Offices of:

                                                                                                            Senator Jarrett T. Barrios

                                                                                                            Senator Dianne Wilkerson

Representative David B. Sullivan

 

Asthma Fact Sheet

 

      In support of: 

 

Senate Bill 2219      Promoting Environmental Justice

 

Summary

 

            Asthma is one of many illnesses that have been linked to environmental factors.  Asthma is a significant health problem that not only affects the wellbeing of millions of Americans but also has a major impact on the cost of U.S. health care.  Asthma rates in Massachusetts are higher than the national average and are linked with health disparities affecting a disproportionate number of minority communities.  Several studies have linked air pollution with asthma and additional studies provide evidence that a reduction in air pollution would reduce the number of asthma episodes.  Efforts to reduce air pollution through Senate Bill 2219 could lead to improved health, a reduction in health disparities and a lower cost of health care.

 

I.  Incidence of Asthma/Respiratory Disorders

  • Approximately 31.3 million Americans have been diagnosed with asthma sometime during their life according to the NHIS 2001 statistics.  This corresponds to a rate of 113.4 per 1000 persons. Rates in 2000/2001 indicate a rising trend.1
  • The current percentage of people with asthma in Massachusetts is higher than the national average (9.4% vs. 7.1% in 2001).2
  • The estimated prevalence of asthma in Massachusetts according to the American Lung Association is 397,186 adults and 77,393 children.3
  • Respiratory Disorders were the 3rd largest indication for Outpatient ED visits in FY 2002 in Massachusetts (across all groups of race/ethnicity)4
  • Asthma is the leading chronic illness affecting children according to the American Lung Association.5

 

II.  Cost of Asthma

  • The total cost of asthma in the U.S. is $14.0 billion annually6, which is nearly 2% of all health care costs in the U.S.7  This includes direct health care costs of  $9.4 billion and indirect costs of $4.6 billion related to lost productivity.8
  • In 1996, $4.6 billion was spent in the U.S. caring for children with asthma.9 
  • Health care costs for children with asthma are more than twice the costs of health care for children who do not have asthma.10
  • Asthma accounts for an estimated 14.5 million lost working days for American adults and 14 million lost school days for children on an annual basis.11
  • Massachusetts FY 2002 charges for inpatient asthma hospitalizations alone totaled $55.5 million.  Inpatient charges for Medicaid and Medicaid Managed Care totaled over $12 million while free care charges were $1.5 million.12

 

 

III.  Health Disparities Related to Asthma

  • The top ten communities for asthma hospitalizations in Massachusetts grouped by zip code are: Dorchester South/02124; Roxbury/02119; Brockton/02301; Dorchester North/02121; Dorchester North/02125; Dorchester South/02126; Medford/02155; Holyoke/01040; Jamaica Plain/02130; and Everett/02149 13
  • Note: 5 out of 10 of the above communities are on the list of the most intensively overburdened communities in Massachusetts according to Faber’s report, Unequal Exposure to Ecological Hazards.14 
  • The communities above have a population with more than twice the percentage of Blacks and Latinos than the Massachusetts average (27.02% vs. 12.2%* calculated by author using 2000 U.S. Census data).15
  • Outpatient ED visit rates for asthma are much higher for Blacks and Hispanics than Whites in Massachusetts: Black = 19.5; Hispanic = 16.0; White =  4.5 (per 1000 population)16

 

*Boston city data used for Dorchester, Roxbury and Jamaica Plain because they are not listed separately on census data

 

IV. Relationship of Asthma to Environmental Pollution

  • The Massachusetts DPH has indicated that ambient air quality is a factor leading to higher rates of asthma in some cities over others.  They cite improving air quality as one of their goals to reduce the burden of asthma in Massachusetts.  They are currently conducting a study of pediatric asthma in the Merrimac Valley due to elevated asthma rates among children that are possibly related to air pollution.17
  • The U.S. DHHS reports links between environmental air pollution and asthma exacerbations. They recommend that parents of children with asthma should schedule their outdoor activities during times when the ozone levels are lowest.18
  • Much of Massachusetts has been designated as an “ozone nonattainment area” according to National Ambient Air Quality Standards.19  Ozone at ground level is the major component of smog and known to induce respiratory inflammation even in normal, healthy people.20

 

A.     Research that has shown an association between air quality and asthma:

·        Jaffe, D.H. et. al. 2003. Air pollution and emergency department visits for asthma among Ohio Medicaid recipients, 1991-1996. Environmental Research; 91, 21-28.

Showed that a 50µg/m3 increase in PM10 correlated with a 12% increase in the likelihood of an ED visit due to asthma in Cleveland and a 50µg/m3 increase in SO2 led to a 35% increase in ED asthma visits in Cincinnati.  This study specifically focused on the Medicaid population.

  • Tolbert, P. et. al. 2000. Air quality and pediatric emergency room visits for asthma in Atlanta, Georgia. American Journal of Epidemiology; 151(8), 798-810.

Showed an increased risk of pediatric emergency room visits for asthma with an increase in ozone level.

 

 

·        Wilson, A. M. (2003). Air Quality, Weather, and Respiratory Visits to the Emergency Room in Portland, Maine and Manchester, New Hampshire. University of New Hampshire: Unpublished Thesis. A study done through UNH revealed that in Portland, Maine an interquartile increase in ozone was associated with a 5% increase in asthma visits to the emergency room.

 

B. Research that has linked improved air quality to improved asthma outcomes

·        Friedman, M. et. al. 2001, Feb. 21. Impact of changes in transportation and commuting behaviors during the 1996 summer Olympic Games in Atlanta on air quality and childhood asthma. JAMA; 285(7), 897-905.

Showed that reduced traffic density due to citywide transportation changes in downtown Atlanta during the Olympic games resulted in a 41.6% reduction in acute asthma care events as recorded in the Georgia Medicaid claims file.

 

  • Levy, J. et. al. 2002, Dec. The importance of population susceptibility for air pollution risk assessment: a case study of power plants near Washington, DC. Environmental Health Perspectives; 110(12), p.1253.

This Harvard group researched the hypothetical application of “Best Available Control Technology” to 5 power plants in the Washington DC area.  They found that reduced air pollution from this model could potentially result in 160 fewer pediatric asthma ED visits per year for that area. Further analysis of subpopulations indicated that 64% of the benefits would be realized in the African American population.

 

·        Levy, J. et. al.  (2000). Estimated Public Health Impacts of Criteria Pollutant Air Emissions from the Salem Harbor and Brayton Point Power Plants.  Retrieved 8/25/03 from http://www.hsph.harvard.edu/papers/plant/executive.pdf

 

This Harvard study analyzed the potential of Best Available Control Technology (BACT) application to Salem Harbor & Brayton Point Power Plants in Massachusetts..  Results included:

 

Ř      Reduction in asthma attacks by 33,600/year

Ř      Reduction in ED visits by 1,330/year

Ř      Reduction in premature deaths by 124/year

                       

 

 

 

 

 

 

 

 

 

Report submitted by Donna Perry, RN, NP

 

 

 References

 

1American Lung Association Epidemiology & Statistics Unit. 2003, March. Trends

 in Asthma Morbidity and Mortality.

 

2American Lung Association Epidemiology & Statistics Unit. 2003, March. Trends

 in Asthma Morbidity and Mortality.

 

3American Lung Association. 2002, May. Estimated Prevalence of Lung Disease by Lung

Association Report May 2002.  Retrieved 7 July, 2003 from

http://www.lungusa.org/data/lae_02/table_ma02.html

 

4Mass.Gov. Emergency Department Charts. Preliminary Analysis of Emergency

Department Data. Retrieved 3 July, 2003 from

http://www.state.ma.us/dhcfp/pages/dhcfp234.htm

 

5American Lung Association. 2003, March. Asthma in Children Fact Sheet. Retrieved

            10 July, 2003 from http://www.lungusa.org/asthma/ascpedfac99.html

 

6American Lung Association Epidemiology & Statistics Unit. 2003, March. Trends

 in Asthma Morbidity and Mortality.

 

7Illinois Health Care Cost Containment Council. 2000. Asthma Hospital Guide

2000. Retrieved 9 July, 2003 from

http://www.state.il.us/agency/hcccc/freepubs/Asthma2000.pdf

 

 8American Lung Association Epidemiology & Statistics Unit. 2003, March. Trends

 in Asthma Morbidity and Mortality.

 

9Camargo C. 1999, Sept. 16. Expenditures: What is the Economic Impact of Asthma?

(Testimony before the U.S. Senate Committee on Health, Education, Labor, and

Pensions, Subcommittee on Public Health, hearing on “Children’s Health:

Protecting Our Most Precious Resource.”) Retrieved 3 July, 2003 from

http://www.chcs.org/AboutChcs/programs/pdf/ACexpenditures.pdf.

 

10Camargo C. 1999, Sept. 16. Expenditures: What is the Economic Impact of Asthma?

(Testimony before the U.S. Senate Committee on Health, Education, Labor, and

Pensions, Subcommittee on Public Health, hearing on “Children’s Health:

Protecting Our Most Precious Resource.”) Retrieved 3 July, 2003 from

http://www.chcs.org/AboutChcs/programs/pdf/ACexpenditures.pdf.

 

11American Lung Association Epidemiology & Statistics Unit. 2003, March. Trends

 in Asthma Morbidity and Mortality.

 

12 Office of Emergency Services, Department of Public Health, Compiled from

Data from State’s Division of Healthcare Finance & Policy. 2003. FY 2002

Massachusetts Asthma Inpatient Hospitalization Charges.

 

13MCDIN. Asthma Statistics & Data. Retrieved 7 July, 2003 from

http://www.mcdin.org/asthma/asstats_data.htm

 

14Faber, D. & Krieg, E. 2001, Jan. 9. Unequal Exposure to Ecological Hazards:

Environmental Injustices in the Commonwealth of Massachusetts.  Retrieved

8 July, 2003 from

            http://www.environmentalleague.org/Unequal_Exposure_Report.pdf

 

15U.S. Census Bureau. Census 2000 Quick Tables. Retrieved 8 July 2003

 From http://factfinder.census.gov

 

16Mass.Gov. Emergency Department Charts. Preliminary Analysis of Emergency

Department Data. Retrieved 3 July, 2003 from

http://www.state.ma.us/dhcfp/pages/dhcfp234.htm

 

17 Massachusetts Department of Public Health Asthma Initiatives and Resources 2002.

Retrieved 9 July, 2003 from     

http://www.asthmaregionalcouncil.org/resources/MA_Asthma_Initiatives_2002.pdf

 

18 U.S. Department of Health and Human Services. Agency for Toxic Substances and

Disease Registry.  2002, April. Case Studies in Environmental Medicine:

Environmental Triggers of Asthma.  Retrieved 10 July, 2003 from

http://www.atsdr.cdc.gov/HEC/CSEM/asthma/asthma.pdf

 

19 United States Environmental Protection Agency (2003, June 23). Ozone nonattainment area

map. Green Book. Retrieved 23 July, 2003 from

http://www.epa.gov/oar/oaqps/greenbk/onmapc.html

 

20 United States Environmental Protection Agency. (2003, June 26). Criteria Pollutants.

Green Book.  Retrieved 23 July, 2003 from

http://www.epa.gov/oar/oaqps/greenbk/o3co.html