asthma burden 2017hospitalizations from asthma can be prevented. these outcomes are an important...

Asthma in Wisconsin 2017 1

SCOPE OF THE PROBLEM Over the past decade, Wisconsin has made significant improvements in reducing the asthma burden in

some areas, but in other areas asthma remains unchanged.

ASTHMA PREVALENCE

Asthma Prevalence by State, 2017

In 2017, U.S. adult current asthma prevalence was 9%. In Wisconsin, adult current asthma prevalence was

9.5% putting the state in the 75th percentile nationally.

U.S. Overall: 9.0%

Wisconsin: 9.5%

Significant

Improvements

Slight Improvements No Change

Reducing emergency department (ED) visits

Reducing hospitalizations Reducing mortality rates

Adults with asthma who got a flu shot

Number of schools with asthma action plans on file for all students with asthma

Racial and ethnic disparities in

asthma prevalence,

hospitalization rates, and

mortality rates

ASTHMA IN WISCONSIN 2017

A summary of asthma burden data in Wisconsin describing prevalence, asthma control and

management, health care utilization, and mortality


Adult and Child Asthma Prevalence, Wisconsin, 2017

Asthma is a key public health problem. From 2016 to 2017, the prevalence of asthma increased slightly in

Wisconsin. This data translates to about 100,000 Wisconsin children and 400,000 Wisconsin adults with

current asthma.

Asthma Prevalence among Wisconsin Adults by Race and Ethnicity, 2015–2017

Similar to the U.S., Wisconsin’s asthma burden disproportionately falls upon racial and ethnic minority

populations. Non-Hispanic African Americans have an asthma prevalence almost 1.5 times higher than

whites, and American Indians have an asthma prevalence twice that of whites. Because of this difference in

prevalence, you might expect that there would also be higher rates of adverse asthma outcomes (such as

ED visits, hospitalizations, and mortality) among these two populations. In Wisconsin, we see

disproportionately higher rates of asthma health care utilization and mortality among African Americans.

13.2%

9.9%

9.5%

7.4%

Adult

Child

9%

14%

18%

4%

8%

White

African American

American Indian/Alaska Native

Asian/Pacific Islander

Hispanic

Lifetime Prevalence (11.9–14.4%)

Current Prevalence

(8.5–10.6%)

Lifetime Prevalence

(7.6–12.2%)

Current Prevalence

(5.1–9.7%)


Asthma Prevalence among Wisconsin Adults by Income, 2015–2017

Asthma disparities also exist by other factors, such as annual household income. Adults in the lowest

income group have over 2.5 times the rate of asthma as those in the highest income group.

Asthma Prevalence among Wisconsin Adults by Sex and Weight Status,

2015–2017

In Wisconsin, obese adults had higher asthma prevalence than both normal and overweight adults, with

dramatically higher prevalence among the morbidly obese.

All Wisconsin Adults

18.7%

12.5%

8.9% 7.5% 7.2%

$<15,000 $15,000 - <$25,000 $25,000 - <$50,000 $50,000 - <$75,000 $75,000+

8.6%

10.1%

15.0%

22.4%

Not Overweight/Obese (BMI<25.0)

Overweight (BMI 25.0-<30.0)

Obese(BMI 30.0-<40.0)

Morbidly Obese

(BMI ≥40.0)


When stratified by sex, we see that a significantly higher percent of obese and morbidly obese females

reported having asthma compared to normal weight and overweight females. Men in the morbidly obese

group report significantly higher asthma prevalence compared to men in other weight status groups.

Females

Males

7.9%

7.4%

10.8%

19.6%



Obese(BMI 30.0-<40.0)

Morbidly Obese

(BMI ≥40.0)

7.0%

5.6%

7.4%

15.5%



Obese(BMI 30.0-<40.0)

Morbidly Obese

(BMI ≥40.0)


ASTHMA CONTROL

The frequency of asthma symptoms, nighttime awakenings, activity limitations and rescue medication use

among persons with asthma were used to classify asthma control into the following categories: well-

controlled, not well-controlled, and very poorly controlled. Combining the top two categories in the figure

below, we can see that 60% of all adults with asthma reported asthma that was not well-controlled or

very poorly controlled.

Control of Asthma by Income, 2012–2016

Poor asthma control is also associated with a lower income. Among adults with current asthma, those in

the highest income group were more likely to report well-controlled asthma than those in the lower income

groups.

Well-Controlled Not Well-Controlled Very Poorly Controlled

Well-Controlled (40%)

Not Well-Controlled (37%)

Very Poorly Controlled (23%)

31.5

31.7

52.9

34.0

40.2

37.8

34.4

28.1

9.3

<$25,000

$25,000-49,999

≥$50,000


ASTHMA MANAGEMENT

Time Since Patient Talked to Doctor about Asthma, among Current

Asthmatics, Wisconsin, 2012–2016

Establishing routine health care visits with a medical provider is an essential part of asthma management.

Nearly one-third of adults with current asthma reported it had been over a year since they discussed

asthma with their doctor.

Percentage of Persistent Asthmatics Who Received a Flu Vaccine by Age

Group among Medicaid Population, 2012–2014 Flu Season

The CDC recommends that all people aged 6 months and older receive a flu vaccine, and it’s especially

important for those with asthma. The Wisconsin Immunization Registry provided flu vaccination data for

Medicaid enrollees with persistent asthma. On average, 44% of Medicaid enrollees with persistent asthma

received a flu vaccination.

67%

17% 7% 8%

< 12 months 1-3 years 3-5 years 5 years or more

Nearly a third of asthmatics haven’t talked to their doctor about

their asthma in over a year.

56%

48%

37%

52%

44%

2-4 years 5-17 years 18-49 years 50-64 years Overall


Control of Asthma by School Practices, 2012–2016

The Health Profiles survey is conducted in Wisconsin high schools among school teachers and principals,

and contains some questions on asthma management practices. The 2016 survey revealed that most

schools report using school records to identify and track students with asthma. However, other questions

revealed that there’s still room for improvement on other asthma-related practices. For example, one-third

of health education teachers indicated they would like to receive training on asthma, although only 14%

actually did in the past two years.

Percentages of schools that…

Routinely use school records to identify and track

students with asthma

Provide referrals to health care professionals for

students diagnosed with or suspected to have asthma

Teachers tried to increase student knowledge on

asthma

Lead health education teacher would like to receive

professional development on asthma

Ever used a self-assessment tool to assess asthma

policies, activities, or programs

Provided parents and families with asthma information

Lead health education teacher received professional

development on asthma during past two years

98.6%

48.0%

46.9%

33.5%

25.0%

14.1%

14.1%


ASTHMA HEALTH CARE UTILIZATION

With proper medication, symptom management, and avoidance of triggers, most ED visits and

hospitalizations from asthma can be prevented. These outcomes are an important surveillance endpoint

because they help identify populations most in need of asthma management and preventive care.

Asthma Hospitalizations, Milwaukee County and Wisconsin, 2003–2017

Wisconsin has lower rates of asthma hospitalizations than the U.S., but Milwaukee County has rates that

are double that of the overall state rate.

Rates per 10,000 people

Note: U.S. rates not available past 2010.

23.2

6.8

19.8

14.1

11.2

3.6

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

ICD-9 to ICD-10

Transition

Milwaukee

U.S.

Wisconsin


Asthma Hospitalizations and ED Visits by Sex and Age Group

Both Sexes

When we look at asthma health care utilization for both males and females, we see that across age

categories, children under five have the highest asthma hospitalization and ED visit rates in Wisconsin

(highlighted below).

† Overall rates are age-adjusted to the 2000 U.S. standard population

11

3

1 2 1

3

6

3 3

6 5 5

8

3 2

4 3 4

0-4 5-14 15-34 35-64 65+ Overall†

77

57

35

21

7

33 41

36

47

33

13

37

59

47 41

27

10

35

0-4 5-14 15-34 35-64 65+ Overall†

Hospitalization Rates by Age Group Per 10,000 people

ED Visit Rates by Age Group Per 10,000 people


Females. Females (highlighted below) have more frequent adverse asthma outcomes in adulthood

compare to adolescence.

Males. Males (highlighted below) are more severely impacted by asthma during childhood.

11

3

1 2 1 3

6

3 3

6 5 5

8

3 2

4 3 4

0-4 5-14 15-34 35-64 65+ Overall†

77

57

35

21

7

33 41 36

47

33

13

37

59

47 41

27

10

35

0-4 5-14 15-34 35-64 65+ Overall†

11

3

1 2 1

3

6

3 3

6 5 5

8

3 2

4 3 4

0-4 5-14 15-34 35-64 65+ Overall†

77

57

35

21

7

33 41

36 47

33

13

37

59

47 41

27

10

35

0-4 5-14 15-34 35-64 65+ Overall†






Asthma Hospitalization Rates by Race and Ethnicity

In Wisconsin, we see the highest asthma hospitalization rates among non-Hispanic African Americans. This

is a disparity that only seems to be getting worse.

Rates per 10,000 people

0

5

10

15

20

25

30

35

40

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

ICD-9 to ICD-10

Transition

African American

American Indian

Hispanic

Asian White


Asthma ED Visit Rates by Wisconsin County, 2015–2017

Certain areas of the state are affected by higher asthma prevalence and rates of asthma health care

utilization. This county-level map shows the rates of asthma ED visit rates during 2015–2017. The darkest

shaded counties had rates that were among the highest in the state.

Milwaukee County and Menominee County, which is primarily composed of members of the Menominee

Tribe, rank at the top for both asthma hospitalizations and ED visits. In addition, Kenosha, Racine, and Rock

counties have had consistently high rates over the past decade.

Overall State Rate:

36.3 per10,000 Population


ASTHMA MORTALITY

Age-adjusted mortality rates have declined over the past two decades from 88 to 59 deaths. However,

there are still approximately 70 deaths each year in Wisconsin for which asthma was the underlying cause.

African Americans are almost three times more likely to die from asthma than whites.

Asthma Mortality Rates, Wisconsin, 2000–2017

Rates per 1,000,000 people

0

5

10

15

20

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

African Americans are almost three times more

likely to die from asthma than whites

WISCONSIN ASTHMA PROGRAM

Division of Public Health

Wisconsin Department of Health Services

dhs.wisconsin.gov/asthma | P-02412 (10/2018)

Data Sources: Wisconsin BRFSS Core and BRFSS Asthma Call-Back Surveys

(prevalence); Wisconsin Inpatient and Emergency Department Visit files

(health care utilization); Wisconsin Vital Records (mortality)

Citation: Asthma in Wisconsin 2017. Wisconsin Department of Health

Services, Division of Public Health, Wisconsin Asthma Program.

asthma burden 2017hospitalizations from asthma can be prevented. these outcomes are an important...

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