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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.

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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

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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

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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.

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


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.


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


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


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.


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).


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/


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.


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/


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.


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.


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.


Pacific IslanderWhite


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.


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.


Appendix II


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

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the

2000

U.S

. pop

ulat

ion.

Cou

ntie

s with

less

than

30

case

s not

show

n.

Appendix III


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


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


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


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


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


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


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


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


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


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


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


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


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


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


APPENDIX IV. MAPS Map 1. California Counties.

california county asthma hospitalization chart book · california county asthma hospitalization...

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