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California County Asthma Hospitalization Chart Book
California Department of Health Services Environmental Health Investigations Branch
September 2003
California County Asthma Hospitalization
Chart Book
Data from 1998-2000
Gray Davis, Governor Grantland Johnson, Secretary Diana M. Bontá, R.N., Dr.P.H., Director State of California Health and Human Services Agency Department of Health Services
California Department of Health Services Environmental Health Investigations Branch
September 2003
Suggested Citation: Stockman JK, Shaikh N, Von Behren J, Bembom O, Kreutzer R. California County Asthma Hospitalization Chart Book: Data from 1998-2000. Oakland, CA: California Department of Health Services, Environmental Health Investigations Branch, September 2003. Copyright Information: All material in this report is in the public domain and may be reproduced or copied without permission; however, citation as to source is appreciated.
iii
TABLE OF CONTENTS
AUTHORS AND ACKNOWLEDGEMENTS ...........................................................................v
HOW TO USE THIS REPORT ...................................................................................................v
I. INTRODUCTION ....................................................................................................................1
II. METHODS ..............................................................................................................................1
Asthma Hospitalization Rates.................................................................................................. 1 Admission Month..................................................................................................................... 2 Repeat Asthma Hospital Admissions....................................................................................... 2 Median Household Income ...................................................................................................... 2 Length of Stay, Costs, and Insurance....................................................................................... 2
III. RESULTS ...............................................................................................................................3
Asthma Hospitalization Rates.................................................................................................. 3 Admission Month..................................................................................................................... 4 Repeat Asthma Hospital Admissions....................................................................................... 4 Median Household Income ...................................................................................................... 4 Length of Stay, Costs, and Insurance....................................................................................... 4
IV. DISCUSSION .........................................................................................................................5
V. REFERENCES ........................................................................................................................7
APPENDIX I. UNITED STATES 2000 POPULATION ...........................................................9
APPENDIX II. TABLES ...........................................................................................................10
Table 1. Age-Adjusted Asthma Hospitalization Rates in California by County and Race/Ethnicity for All Ages, 1998-2000 ………………..…................................. 10 Table 2. Age-Adjusted Asthma Hospitalization Rates in California Children (Ages 0-14 years) by County and Race/Ethnicity for All Ages, 1998-2000…….. 12 Table 3. Three Year Totals of the Number of Asthma Hospital Discharges by County and Race/Ethnicity for All Ages and Children (Ages 0-14 years), 1998-2000………. 14 Table 4. Age-Adjusted Asthma Hospitalization Rates by Median Household Income, Sex, and Race in California, 2000……………………………………………….. 16
APPENDIX III. FIGURES………………………………………………………………………17
Figure 1. Asthma Hospitalization Rates in California Compared to the United States, 1998-2000………………………………………………………………………... 17 Figure 2. Age-Adjusted Asthma Hospital Discharge Rates for All Races by County, 1998-2000, with 95% Confidence Intervals……………………………………... 18 Figure 3. Age-Adjusted Asthma Hospital Discharge Rates for All Races by County,
1998-2000, with 95% Confidence Intervals……………………………………... 19 Figure 4. Age-Adjusted Asthma Hospital Discharge Rates for Blacks by County,
1998-2000, with 95% Confidence Intervals........................................................... 20 Figure 5. Age-Adjusted Asthma Hospital Discharge Rates for Hispanics by County,
1998-2000, with 95% Confidence Intervals…………………………………....…21
iv
Figure 6. Age-Adjusted Asthma Hospital Discharge Rates for Asian/Pacific Islanders by County, 1998-2000, with 95% Confidence Intervals.….…….…………………22
Figure 7. Age-Adjusted Asthma Hospital Discharge Rates for Children (Ages 0-14 yrs) for All Races, by County, 1998-2000, with 95% Confidence Intervals…….…..… 23
Figure 8. Age-Adjusted Asthma Hospital Discharge Rates for Non-Hispanic White Children (Ages 0-14 years) by County, 1998-2000,
with 95% Confidence Intervals……………………………………………………. 24 Figure 9. Age-Adjusted Asthma Hospital Discharge Rates for Black Children (Ages 0-14 years) by County, 1998-2000, with 95% Confidence Intervals…....... 25 Figure 10. Age-Adjusted Asthma Hospital Discharge Rates for Hispanic Children
(Ages 0-14 years) by County, 1998-2000, with 95% Confidence Intervals….....… 26 Figure 11. Age-Adjusted Asthma Hospital Discharge Rates for Asian/Pacific Islander
Children (Ages 0-14 years) by County, 1998-2000, with 95% Confidence Intervals….............................................................................................................. ..27
Figure 12. Mean Number of Asthma-Related Hospitalizations per Month for All Ages and for Children (Ages 0-14 years) in California, 1998-2000.……………….....… 28
Figure 13. Percent of Repeat Asthma Hospital Admissions by Gender and Race/Ethnicity For Adults (Ages 18+ years) in California, 2000……….………………………… 29 Figure 14. Mean Length of Stay in Days for Asthma Hospital Admissions for Adults (Ages >14 years) and for Children (Ages 0-14 years) by Race/Ethnicity, 1998-2000....... 30 Figure 15. Mean Total Charges Incurred from Asthma Hospital Admissions for Adults (Ages >14 years) and for Children (Ages 0-14 years) by Race/Ethnicity, 1998-2000…………………………………………………………………………. 31
APPENDIX IV. MAPS
Map 1. California Counties…………………………………………………………… ... .. 33 Map 2. Age-Adjusted Asthma Hospitalization Rates, 1998-2000. All Ages…………...... . 34 Map 3. Age-Adjusted Asthma Hospitalization Rates, 1998-2000.
Children, Ages 0-14 years…………………………………………………………. 35
v
AUTHORS AND ACKNOWLEDGEMENTS This report was developed and prepared by Jamila K. Stockman, Nazerah Shaikh, Julie Von Behren, and Richard Kreutzer of the Environmental Health Investigations Branch (EHIB) of the California Department of Health Services. The maps were produced by Oliver Bembom, University of California, Berkeley. This work was supported in part by the Centers for Disease Control and Prevention grant # U59/CCU922471-01-2.
HOW TO USE THIS REPORT
This report presents asthma hospitalization rates in California counties for 1998 through 2000. This report is intended to provide information to counties on progress toward achieving the national Healthy People 2000 objective of reduced asthma hospitalizations. Rates are shown separately by race/ethnicity and for children (0 to 14 years) to help county health officials identify populations most at risk for severe asthma morbidity. Individual county data are presented in tables and figures. Hospitalization rates are not indicators of asthma prevalence, or current asthma. Asthma is a chronic disorder that can present on a spectrum of severity. Hospitalization rates measure an infrequent, severe outcome of this disorder. Please contact the California Department of Health Services, Environmental Health Investigations Branch at 510-622-4500 for assistance with data interpretation and more information about additional data available for your area. Also, please visit our website at www.californiabreathing.org.
vi
California Department of Health Services 1
I. INTRODUCTION
Asthma is a chronic inflammatory lung disorder characterized by recurrent episodes of breathlessness, wheezing, coughing, and chest tightness, called exacerbations. Asthma prevalence increased dramatically during the last two decades.1 In 2001, an estimated 3.9 million Californian adults and children reported that they had been diagnosed with asthma at some time in their life.2 Nationwide asthma hospital admissions have gradually declined since the mid-1980s.3 However, rates among blacks have remained much higher than the rates for other racial groups and the rates among children are much higher than other age groups.4 Every year about 40,000 Californians are hospitalized because of asthma. This report examines county variations in asthma hospitalization rates in California. Information on asthma hospitalization rates in California compared to the United States and progress toward meeting the Healthy People 2000 objective of reduced asthma hospitalizations are also presented.
II. METHODS
Asthma Hospitalization Rates
Data for hospital discharges from 1998 through 2000 were obtained from the Patient Discharge Database, maintained by the California Office of Statewide Health Planning and Development (OSHPD). These computerized records included all hospital discharges in California, except from federal facilities.5 This database contains demographic information on each patient discharged, including age, gender, race, and zip code of residence. The zip code of each patient was used to assign county of residence. Additional data elements include principal diagnosis, other diagnoses, admission month, length of stay, principal medical procedure performed, disposition of patient, expected source of payment, and total charges. All discharges with asthma as the primary diagnosis were selected, based on the ninth revision of the International Classification of Diseases (ICD-9), code 493.6 Three years of data were combined to provide more stable estimates in sparsely populated counties. Rates were calculated by gender, race, age, and county using yearly population estimates provided by the California Department of Finance.7 Four race/ethnicity groups were used: Non-Hispanic White, Black, Hispanic (of any race), and Asian/Pacific Islander. Individuals with a race/ethnicity of ‘other,’ ‘unknown,’ or ‘American Indian’ were excluded from race-specific calculations but included in the overall estimates. County rates were age-adjusted (using the direct method) to the 2000 U.S. population obtained from the United States Census Bureau (Appendix A).8 Twelve age groups were used: 0 - 24 years in 5-year age intervals, 25 - 84 years in 10-year age intervals, and over 84 years. The 95% confidence intervals were calculated for age-adjusted rates using a square root transformation assuming a Poisson distribution.9 We caution that overlapping 95% confidence intervals are not a statistical test to determine significance of the difference between county rates.10 Data were analyzed using SAS (version 8.2).11 All statistically significant differences are based on p-values less than 0.05.
2 California Department of Health Services
For some sparsely-populated counties and some race/ethnicity groups, rates were based on small numbers and were unstable. These rates were omitted from tables when the number of hospital discharges for a stratum was less than 30.12 Admission Month
The number of asthma hospitalizations per month was analyzed to present a seasonal pattern of asthma hospitalizations. Admission month was defined as the month of the year the patient was admitted to the hospital. Repeat Asthma Hospital Admissions
To determine the percent of repeat asthma hospital admissions, we analyzed the ‘record linkage number’ – a unique patient identification number, derived from the Social Security Number, used to link records for the same patient. Median Household Income
Asthma hospitalization rates were analyzed by the median household income quartiles of the patient’s five-digit zip code of residence. Information on population characteristics by five-digit zip code (i.e., each zip code’s population by age, sex, race, and median household income) was abstracted from the U.S. Census 2000 website. Data from the U.S. Census 2000 file was matched to the five-digit zip code of the residence for each hospital discharge in 2000. The rate of hospitalization was calculated for five-digit zip code areas within each median income quartile for the state. Rate calculations were based on statewide population estimates from the U.S. Census 2000 and age-adjusted to the U.S. Census 2000 Population.
Length of Stay, Costs, and Insurance
Additional variables were examined to give a larger picture of the hospitalization data. These variables were ‘length of stay’ – the time spent in the hospital for each individual hospitalization given in days; ‘total charges’ – the total charges associated with each hospitalization; and ‘expected principal source of payment’ – the source from which the hospital expected to receive payment for charges incurred from the hospitalization. It is important to note for the total charges estimates that not all hospitals report charges to OSHPD. Kaiser Foundation and Shriner’s Hospitals are exempt from reporting charges. The expected source of payment as given in the database is divided into fourteen categories. For the purposes of this analysis they have been grouped as follows:
• Medicare = Medicare (including Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO))
• Medi-Cal = Medi-Cal (including HMO and PPO) • Private Insurance = private insurance company, HMO, PPO, Blue Cross/Blue Shield; Self
Pay • Other = worker’s compensation, county indigent program, CHAMPUS/CHAMPVA/VA,
other governmental, charity care, no charge, and other nongovernmental sources
California Department of Health Services 3
III. RESULTS
Asthma Hospitalization Rates
Comparing U.S. and California age-adjusted asthma hospital discharge rates for the year 2000 (the last year for which data were analyzed) showed that California had lower asthma hospitalization rates among all ages (Figure 1). Similar to national trends, female Californians had higher asthma hospitalization rates than males (all ages combined). Non-Hispanic Whites and Blacks in California had slightly lower asthma hospital discharge rates compared to the national rates. In California and the U.S., the asthma hospital discharge rate for Blacks was over three times higher than the rate for Non-Hispanic Whites. The overall age-adjusted asthma hospital discharge rate in California from 1998 through 2000 was 11.11 per 10,000 residents (Table 1). Rates varied by gender, race, age group, and county. For all ages combined, hospitalization rates were higher for females (12.83 per 10,000) than males (9.24 per 10,000). Among children, 0 to 14 years of age, rates were higher for males (22.43 per 10,000) than females (13.07 per 10,000). The overall hospital discharge rate for Blacks was 33.01 per 10,000, three times higher than that of Non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders. Children (all races combined), 0 to 4 years of age had the highest asthma hospitalization rate (29.73 per 10,000). Table 1 presents age-adjusted asthma hospitalization rates by county and race/ethnicity for all ages. County-specific asthma hospitalization rates for children 0 to 14 years of age are presented separately in Table 2 because children are a population of specific concern for asthma morbidity. Figures 2 through 11 illustrate the same data with counties ranked from lowest to highest by asthma hospitalization rates. The figures include 95% confidence intervals, the state asthma hospital discharge rates, and Healthy People 2000 objectives. Table 3 shows the counts of asthma hospitalizations by county and race/ethnicity for all ages and separately for children. Maps 2 and 3 show counties shaded according to their asthma hospitalization rate for all ages and separately for children 0 to 14 years of age. If a county asthma hospitalization rate is significantly higher than the state, it is indicated by a star ( ). Among all ages, several counties had race-specific rates that exceeded the state rate. Alameda County had an elevated rate for all race/ethnicity groups combined as well as for race-specific analyses. Fresno, Imperial, Kings, Los Angeles, San Bernardino, San Joaquin, and Tulare Counties had at least three race/ethnicity groups with higher rates of asthma-related hospitalizations compared to the state rate. Imperial County had the highest county-specific rates of asthma hospitalizations for all race/ethnicity groups examined, with the exception of Asian/Pacific Islanders. Although Sutter County had the highest rate for Asian/Pacific Islanders, it is important to note that the number of asthma hospitalizations was small and the 95% confidence interval was wide, indicating instability in the calculated rates. Among all race/ethnicity groups, the asthma hospitalization rates of individual counties were well below the Healthy People 2000 target rate of 16.0 per 10,000 residents, with the exception of Alameda and Imperial Counties. County asthma hospitalization rates for Non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders were also well below the Healthy People 2000 target rate of 26.5 per 10,000. However, county asthma hospitalization rates for Blacks exceeded this target rate.
4 California Department of Health Services
Among children 0 to 14 years of age, Imperial and Alameda Counties had the most elevated rate for all race/ethnicity groups combined. Imperial County had the highest rate for Non-Hispanic White and Hispanic children whereas Alameda County had the highest rate for Blacks and Asian/Pacific Islander children. Among all race/ethnicity groups, the county asthma hospitalization rates were well below the Healthy People 2000 target (22.50 per 10,000), with the exception of San Bernardino, Alameda, and Imperial Counties. County asthma hospitalization rates for Non-Hispanic White and Hispanic children were below the Healthy People 2000 target, with the exception of Imperial County. County rates for Black children were well above the Healthy People 2000 target, whereas county rates for Asian/Pacific Islander children were well below the Healthy People 2000 target. There were also several counties that had lower rates than the state asthma-related hospitalization rate. Among all ages, Orange and San Diego Counties had lower rates than California in all race/ethnicity groups combined and for race-specific analyses. Among children, Orange, Sacramento, San Diego, and Santa Clara Counties had lower rates than California in all race/ethnicity groups combined as well as for race-specific analyses.
Admission Month
Between 1998-2000, a seasonal variation of asthma-related hospitalizations was observed (Figure 12). Among all ages and children 0 to 14 years of age, most of the asthma-related admissions occurred in the fall and early winter months, with the fewest in the summer months. Repeat Asthma Hospital Admissions
Between 1998-2000, the percent of repeat asthma hospital admissions overall and by gender and race/ethnicity were similar for each year so results are presented for 2000, the last year for which data were analyzed (Figure 13). Adults (18 years of age and older) with repeat asthma hospital admissions accounted for 17.8% of the total hospital stays. Of 20,518 adult asthma hospitalizations, men and women displayed similar proportions of repeat asthma hospital admissions (17% and 18%, respectively). Black adults accounted for the highest proportion experiencing repeat asthma hospital admissions (24.7%) and Non-Hispanic Whites had the lowest proportion (15.3%). Hispanic and Asian/Pacific Islander adults had similar proportions of repeat admissions (18.6% and 17.9%, respectively). The record linkage number was missing for 3% of adults and 36% of children, so percent of repeat asthma hospital admissions were not calculated for children. Median Household Income
After controlling for socioeconomic status, significant differences in asthma hospitalization rates by race persisted. In the year 2000, Black males and females were hospitalized three times more than their Non-Black counterparts (including Non-Hispanic Whites, Hispanics, Asians, American Indians, and others) regardless of neighborhood income level (Table 4). Length of Stay, Costs, and Insurance
On the average, adults with a primary diagnosis of asthma had longer hospital stays than children. The mean number of days spent in the hospital for asthma was 3.85 days among adults and 2.38
California Department of Health Services 5
days among children; a statistically significant difference. Among adults (14 years of age and older), the average number of days spent in the hospital for asthma was significantly different between Non-Hispanic Whites and Blacks, as well as Asians compared to all other race/ethnicity groups. Among children (ages 0 to 14 years), the average length of stay among Hispanics and Blacks was significantly different from that of Asians and Non-Hispanic Whites (Figure 14). In the year 2000, the total charges incurred from asthma hospitalizations in California were $480 million (excluding Kaiser and Shriner’s hospitals as previously noted). A quarter of this cost was for children under 15 years of age ($126 million). Between 1998-2000, the mean total charges incurred from an asthma hospitalization were approximately $14,400 for adults and $8,100 for children; a statistically significant difference. Among adults (14 years of age and older), the only statistically significant difference for average total charges was observed between Blacks and Hispanics. Among children (ages 0 to 14 years), a significant difference was observed between Hispanics and Non-Hispanic Whites (Figure 15). In the year 2000, private insurance, Medi-Cal, and Medicare accounted for most of the expected source of payment for the asthma hospital stays for all ages. Non-Hispanic Whites that were hospitalized for asthma accounted for about half of the private insurance payments. Of 12,683 asthma hospitalizations with an expected payment of Medi-Cal, the race/ethnicity groups with the highest proportions were Hispanics (37.8%) and Blacks (28.1%). Among adults 65 years of age and older, approximately one third as many Hispanics, one fourth as many Asian/Pacific Islanders and one sixth as many Blacks reported having Medicare compared to Non-Hispanic Whites. Of 15,808 childhood asthma hospitalizations, 51.6% were paid for by private insurance and 45.1% were paid for by Medi-Cal.
IV. DISCUSSION
Although asthma hospitalization rates have decreased over the last decade, significant racial disparities in the rates remain. Blacks continue to have much higher rates than all other race/ethnicity groups analyzed, even after controlling for socioeconomic status. Similar results were observed in a study conducted by Ray et al.,13 the main difference being that the current analysis was asthma hospitalization rates in California by median household income by five-digit zip code, rather than three-digit zip code. Similarly, children continue to have increased asthma hospital discharge rates. This highlights the need for interventions targeted toward Blacks and children throughout the state. Large variations in asthma hospitalization rates exist among counties. Imperial County had the highest county-specific asthma hospitalization rates for all race/ethnicity groups among all ages and for most race/ethnicity groups among children. In Imperial County, the high asthma hospitalization rates among children may be partially related to high levels of poverty and poor air quality conditions.14 Many other counties, including Alameda, Fresno, Kings, Los Angeles, San Bernardino, and San Joaquin had several groups with higher rates of asthma-related hospitalizations compared to the state rate. Some counties had low rates, such as Orange and San Diego. The counties with the highest asthma hospitalization rates were not the counties with the highest estimated asthma prevalence rates (based on the California Health Interview Survey).2 Many
6 California Department of Health Services
factors influence county asthma hospitalization rates other than prevalence, including but not limited to the following: racial composition, access to preventive medical care, appropriateness of medication, insurance status, poverty levels, quality of housing, other indoor environments, and outdoor air quality. Asthma hospitalizations occur only for the most severe episodes of this disease, but they continue to place a large economic burden on the state, over $480 million annually. The cost associated with each asthma-related hospital stay was influenced by age. For children, the total charges incurred per hospital stay are approximately one-half that of adults. This correlated with fewer total days spent per hospital admission for children. Analysis and interpretation of the data at a population level presented certain limitations. Incorrect diagnosis and inconsistent coding could have affected the overall estimates. The race-specific rates presented in this analysis were underestimated because cases with missing race information or race coded as “other” or “unknown” were excluded from these calculations. Also, misclassification of race/ethnicity groups could have occurred in both the hospital discharge database and the population estimates resulting in altered race-specific rates. Differences in rates could be explained wholly or in part by factors that would have influenced the numerator such as changes in outpatient care, hospital admission practices, health care financing, and small number of asthma hospitalizations. Further, the population estimates used in the denominator for all rates calculated are not always accurate. Also, large variations in rates may exist among different communities in the same county. Despite these limitations, the hospitalization data had a number of strengths. The analysis was conducted at a population level. Also, the hospital discharge rates were age-adjusted to the 2000 U.S. population, which eliminated any differences in observed rates that could have resulted from age differences in the population. Finally, the analysis used a statewide hospital discharge database, which allowed the calculation of statewide and county-level asthma hospital discharge rates to describe demographic patterns in California. Using the information presented, we are able to conclude that California has met the Healthy People 2000 objective of reduced asthma hospitalizations for all ages and children 0 to 14 years of age, with the exception of Blacks and select counties. Healthy People 2010’s objective of reduced asthma hospitalizations is even lower. We will continue to track our progress toward meeting this objective. Hospitalization data continue to provide a useful source of information for surveillance of asthma. By targeting interventions to populations most at risk for severe asthma morbidity, as measured by hospitalizations, California can reduce the burden and huge costs associated with this largely preventable outcome.
California Department of Health Services 7
V. REFERENCES 1. Mannino DM, Homa D, Pertowski CA, et. al., Surveillance for asthma — United States, 1960–1995. In: Centers for Disease Control and Prevention Surveillance Summaries. MMWR. 1998;47 (No. SS-1).
2. Brown ER, Ying-Ying M, Babey SH, et al. Asthma in California in 2001: High rates affect most population groups. Los Angeles: California Health Interview Survey Policy Brief, UCLA Center for Health Policy Research, May 2002.
3. Mannino DM, Homa D, Pertowski CA, et. al. Surveillance for asthma — United States, 1980–1999. In: Centers for Disease Control and Prevention Surveillance Summaries. MMWR. 2002;51 (No. SS-1).
4. California Department of Health Services, Environmental Health Investigations Branch. California County Asthma Hospitalization Chart Book. 2000;Technical Report. Oakland, CA.
5. Office of Statewide Health Planning and Development. Hospital Discharge Database. Patient Discharge Data Program, Sacramento, CA.
6. U.S. Department of Health and Human Services. The International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM. Third Edition. DHHS Publication
No. (PHS) 89-1260. 1989.
7. State of California, Department of Finance. Race/Ethnic Population Estimates with Age and Sex Detail. 1970-2040. Sacramento, CA. December 1998.
8. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, MD: National Center for Health Statistics. January 2001.
9. Miettinen OS. Theoretical Epidemiology. New York, John Wiley and Sons. 1985.
10. Schenker N, Gentleman JF. On judging the significance of differences by examining the overlap between confidence intervals. The American Statistician. August 2001;55 (No. 3).
11. SAS Institute, Inc. Version 8.2. Cary, NC: SAS Institute Inc., 2002.
12. Klein RJ, Proctor SE, Boudreault MA, et al. Healthy People 2010 criteria for data suppression. Statistical Notes, no. 24. Hyattsville, MD: National Center for Health Statistics. June 2002.
13. Ray NF, Thamer M, Fadillioglu B, et al. Race, income, urbanicity, and asthma hospitalization in California: a small area analysis. Chest. 1998 May; 113(5):1277-84.
14. English PB, Von Behren J, Harnly M, et al. Childhood asthma along the United States/Mexico border: hospitalizations and air quality in two California counties. Pan Am J Public Health 1998;3(6).
8 California Department of Health Services
California Department of Health Services 9
APPENDIX I. UNITED STATES 2000 POPULATION United States Census Bureau Population Estimates for the U.S. in 2000, used for age-adjusting rates.
Age Group Population Estimate 0-4 18,987,000 5-9 19,920,000 10-14 20,057,000 15-19 19,820,000 20-24 18,257,000 25-34 37,233,000 35-44 44,659,000 45-54 37,030,000 55-64 23,961,000 65-74 18,136,000 75-84 12,315,000 85+ 4,259,000 TOTAL 274,634,000
APPENDIX II. TABLES
County Annual Rate
Annual Rate
Annual Rate
Annual Rate
Annual Rate
CALIFORNIA 11.11 (11.00 - 11.22) 9.48 (9.34 - 9.63) 33.01 (32.26 - 33.77) 10.25 (10.04 - 10.47) 7.82 (7.54 - 8.11)
Alameda 17.92 (17.24 - 18.62) 11.06 (10.25 - 11.90) 43.07 (40.50 - 45.71) 11.66 (10.30 - 13.11) 10.97 (9.77 - 12.25)
Alpine ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Amador 8.79 (5.17 - 13.36) 9.16 (5.05 - 14.48) ** ** ** ** ** ** ** ** **
Butte 10.50 (9.13 - 11.97) 10.61 (9.09 - 12.23) ** ** ** 9.26 (3.96 - 16.79) ** ** **
Calaveras 9.78 (6.71 - 13.44) 10.36 (7.01 - 14.35) ** ** ** ** ** ** ** ** **
Colusa 11.07 (6.14 - 17.45) 16.05 (8.23 - 26.45) ** ** ** 9.90 (3.21 - 20.27) ** ** **
Contra Costa 12.85 (12.13 - 13.60) 9.47 (8.70 - 10.28) 37.88 (33.78 - 42.22) 10.94 (9.08 - 12.98) 9.79 (7.84 - 11.96)
Del Norte 6.94 (3.83 - 10.97) 8.07 (4.25 - 13.12) ** ** ** ** ** ** ** ** **
El Dorado 6.43 (5.23 - 7.76) 6.45 (5.16 - 7.87) ** ** ** ** ** ** ** ** **
Fresno 11.19 (10.45 - 11.94) 9.37 (8.39 - 10.40) 38.68 (32.46 - 45.45) 11.12 (9.86 - 12.45) 4.66 (3.16 - 6.45)
Glenn 9.59 (6.01 - 14.01) 11.72 (6.67 - 18.17) ** ** ** ** ** ** ** ** **
Humboldt 8.97 (7.40 - 10.70) 8.62 (6.96 - 10.46) ** ** ** ** ** ** ** ** **
Imperial 19.56 (17.32 - 21.94) 21.55 (16.60 - 27.14) 62.63 (35.32 - 97.70) 19.29 (16.57 - 22.21) ** ** **
Inyo 11.21 (5.55 - 18.85) 11.56 (4.99 - 20.85) ** ** ** ** ** ** ** ** **
Kern 8.74 (8.04 - 9.48) 10.61 (9.60 - 11.68) 21.58 (17.03 - 26.68) 5.34 (4.23 - 6.58) ** ** **
Kings 14.13 (12.03 - 16.39) 11.70 (9.07 - 14.68) 39.23 (23.12 - 59.56) 17.76 (13.48 - 22.63) ** ** **
Lake 13.49 (10.54 - 16.79) 12.75 (9.50 - 16.48) ** ** ** ** ** ** ** ** **
Lassen 7.29 (4.23 - 11.19) 8.62 (4.93 - 13.33) ** ** ** ** ** ** ** ** **
Los Angeles 12.50 (12.27 - 12.73) 10.53 (10.17 - 10.91) 32.85 (31.69 - 34.03) 11.53 (11.17 - 11.88) 7.59 (7.10 - 8.09)
Madera 9.78 (8.06 - 11.67) 8.25 (6.15 - 10.66) 39.76 (21.49 - 63.62) 10.85 (7.92 - 14.25) ** ** **
Marin 6.28 (5.30 - 7.35) 5.76 (4.70 - 6.93) 25.54 (12.79 - 42.64) 7.40 (3.99 - 11.84) ** ** **
Mariposa 9.98 (5.53 - 15.73) 11.33 (6.09 - 18.19) ** ** ** ** ** ** ** ** **
Mendocino 10.07 (8.05 - 12.32) 11.09 (8.47 - 14.05) ** ** ** ** ** ** ** ** **
Merced 8.97 (7.71 - 10.33) 8.55 (6.86 - 10.44) 37.23 (21.90 - 56.62) 10.00 (7.52 - 12.85) ** ** **
Modoc ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Mono ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Monterey 9.84 (8.88 - 10.86) 8.96 (7.62 - 10.41) 19.01 (12.01 - 27.60) 9.87 (8.09 - 11.84) 13.80 (9.60 - 18.75)
Napa 6.77 (5.37 - 8.32) 6.94 (5.19 - 8.94) ** ** ** 8.29 (3.34 - 15.45) ** ** **
Nevada 5.47 (3.91 - 7.28) 5.63 (3.98 - 7.55) ** ** ** ** ** ** ** ** **
Orange 7.56 (7.24 - 7.89) 8.35 (7.89 - 8.81) 18.16 (14.03 - 22.81) 6.14 (5.51 - 6.80) 6.05 (5.24 - 6.92)
Placer 5.56 (4.64 - 6.56) 5.67 (4.67 - 6.75) ** ** ** ** ** ** ** ** **
Plumas 15.64 (9.96 - 22.60) 14.82 (8.63 - 22.68) ** ** ** ** ** ** ** ** **
95% CI
Hispanic
95% CI
White
Black
Table 1: Age-Adjusted Asthma Hospitalization Rates* in California by County and Race/Ethnicity for All Ages, 1998-2000.
95% CI
Non-Hispanic
Pacific Islander
95% CI
Total
95% CI
Asian/
10 California Department of Health Services
Appendix II
County Annual Rate
Annual Rate
Annual Rate
Annual Rate
Annual Rate
95% CI
Hispanic
95% CI
White
Black
Table 1: Age-Adjusted Asthma Hospitalization Rates* in California by County and Race/Ethnicity for All Ages, 1998-2000.
95% CI
Non-Hispanic
Pacific Islander
95% CI
Total
95% CI
Asian/
Riverside 12.66 (12.09 - 13.23) 11.45 (10.76 - 12.17) 37.85 (33.57 - 42.40) 11.26 (10.16 - 12.40) 7.05 (5.03 - 9.42)
Sacramento 11.84 (11.23 - 12.47) 9.51 (8.83 - 10.21) 29.38 (26.19 - 32.76) 10.60 (8.93 - 12.41) 9.51 (7.87 - 11.30)
San Benito 5.41 (3.37 - 7.92) 6.98 (3.46 - 11.71) ** ** ** ** ** ** ** ** **
San Bernardino 15.28 (14.68 - 15.89) 13.11 (12.37 - 13.87) 43.85 (40.13 - 47.74) 13.46 (12.36 - 14.61) 7.72 (5.74 - 10.01)
San Diego 8.61 (8.27 - 8.96) 7.34 (6.93 - 7.75) 23.82 (21.27 - 26.52) 8.18 (7.44 - 8.94) 7.57 (6.50 - 8.73)
San Francisco 12.17 (11.40 - 12.98) 9.39 (8.20 - 10.66) 34.24 (30.27 - 38.46) 10.51 (8.76 - 12.42) 8.39 (7.30 - 9.55)
San Joaquin 13.69 (12.73 - 14.67) 13.11 (11.86 - 14.43) 39.90 (32.89 - 47.59) 10.75 (9.01 - 12.64) 10.31 (8.07 - 12.81)
San Luis Obispo 6.06 (5.11 - 7.09) 6.08 (5.02 - 7.24) ** ** ** 5.52 (2.82 - 9.12) ** ** **
San Mateo 7.85 (7.22 - 8.50) 7.45 (6.57 - 8.38) 25.21 (19.72 - 31.36) 6.71 (5.39 - 8.17) 8.05 (6.63 - 9.61)
Santa Barbara 5.48 (4.78 - 6.22) 5.41 (4.51 - 6.38) 14.85 (7.43 - 24.81) 5.98 (4.55 - 7.61) ** ** **
Santa Clara 8.10 (7.68 - 8.53) 7.09 (6.52 - 7.68) 19.64 (15.76 - 23.94) 9.37 (8.38 - 10.42) 7.86 (6.99 - 8.79)
Santa Cruz 6.44 (5.49 - 7.46) 6.90 (5.72 - 8.19) ** ** ** 6.89 (4.46 - 9.84) ** ** **
Shasta 11.15 (9.62 - 12.81) 11.86 (10.18 - 13.67) ** ** ** ** ** ** ** ** **
Sierra ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Siskiyou 8.54 (5.15 - 12.79) 8.85 (5.56 - 12.89) ** ** ** ** ** ** ** ** **
Solano 12.80 (11.69 - 13.95) 10.76 (9.43 - 12.19) 26.09 (21.69 - 30.90) 8.60 (6.22 - 11.37) 11.21 (8.36 - 14.47)
Sonoma 6.77 (6.03 - 7.55) 6.75 (5.92 - 7.63) 33.78 (18.57 - 53.49) 5.21 (3.05 - 7.95) ** ** **
Stanislaus 9.75 (8.85 - 10.70) 10.50 (9.36 - 11.71) 45.34 (30.07 - 63.72) 6.50 (4.81 - 8.44) 7.74 (4.11 - 12.51)
Sutter 12.79 (10.38 - 15.44) 12.61 (9.73 - 15.87) ** ** ** 10.86 (4.69 - 19.58) 20.64 (12.47 - 30.84)
Tehama 11.42 (8.68 - 14.54) 13.06 (9.82 - 16.75) ** ** ** ** ** ** ** ** **
Trinity 15.67 (8.07 - 25.76) 15.83 (8.16 - 26.02) ** ** ** ** ** ** ** ** **
Tulare 9.63 (8.64 - 10.67) 9.95 (8.54 - 11.47) 39.89 (21.53 - 63.87) 8.98 (7.43 - 10.69) 11.87 (6.27 - 19.24)
Tuolumne 7.24 (4.92 - 10.02) 7.78 (5.19 - 10.89) ** ** ** ** ** ** ** ** **
Ventura 9.76 (9.06 - 10.49) 9.25 (8.37 - 10.16) 24.61 (16.53 - 34.28) 11.11 (9.65 - 12.67) 7.60 (4.86 - 10.94)
Yolo 9.15 (7.69 - 10.74) 9.02 (7.25 - 11.00) ** ** ** 11.73 (7.70 - 16.60) ** ** **
Yuba 13.57 (10.75 - 16.72) 15.66 (12.03 - 19.76) ** ** ** ** ** ** ** ** **
CI = Confidence Interval, a measure of statistical uncertainty.
* Rates were calculated per 10,000 residents and age-adjusted to the 2000 U.S. population.
** Rate not presented if the number of cases was less than thirty.
California Department of Health Services 11
Appendix II
County Annual Rate
Annual Rate
Annual Rate
Annual Rate
Annual Rate
CALIFORNIA 18.09 (17.80 - 18.38) 14.90 (14.48 - 15.33) 57.62 (55.72 - 59.57) 14.93 (14.52 - 15.35) 9.73 (9.10 - 10.38)
Alameda 37.93 (35.84 - 40.09) 17.67 (15.30 - 20.20) 96.78 (89.22 - 104.64) 23.92 (20.58 - 27.51) 17.75 (14.72 - 21.06)
Alpine ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Amador ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Butte 18.28 (14.37 - 22.65) 18.16 (13.72 - 23.23) ** ** ** ** ** ** ** ** **
Calaveras ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Colusa ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Contra Costa 21.14 (19.16 - 23.21) 12.91 (10.86 - 15.14) 62.66 (52.78 - 73.37) 15.50 (11.84 - 19.67) 13.79 (9.69 - 18.61)
Del Norte ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
El Dorado 6.67 (4.13 - 9.81) 6.47 (3.75 - 9.93) ** ** ** ** ** ** ** ** **
Fresno 23.30 (21.32 - 25.37) 16.37 (13.48 - 19.54) 73.37 (59.12 - 89.17) 23.63 (20.77 - 26.67) 9.84 (6.60 - 13.73)
Glenn ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Humboldt 12.71 (8.70 - 17.47) 12.94 (8.44 - 18.41) ** ** ** ** ** ** ** ** **
Imperial 52.43 (45.59 - 59.74) 52.87 (35.41 - 73.82) ** ** ** 50.44 (43.08 - 58.37) ** ** **
Inyo ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Kern 16.07 (14.26 - 17.99) 22.72 (19.55 - 26.12) 48.22 (36.27 - 61.85) 5.88 (4.30 - 7.72) ** ** **
Kings 16.06 (11.99 - 20.74) 11.89 (6.82 - 18.36) ** ** ** 16.91 (10.93 - 24.18) ** ** **
Lake 18.94 (11.27 - 28.59) 22.70 (11.80 - 37.14) ** ** ** ** ** ** ** ** **
Lassen ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Los Angeles 19.44 (18.89 - 20.00) 16.58 (15.47 - 17.72) 57.92 (54.87 - 61.05) 15.14 (14.51 - 15.79) 9.90 (8.73 - 11.16)
Madera 18.32 (13.77 - 23.51) 16.94 (10.39 - 25.09) ** ** ** 17.58 (11.64 - 24.74) ** ** **
Marin 11.72 (8.71 - 15.18) 10.05 (6.83 - 13.88) ** ** ** 16.57 (5.94 - 32.54) ** ** **
Mariposa ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Mendocino 9.52 (5.32 - 14.95) 10.43 (4.44 - 18.95) ** ** ** ** ** ** ** ** **
Merced 12.22 (9.59 - 15.17) 13.35 (8.96 - 18.62) 47.18 (23.63 - 78.80) 10.89 (7.29 - 15.22) ** ** **
Modoc ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Mono ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Monterey 14.55 (12.30 - 16.98) 14.41 (10.68 - 18.70) ** ** ** 12.74 (9.93 - 15.90) ** ** **
Napa 9.48 (6.01 - 13.75) 8.66 (4.33 - 14.47) ** ** ** ** ** ** ** ** **
Nevada 7.42 (3.59 - 12.62) ** ** ** ** ** ** ** ** ** ** ** **
Orange 11.82 (11.02 - 12.66) 14.11 (12.77 - 15.52) 33.31 (23.95 - 44.19) 9.55 (8.43 - 10.74) 5.92 (4.41 - 7.64)
Placer 7.97 (5.70 - 10.62) 8.00 (5.52 - 10.93) ** ** ** ** ** ** ** ** **
Plumas ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Riverside 22.36 (20.89 - 23.88) 19.09 (17.12 - 21.17) 74.42 (63.68 - 85.99) 19.31 (17.20 - 21.55) 8.79 (4.62 - 14.29)
Pacific Islander
95% CI 95% CI 95% CI 95% CI 95% CI
White
Table 2: Age-Adjusted Asthma Hospitalization Rates* in California Children (Ages 0-14 years) by County and Race/Ethnicity, 1998-2000.
Total Non-Hispanic Black Hispanic Asian/
12 California Department of Health Services
Appendix II
County Annual Rate
Annual Rate
Annual Rate
Annual Rate
Annual Rate
Pacific Islander
95% CI 95% CI 95% CI 95% CI 95% CI
White
Table 2: Age-Adjusted Asthma Hospitalization Rates* in California Children (Ages 0-14 years) by County and Race/Ethnicity, 1998-2000.
Total Non-Hispanic Black Hispanic Asian/
Sacramento 15.79 (14.36 - 17.30) 11.64 (10.00 - 13.39) 38.32 (32.09 - 45.10) 14.84 (11.63 - 18.44) 8.81 (6.10 - 12.02)
San Benito 10.23 (5.04 - 17.25) ** ** ** ** ** ** ** ** ** ** ** **
San Bernardino 26.16 (24.71 - 27.65) 21.85 (19.85 - 23.96) 78.29 (70.38 - 86.63) 20.01 (18.04 - 22.07) 10.54 (6.76 - 15.14)
San Diego 13.76 (12.89 - 14.66) 11.07 (9.95 - 12.26) 31.84 (27.05 - 37.02) 12.95 (11.53 - 14.44) 9.65 (7.39 - 12.22)
San Francisco 18.73 (16.44 - 21.17) 14.72 (11.02 - 18.94) 36.49 (27.94 - 46.18) 19.37 (14.55 - 24.87) 11.59 (8.73 - 14.85)
San Joaquin 19.85 (17.61 - 22.23) 19.98 (16.59 - 23.68) 57.76 (42.98 - 74.73) 17.30 (13.69 - 21.33) 7.64 (4.63 - 11.41)
San Luis Obispo 7.54 (5.22 - 10.28) 7.39 (4.75 - 10.63) ** ** ** ** ** ** ** ** **
San Mateo 13.08 (11.34 - 14.96) 13.14 (10.44 - 16.15) 25.85 (15.24 - 39.25) 11.01 (8.26 - 14.16) 9.85 (6.82 - 13.42)
Santa Barbara 8.65 (6.83 - 10.68) 7.82 (5.28 - 10.86) ** ** ** 9.10 (6.48 - 12.17) ** ** **
Santa Clara 12.11 (11.04 - 13.24) 11.13 (9.47 - 12.93) 22.64 (15.43 - 31.23) 13.87 (11.88 - 16.03) 7.90 (6.26 - 9.72)
Santa Cruz 10.33 (7.81 - 13.20) 11.39 (7.87 - 15.57) ** ** ** 9.10 (5.50 - 13.61) ** ** **
Shasta 21.13 (16.66 - 26.13) 23.38 (18.29 - 29.09) ** ** ** ** ** ** ** ** **
Sierra ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Siskiyou 14.56 (6.98 - 24.92) ** ** ** ** ** ** ** ** ** ** ** **
Solano 16.82 (14.30 - 19.54) 13.32 (10.24 - 16.80) 31.86 (23.20 - 41.89) 10.94 (6.59 - 16.38) 13.98 (8.53 - 20.78)
Sonoma 8.52 (6.74 - 10.51) 8.66 (6.55 - 11.06) ** ** ** 6.26 (3.22 - 10.30) ** ** **
Stanislaus 13.91 (11.84 - 16.15) 15.25 (12.33 - 18.47) 67.66 (39.38 - 103.53) 9.60 (6.79 - 12.90) ** ** **
Sutter 16.87 (11.53 - 23.22) 18.12 (11.06 - 26.93) ** ** ** ** ** ** ** ** **
Tehama 14.66 (8.14 - 23.10) 16.56 (8.51 - 27.27) ** ** ** ** ** ** ** ** **
Trinity ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
Tulare 11.99 (9.97 - 14.19) 13.56 (10.04 - 17.61) ** ** ** 10.15 (7.73 - 12.89) ** ** **
Tuolumne 12.64 (5.85 - 22.03) 13.26 (5.90 - 23.54) ** ** ** ** ** ** ** ** **
Ventura 13.97 (12.28 - 15.77) 13.63 (11.28 - 16.20) 46.18 (26.82 - 70.76) 12.89 (10.41 - 15.64) ** ** **
Yolo 10.10 (7.04 - 13.72) 10.87 (6.67 - 16.09) ** ** ** 10.62 (5.10 - 18.15) ** ** **
Yuba 13.76 (8.85 - 19.75) 15.08 (8.22 - 24.00) ** ** ** ** ** ** ** ** **
CI = Confidence Interval, a measure of statistical uncertainty.
* Rates were calculated per 10,000 residents and age-adjusted to the 2000 U.S. population.
** Rate not presented if the number of cases was less than thirty.
California Department of Health Services 13
Appendix II
County All Children All Children All Children All Children All Children
CALIFORNIA 114,986 45,532 48,877 13,793 23,393 10,365 30,891 16,664 8,123 2,768
Alameda 7,825 3,767 2,103 588 3,364 1,822 995 612 863 382
Alpine < 5 < 5 < 5 < 5 ** ** ** ** ** **
Amador 67 22 56 16 5 < 5 < 5 < 5 ** **
Butte 646 221 546 161 18 7 38 28 25 16
Calaveras 107 25 102 22 < 5 < 5 < 5 < 5 ** **
Colusa 52 15 33 6 < 5 ** 13 9 < 5 **
Contra Costa 3,566 1,256 1,691 411 1,007 430 397 190 292 110
Del Norte 44 19 40 17 < 5 ** < 5 < 5 < 5 < 5
El Dorado 304 63 270 50 5 < 5 22 7 ** **
Fresno 2,911 1,570 985 331 507 284 1,190 801 124 87
Glenn 73 14 59 < 5 ** ** 8 6 < 5 < 5
Humboldt 341 95 277 76 9 < 5 17 < 5 10 < 5
Imperial 974 652 180 85 47 25 727 528 < 5 < 5
Inyo 45 23 31 12 ** ** < 5 < 5 < 5 < 5
Kern 1,842 884 1,187 535 278 166 313 154 27 12
Kings 489 161 200 48 73 28 205 82 5 < 5
Lake 206 59 153 48 29 ** 7 < 5 ** **
Lassen 59 13 51 11 < 5 ** ** ** < 5 **
Los Angeles 36,462 14,747 10,028 2,471 9,458 4,047 13,653 7,037 2,423 774
Madera 366 171 150 60 38 8 164 93 < 5 < 5
Marin 443 152 320 91 33 10 50 35 15 6
Mariposa 42 11 40 11 ** ** 2 ** ** **
Mendocino 268 49 227 31 ** ** 20 11 ** **
Merced 572 225 262 85 82 34 199 94 22 10
Modoc 17 < 5 17 < 5 ** ** ** ** ** **
Mono < 5 < 5 < 5 < 5 ** ** ** ** ** **
Monterey 1,172 458 488 145 69 21 435 234 112 25
Napa 258 69 197 35 9 5 36 25 12 < 5
Nevada 151 32 146 27 ** ** ** ** < 5 < 5
Orange 6,358 2,538 3,830 1,216 245 126 1,498 925 509 164
Placer 388 120 342 99 7 < 5 21 6 5 < 5
Plumas 78 13 61 11 6 ** < 5 < 5 ** **
Riverside 5,987 2,621 3,040 981 995 519 1,654 997 120 46
Table 3: Three Year Totals of the Number of Asthma Hospital Discharges by County and Race/Ethnicity for All Ages and Children (Ages 0-14 years), 1998-2000.
Total Non-Hispanic Black Hispanic Asian/
Pacific IslanderWhite
14 California Department of Health Services
Appendix II
County All Children All Children All Children All Children All Children
Table 3: Three Year Totals of the Number of Asthma Hospital Discharges by County and Race/Ethnicity for All Ages and Children (Ages 0-14 years), 1998-2000.
Total Non-Hispanic Black Hispanic Asian/
Pacific IslanderWhite
Sacramento 4,228 1,349 2,208 537 1,029 404 497 233 344 107
San Benito 70 35 37 16 < 5 ** 28 16 < 5 < 5
San Bernardino 8,055 3,706 3,516 1,249 1,994 1,076 2,226 1,234 174 76
San Diego 7,400 2,914 3,653 1,057 1,180 474 1,832 1,043 510 197
San Francisco 2,889 752 873 168 804 180 391 176 693 170
San Joaquin 2,350 860 1,196 356 379 158 498 256 217 57
San Luis Obispo 426 101 344 71 19 5 41 18 < 5 < 5
San Mateo 1,746 621 853 245 210 53 312 174 316 108
Santa Barbara 675 239 388 87 36 14 230 130 14 5
Santa Clara 4,104 1,455 1,755 475 311 95 1,116 558 790 260
Santa Cruz 494 172 359 96 15 5 108 68 < 5 **
Shasta 553 224 518 210 5 5 22 < 5 < 5 **
Sierra < 5 < 5 < 5 < 5 ** ** ** ** ** **
Siskiyou 96 31 87 28 < 5 < 5 < 5 ** < 5 < 5
Solano 1,471 472 693 183 397 134 148 60 168 61
Sonoma 916 233 729 162 52 12 79 39 25 6
Stanislaus 1,319 484 919 280 105 51 216 122 38 14
Sutter 307 97 203 59 13 < 5 33 20 42 10
Tehama 171 47 157 37 < 5 < 5 10 7 ** **
Trinity 43 9 37 7 < 5 < 5 < 5 ** ** **
Tulare 1,077 387 542 146 52 27 424 197 40 6
Tuolumne 106 30 100 28 < 5 ** < 5 < 5 < 5 < 5
Ventura 2,171 750 1,246 350 99 51 688 303 74 15
Yolo 398 108 260 61 18 < 5 92 36 14 < 5
Yuba 243 73 197 46 16 10 16 8 10 6
** No asthma hospitalizations.
California Department of Health Services 15
Appendix II
16 California Department of Health Services
Table 4. Age-Adjusted*Asthma Hospitalization Rates by Median Household Income**, Sex and Race in California, 2000. Males Females
Median Household Income Quartile Black Non-
Black Rate
Ratio Black Non-Black
Rate Ratio
1-Lowest (<$31,233) 35.48 10.37 3.4 43.76 14.05 3.1 2- ($31,233 - $41,845) 29.31 9.43 3.1 38.13 12.51 3.0 3- ($41,845 - $56,930) 23.68 7.42 3.2 28.85 9.56 3.0 4-Highest (>$56,930) 18.57 6.09 3.0 23.30 7.18 3.2 * Age-Adjusted to the 2000 U.S. Population ** Income quartiles based on patient’s zip code of residence distribution of median household income from 2000 U.S. Census
APPENDIX III. FIGURES
California Department of Health Services 17
Figu
re 1
: A
sthm
a H
ospi
taliz
atio
n R
ates
* in
Cal
iforn
ia C
ompa
red
to th
e U
nite
d St
ates
,20
00.
11
9
12
9
31
15
19
32
17
10
05101520253035
Total
Male
Female
White
Black
Annual Discharges (per 10,000)
California
U.S.
Appendix III
18 California Department of Health Services
Figu
re 2
: Age
-Adj
uste
d* A
sthm
a H
ospi
tal D
isch
arge
Rat
es fo
r All
Rac
es b
y C
ount
y,
1998
-200
0, w
ith 9
5% C
onfid
ence
Inte
rval
s.
0.0
5.0
10.0
15.0
20.0
25.0
30.0
San B
enito Nevad
a
Santa
Barbara Plac
er
San Lu
is Obis
po Marin
El Dora
do
Santa
CruzNap
aSon
oma
Del Nort
eTuo
lumne La
ssen Orange
San M
ateo
Santa
Clara
Siskiyo
uSan
Dieg
o Kern Amador
Humbo
ldt Merced
Yolo Glenn Tulare
Stanisla
us Ventur
a Madera
Calave
ras Monter
eyMari
posa
Mendo
cino Butte Colusa Shasta FresnoIny
oTeh
ama
Sacram
ento
San Fran
cisco
Los A
ngele
sRive
rside Sutter Solano
Contra
Cos
ta Lake Yub
a
San Jo
aquin King
s
San B
ernard
ino Plumas Trinity Alamed
aIm
peria
lAnnual Discharges (per 10,000)
Sta
te R
ate
Hea
lthy
Peop
le 2
000
Targ
et
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
California Department of Health Services 19
Figu
re 3
: Age
-Adj
uste
d* A
sthm
a H
ospi
tal D
isch
arge
Rat
es fo
r Non
-His
pani
c W
hite
s by
Cou
nty,
199
8-20
00, w
ith 9
5% C
onfid
ence
Inte
rval
s.
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Santa
Barbara Nevad
a Placer Marin
San Lu
is Obis
poEl D
orado Son
oma
Santa
Cruz Napa
San B
enito
Santa
Clara
San D
iego
San M
ateo
Tuolum
neDel
Norte Mad
era Orange Merced
Humbo
ldt Lass
en Siskiyo
uMon
terey Yolo Amador Ven
tura Fresno
San Fran
cisco
Contra
Cos
ta
Sacram
ento Tulare
Calave
rasStan
islaus
Los A
ngele
s Butte Kern Solano
Alamed
a
Mendo
cino
Maripo
saRive
rsideIny
o Kings Glenn Sha
sta Sutter Lake Teh
ama
San B
ernard
ino
San Jo
aquin Plumas Yub
a Trinity Colusa Im
peria
lAnnual Discharges (per 10,000)
Stat
e R
ate
Hea
lthy
Peop
le 2
000
Targ
et
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
20 California Department of Health Services
Figu
re 4
: Age
-Adj
uste
d* A
sthm
a H
ospi
tal D
isch
arge
Rat
es fo
r Bla
cks
by C
ount
y, 1
998-
2000
, with
95%
Con
fiden
ce In
terv
als.
0.0
20.0
40.0
60.0
80.0
100.
0
120.
0
Santa
Barbara
Orange
Monter
ey Santa
Clara
Kern San D
iego
Ventur
a San M
ateo
Marin
Solano Sac
ramen
to Los A
ngele
s Sonom
aSan
Francis
coMerc
edRive
rside Con
tra C
osta
Fresno
Kings
Madera
Tulare San
Joaq
uinAlam
eda
San B
ernard
ino Stanisl
aus
Impe
rial
Annual Discharges (per 10,000)
St
ate
Rat
e
H
ealth
y Pe
ople
200
0 Ta
rget
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
California Department of Health Services 21
Figu
re 5
: Age
-Adj
uste
d* A
sthm
a H
ospi
tal D
isch
arge
Rat
es fo
r His
pani
cs
by C
ount
y, 1
998-
2000
, with
95%
Con
fiden
ce In
terv
als.
0.0
5.0
10.0
15.0
20.0
25.0
30.0 Son
oma
Kern
San Lu
is Obis
po
Santa
Barbara
Orange Stan
islau
sSan
Mate
oSan
ta CruzMari
n San D
iego
Napa Solano
Tulare
Butte
Santa
Clara Mon
terey
Colusa
Merced
San Fran
cisco
Sacram
ento
San Jo
aquin
Madera
Sutter
Contra
Cos
ta Ventur
a Fresno Rive
rside
Los A
ngele
s Alamed
aYolo
San B
ernard
inoKing
s Impe
rial
Annual Discharges (per 10,000)
Stat
e R
ate
Hea
lthy
Peop
le 2
000
Targ
et
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
22 California Department of Health Services
Figu
re 6
: Age
-Adj
uste
d* A
sthm
a H
ospi
tal D
isch
arge
Rat
es fo
r Asi
an/P
acifi
c Is
land
ers
by C
ount
y, 1
998-
2000
, with
95%
Con
fiden
ce In
terv
als.
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Fresno
Orange
Riversi
deSan
Dieg
o Los A
ngele
s
Ventur
a San B
ernard
inoStan
islaus
Santa
Clara
San M
ateo San
Francis
coSac
ramen
to Contra
Cos
ta San Jo
aquin
Alamed
a
Solano
Tulare
Monter
ey
Sutter
Annual Discharges (per 10,000)
Stat
e R
ate
Hea
lthy
Peop
le 2
000
Targ
et
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
California Department of Health Services 23
Figu
re 7
: Age
-Adj
uste
d* A
sthm
a H
ospi
tal D
isch
arge
Rat
es fo
r Chi
ldre
n (A
ges
0-14
yea
rs) f
or
All R
aces
, by
Cou
nty,
199
8-20
00, w
ith 9
5% C
onfid
ence
Inte
rval
s.
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
El Dora
do Nevad
a
San Lu
is Obis
po Placer Son
oma
Santa
Barbara
Napa
Mendo
cino
YoloSan
Ben
itoSan
ta CruzMari
n Orange Tulare
Santa
Clara Merced
Tuolum
ne Humbo
ldtSan
Mate
oSan
Dieg
o Yuba
Stanisla
us Ventur
aMon
terey Sisk
iyou Teh
ama
Sacram
ento Kings Kern Solano Sutter Butte Mad
era
San Fran
cisco
Lake
Los A
ngele
s
San Jo
aquin Shasta
Contra
Cos
ta Riversi
de Fresno
San B
ernard
ino Alamed
a Impe
rial
Annual Discharges (per 10,000)
Stat
e R
ate
Hea
lthy
Peop
le 2
000
Targ
et
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
24 California Department of Health Services
Figu
re 8
: Age
-Adj
uste
d* A
sthm
a H
ospi
tal D
isch
arge
Rat
es fo
r Non
--His
pani
c W
hite
Chi
ldre
n (A
ges
0-14
yea
rs) b
y C
ount
y, 1
998-
2000
, with
95%
Con
fiden
ce In
terv
als.
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
El Dora
do
San Lu
is Obis
po
Santa
Barbara
Placer Son
oma Napa Marin
Mendo
cino
Yolo San D
iego
Santa
Clara
Santa
CruzSac
ramen
toKing
s
Contra
Cos
ta Humbo
ldtSan
Mate
oTuo
lumne Solano Merced Tulare Ven
tura Orange Mon
terey
San Fran
cisco
Yuba
Stanisla
us Fresno Teh
ama
Los A
ngele
s Madera Alamed
a Sutter
Butte
Riversi
de
San Jo
aquin
San B
ernard
inoLa
keKern Sha
sta Impe
rial
Annual Discharges (per 10,000)
Stat
e R
ate
Hea
lthy
Peop
le 2
000
Targ
et
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
California Department of Health Services 25
Figu
re 9
: Age
-Adj
uste
d* A
sthm
a H
ospi
tal D
isch
arge
Rat
es fo
r Bla
ck C
hild
ren
(Age
s 0-
14 y
ears
) by
Cou
nty,
199
8-20
00, w
ith 9
5% C
onfid
ence
Inte
rval
s.
0.0
20.0
40.0
60.0
80.0
100.
0
120.
0 Santa
Clara
San M
ateo
San D
iego
Solano
Orange San
Francis
coSac
ramen
to
Ventur
a
Merced
KernSan
Joaq
uinLo
s Ang
eles Con
tra C
osta
Stanisla
us
Fresno
Riversi
de San B
ernard
ino
Alamed
a
Annual Discharges (per 10,000)
Stat
e R
ate
Hea
lthy
Peop
le 2
000
Targ
et
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
26 California Department of Health Services
Figu
re 1
0: A
ge-A
djus
ted*
Ast
hma
Hos
pita
l Dis
char
ge R
ates
for H
ispa
nic
Chi
ldre
n (A
ges
0-14
yea
rs) b
y C
ount
y, 1
998-
2000
, with
95%
Con
fiden
ce In
terv
als.
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
KernSon
oma
Santa
Barbara San
ta Cruz
Orange Stan
islau
sTula
re
YoloMerc
edSola
no San M
ateo Mon
terey
Ventur
a San D
iego San
ta Clar
aSac
ramen
to Los A
ngele
sCon
tra C
osta
Marin
Kings
San Jo
aquin
Madera
Riversi
deSan
Francis
co
San B
ernard
inoFres
noAlam
eda Im
peria
lAnnual Discharges (per 10,000)
Sta
te R
ate
Hea
lthy
Peop
le 2
000
Targ
et
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
California Department of Health Services 27
Figu
re 1
1: A
ge-A
djus
ted*
Ast
hma
Hos
pita
l Dis
char
ge R
ates
for A
sian
/Pac
ific
Isla
nder
C
hild
ren
(Age
s 0-
14 y
ears
) by
Cou
nty,
199
8-20
00, w
ith 9
5% C
onfid
ence
Inte
rval
s.
0.0
5.0
10.0
15.0
20.0
25.0
Orange
San Jo
aquin
Santa
Clara
Riversi
de
Sacram
ento
San D
iego
Fresno
San M
ateo
Los A
ngele
sSan
Bern
ardino
San Fran
cisco
Contra
Cos
ta
Solano
Alamed
a
Annual Discharges (per 10,000)
Stat
e R
ate
Hea
lthy
Peop
le 2
000
Targ
et
*Age
-adj
uste
d to
the
2000
U.S
. pop
ulat
ion.
Cou
ntie
s with
less
than
30
case
s not
show
n.
Appendix III
28 California Department of Health Services
Figu
re 1
2. M
ean
Num
ber o
f Ast
hma-
Rel
ated
Hos
pita
lizat
ions
per
Mon
th fo
r All
Ages
and
for
Chi
ldre
n (A
ges
0-14
yea
rs) i
n C
alifo
rnia
, 199
8-20
00.
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Mean Number of Asthma Hospitalizations
All A
ges
Chi
ldre
n
Appendix III
California Department of Health Services 29
Figu
re 1
3. P
erce
nt o
f Rep
eat A
sthm
a H
ospi
tal A
dmis
sion
s by
Gen
der a
nd R
ace/
Ethn
icity
for
Adul
ts (A
ges
18+
year
s) in
Cal
iforn
ia, 2
000.
051015202530
Tota
lM
ale
Fem
ale
Non
-His
pani
cW
hite
Bla
ckH
ispa
nic
Asi
an/P
acifi
cIs
land
er
Percent (%)
Appendix III
30 California Department of Health Services
Figu
re 1
4. M
ean
Leng
th o
f Sta
y in
Day
s fo
r Ast
hma
Hos
pita
l Adm
issi
ons
for A
dults
(Age
s >1
4 ye
ars)
and
for C
hild
ren
(Age
s 0-
14 y
ears
) by
Rac
e/Et
hnic
ity, 1
998-
2000
.
01
23
45
Non
-His
pani
c W
hite
Blac
k
His
pani
c
Asia
n/Pa
cific
Isla
nder
Tota
l
Day
s
Chi
ldre
nAd
ults
Appendix III
California Department of Health Services 31
Figu
re 1
5. M
ean
Tota
l Cha
rges
Incu
rred
from
Ast
hma
Hos
pita
l Adm
issi
ons
for A
dults
(A
ges
> 14
yea
rs) a
nd fo
r Chi
ldre
n (A
ges
0-14
yea
rs) b
y R
ace/
Ethn
icity
, 199
8-20
00.
$0$2
,000
$4,0
00$6
,000
$8,0
00$1
0,00
0$1
2,00
0$1
4,00
0$1
6,00
0$1
8,00
0
Non
-His
pani
c W
hite
Bla
ck
His
pani
c
Asi
an/P
acifi
c Is
land
er
All
Rac
es
Cha
rges
Chi
ldre
nA
dults
32 California Department of Health Services
California Department of Health Services 33
APPENDIX IV. MAPS Map 1. California Counties.