result was considered statistically significant if there was no overlap in the 95%

confidence intervals (95% CI) of the percentages being compared.