Focus Area 24Respiratory Diseases

Progress Review

June 29, 2004

Burden of Respiratory Diseases

Prevalence (self or proxy-reported)• 3.6 million children• 22 million adults

Annual Burden (estimated) • 20 million physician and outpatient

visits• 3.5 million hospital emergency visits • 1.2 million hospitalizations• 124,000 deaths

Children under 5 yearsChildren 5-14 years Adolescents and adults 15-34 yearsAdults 35-64 yearsAdults 65 years and over

24-1 Deaths from Asthma

Children under 5 yearsChildren and adults 5-64 years Adults 65 years and over

24-2 Hospitalizations for Asthma

24-4 Activity Limitations

24-5 School or Work Days Lost

24-6 Patient Education

24-7 Appropriate Asthma Care

Written asthma management plansPersons with prescribed inhalers who …….receive instructionEducation about recognizing early signsMedication regimensFollowup medical careAssistance with assessing….…environmental risks

24-8 Surveillance SystemsChildren under 5 yearsChildren and adults 5-64 yearsAdults 65 years and over

24-3 Hospital Emergency Department Visits for Asthma

Asthma

Cannot assess (limited data)Getting worseImproving Little or no change

Respiratory Diseases Objectives

24-9 Activity Limitations due to Chronic Lung and Breathing Problems

24-10 Deaths from COPD

Seek medical evaluationReceive follow-up care

24-11 Medical Evaluation and Followup

Chronic Obstructive Pulmonary Disease (COPD)

Obstructive Sleep Apnea (OSA)

24-12 Vehicular Crashes Related to Excessive Sleepiness

Cannot assess (limited data)Getting worseImproving Little or no change

Respiratory Diseases Objectives

COPD24-9. Activity limitations 24-10. Deaths

Asthma

24-1. Deaths

24-2. Hospitalizations

24-4. Activity limitations

24-5. School or work days lost

24-6. Patient education

Highlighted Objectives

Asthma Facts

• Chronic condition occurring among both children and adults

• 74% increase in self-reported asthma from 1980 to 1996

• 85% increase in physician visits from 1980 to 1999 • 18 days of school or work lost due to asthma per

person with asthma

• 75 emergency department visits and 18 hospitalizations for asthma per 10,000 population

• Evidence of some declines in recent years (except young children)

0 20 40 60 80 Deaths per Million

Under 5 years

5-14 years

15-34 years

35-64 years

65 years and over

1999

20012010Target

Obj. 24-1a-e Source: National Vital Health Statistics System, NCHS, CDC.

Asthma Deaths

0

5

10

15

20

25

1980 1985 1990 1995 2000

Age-adjusted death rate per million

Deaths per MillionNote: Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons were asked to select only one race; selection of more than one race was not an option.Source: National Vital Health Statistics System, NCHS, CDC.

Asian or Pacific

IslanderBlack

White

Hispanic

Female

Male0 10 20 30 40 50

2010 Target

Obj. 24-1d

Asthma DeathsAges 35 – 64 Years

1999

2001

Hospitalizations per 10,000

Asthma Hospitalizations

Note: Data for ages 5-64 and 65 and over are age-adjusted to the 2000 standard population.Source: National Hospital Discharge Survey, NCHS, CDC.

Under 5 years

5-64 years

65 years and over

0 20 40 60 80

1998

2001

2010Target

Obj. 24-2a-c

Hospitalizations per 10,000

Ages 65 Years and Over

Note: Data are age adjusted to the 2000 standard population. Black and white include persons of Hispanic or non-Hispanic origin. Persons were asked to select only one race category; selection of more than one race category was not an option in 1998. In 2001, persons reported one or more races. Data by race are shown for persons who reported one racial group.Source: National Hospital Discharge Survey, NCHS, CDC.

Black

White

Female

Male

0 10 20 30 40

Obj. 24-2c

2010 Target

Asthma Hospitalizations

1998

2001

PercentNote: Data are age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. In 1997, persons reported one or more races and identified one race as best representing their race. Data by single race category are for persons who reported only one racial group.Source: National Health Interview Survey, NCHS, CDC.

Total

Asian or Pacific Islander

Black

White

Hispanic

0 5 10 15 20

Activity Limitations Among Persons with Asthma

1997

2002

Obj. 24-4

2010 Target

Percent

Note: Data are age adjusted to the 2000 standard population. Source: National Health Interview Survey, NCHS, CDC..

Female

Male

Poor

Near poor

Middle/high

income0 10 20 30

Activity Limitations Among Persons with Asthma

1997

2002

Obj. 24-4

2010 Target

School or Work Days Lost Among Persons with Asthma, 2002

Number of Days Lost

Total

Black

White

Hispanic

Female

Male

0 10 20 30 40

Note: Data are age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons reported one or more races. Data by single race category are for persons who reported only one racial group.Source: National Health Interview Survey, NCHS, CDC. Obj. 24-5

Patient Education Among Adults with Asthma

Percent

Total

Black

White

Hispanic

Female

Male

0 10 20 30

2010 Target

Note: Data are for ages 18 and over and age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons reported one or more races. Data by single race category are for persons who reported only one racial group.Source: National Health Interview Survey, NCHS, CDC. Obj. 24-6

1998

1999

Chronic Obstructive Pulmonary Disease (COPD) Facts

Prevalence - COPD is under-diagnosed• 10 million adults reported physician-diagnosed COPD • 24 million adults have evidence of impaired lung

function according to NHANES III

Annual Burden (estimated) • 8 million physician and outpatient visits• 1.5 million hospital emergency visits • 726,000 hospitalizations• 119,000 deaths• Increasing trend in recent decades with some

evidence of recent declines

Estimated Prevalence of COPD1988 - 94

Note: NHIS and NHANES data are based on self-reports. Mild and moderate COPD is defined by spirometric ratio of FEV1 (forced expiratory volume in 1 second) to FVC (forced vital capacity) less than 70%. Source: Mannino, et al. MMWR 2002 / 51(SS06);1-16.

Per 100,000

Percent50

40

30

20

10

0

NHIS self-report NHANES self-report Mild/moderate COPD

25-44 45-54 55-64 65-74 75+ Age group

1980 2000

Note: COPD is defined as ICD-9 codes 490-492 and 496 for 1980 data and ICD-10 codes J40-J44 for 2000 data, and excludes asthma. Data are age adjusted to 2000 standard population Source: Mannino, et al. MMWR 2002 / 51(SS06);1-16.

Per 100,000

Female Male

Deaths per 100,000100

80

60

40

20

0

COPD DeathsAges 25 Years and Over

COPD Deaths

American Indian

Asian or Pacific Islander

Black

White

Hispanic

Note: COPD is defined as ICD-10 J40-J44, and excludes asthma. Data are for ages 45 years and over and age adjusted to 2000 standard population. American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons were asked to select only one race; selection of more than one race was not an option.Source: National Vital Statistics System, NCHS, CDC.

2010 Target

Deaths per 100,0000 50 100 150 200

Obj. 24-10

1999

2001

PercentNote: Data are for ages 45 years and over and age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons reported one or more races. Data by single race category are for persons who reported only one racial group.Source: National Health Interview Survey, NCHS, CDC.

Total

Black

White

Hispanic

0 1 2 3 4 5

2010 Target

1997

2002

Obj. 24-9

Activity Limitations Due toChronic Lung and Breathing

Problems

Percent

Note: Data are for ages 45 years and over and age adjusted to the 2000 standard population. Source: National Health Interview Survey, NCHS, CDC.

Female

Male

Poor

Near poor

Middle/high

income0 1 2 3 4 5 6 7

2010 Target

1997

2002

Obj. 24-9

Activity Limitations Due toChronic Lung and Breathing

Problems

Progress review data and slidescan be found on the web at:

http://www.cdc.gov/nchs/hphome.htmhttp://www.cdc.gov/nchs/hphome.htm