Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-16 (of 16 Records) |
Query Trace: Garbe P[original query] |
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Where there is smoke: Introduction to the virtual special issue of health impacts of wildland fire smoke exposure - Selected papers from the 2nd International Smoke Symposium
McCarty JL , Garbe PL . Sci Total Environ 2018 626 1259-1260 The Second International Smoke Symposium (ISS2: http://www.iawfonline.org/2016SmokeSymposium/), held in November 2016 in Long Beach, California, USA, was sponsored by the International Association of Wildland Fire and had participation from atmospheric scientists, ecologists, mathematicians, computer scientists, climatologists, social scientists, health professionals, smoke responders, wildland fire-fighters, business owners, national, tribal, state, and local government officials from North America, Europe, and Australia, and others to discuss the complex issues of wildland fire smoke and identify knowledge gaps and opportunities for innovation and development. This Virtual Special Issue, composed of five original contributions invited from the over 100 oral and poster presentations at ISS2, illustrates current interdisciplinary approaches and technological advances needed to quantify, understand, and communicate the human impact of wildland prescribed fires. |
Air quality awareness among U.S. adults with respiratory and heart disease
Mirabelli MC , Boehmer TK , Damon SA , Sircar KD , Wall HK , Yip FY , Zahran HS , Garbe PL . Am J Prev Med 2018 54 (5) 679-687 INTRODUCTION: Poor air quality affects respiratory and cardiovascular health. Information about health risks associated with outdoor air quality is communicated to the public using air quality alerts. This study was conducted to assess associations of existing respiratory and heart disease with three aspects of air quality awareness: awareness of air quality alerts, discussing with a health professional strategies to reduce air pollution exposure, and avoiding busy roads to reduce air pollution exposure when walking, biking, or exercising outdoors. METHODS: During 2014-2016, a total of 12,599 U.S. adults participated in summer waves of the ConsumerStyles surveys and self-reported asthma, emphysema/chronic obstructive pulmonary disease, heart disease, and each aspect of air quality awareness. In 2017, associations between each health condition and air quality awareness were estimated using log binomial and multinomial regression. RESULTS: Overall, 49% of respondents were aware of air quality alerts, 3% discussed with a health professional strategies to reduce air pollution exposure, and 27% always/usually avoided busy roads to reduce air pollution exposure. Asthma was associated with increased prevalence of awareness of air quality alerts (prevalence ratio=1.11, 95% CI=1.04, 1.20), discussing with a health professional (prevalence ratio=4.88, 95% CI=3.74, 6.37), and always/usually avoiding busy roads to reduce air pollution exposure (prevalence ratio=1.13, 95% CI=1.01, 1.27). Heart disease was not associated with air quality awareness. CONCLUSIONS: Existing respiratory disease, but not heart disease, was associated with increased air quality awareness. These findings reveal important opportunities to raise awareness of air quality alerts and behavior changes aimed at reducing air pollution exposure among adults at risk of exacerbating respiratory and heart diseases. |
Vital Signs: Asthma in children - United States, 2001-2016
Zahran HS , Bailey CM , Damon SA , Garbe PL , Breysse PN . MMWR Morb Mortal Wkly Rep 2018 67 (5) 149-155 BACKGROUND: Asthma is the most common chronic lung disease of childhood, affecting approximately 6 million children in the United States. Although asthma cannot be cured, most of the time, asthma symptoms can be controlled by avoiding or reducing exposure to asthma triggers (allergens and irritants) and by following recommendations for asthma education and appropriate medical care. METHODS: CDC analyzed asthma data from the 2001-2016 National Health Interview Survey for children aged 0-17 years to examine trends and demographic differences in health outcomes and health care use. RESULTS: Asthma was more prevalent among boys (9.2%) than among girls (7.4%), children aged >/=5 years (approximately 10%) than children aged <5 years (3.8%), non-Hispanic black (black) children (15.7%) and children of Puerto Rican descent (12.9%) than among non-Hispanic white (white) children (7.1%), and children living in low income families (10.5%) than among those living in families with income >/=250% of the Federal Poverty Level (FPL) (approximately 7%). Asthma prevalence among children increased from 8.7% in 2001 to 9.4% in 2010, and then decreased to 8.3% in 2016. Although not all changes were statistically significant, a similar pattern was observed among subdemographic groups studied, with the exception of Mexican/Mexican-American children, among whom asthma prevalence increased from 5.1% in 2001 to 6.5% in 2016. Among children with asthma, the percentage who had an asthma attack in the past 12 months declined significantly from 2001 to 2016. Whereas asthma prevalence was lower among children aged 0-4 years than among older children, the prevalence of asthma attacks (62.4%), emergency department or urgent care center (ED/UC) visits (31.1%), and hospitalization (10.4%) were higher among children with asthma aged 0-4 years than among those aged 12-17 years (44.8%, 9.6%, and 2.8%, respectively). During 2013, children with asthma aged 5-17 years missed 13.8 million days of school per year (2.6 days per child). Compared with 2003, in 2013, the prevalence of adverse health outcomes and health care use were significantly lower and the prevalence of having an action plan to manage asthma was higher. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Asthma remains an important public health and medical problem. The health of children with asthma can be improved by promoting asthma control strategies, including asthma trigger reduction, appropriate guidelines-based medical management, and asthma education for children, parents, and others involved in asthma care. |
The economic burden of asthma in the United States, 2008 - 2013
Nurmagambetov T , Kuwahara R , Garbe P . Ann Am Thorac Soc 2018 15 (3) 348-356 RATIONALE: Asthma is a chronic disease that affects quality of life, productivity at work and school, healthcare use, and can result in death. Measuring the current economic burden of asthma provides important information on the impact of asthma on society. This information can be used to make informed decisions about allocation of limited public health resources. OBJECTIVES: In this paper, we provide a comprehensive approach to estimate current prevalence, medical costs, cost of absenteeism (missed work and schooldays) and mortality attributable to asthma from a national perspective. In addition, we estimate the association of incremental medical cost of asthma with several important factors, including race/ethnicity, education, poverty, and insurance status. METHODS: The primary source of data was the 2008-2013 household component of the Medical Expenditure Panel Survey. We defined treated asthma as the presence of at least one medical or pharmaceutical encounter or claim associated with asthma. For the main analysis, we applied two-part regression models to estimate asthma-related annual per-person incremental medical costs and negative binomial models to estimate absenteeism associated with asthma. RESULTS: Out of 213,994 people in the pooled sample, 10,237 persons had treated asthma (prevalence = 4.8%). The annual per-capita incremental medical cost of asthma was $3,266 (in 2015 US dollars): $1,830 was attributable to prescription medication, $640 to office visits, $529 to hospitalizations, $176 to hospital-based outpatient visits, and $105 to emergency room visits. For certain groups, the per-person incremental medical cost of asthma differed from that of the population average, namely, $2,145 for uninsured persons and $3.581 for those living below the poverty line. During 2008-2013, asthma was responsible for $3 billion in losses from missed work and school days, $29 billion from asthma-related mortality, and $50.3 billion in medical costs. All combined, the total cost of asthma in the U.S. based on the pooled sample amounted to $81.9 billion in 2013. CONCLUSION: Asthma places a significant economic burden on the United States with a total cost of asthma, including costs incurred by absenteeism and mortality, of $81.9 billion in 2013. |
Developing an online tool for identifying at-risk populations to wildfire smoke hazards
Vaidyanathan A , Yip F , Garbe P . Sci Total Environ 2017 619-620 376-383 Wildfire episodes pose a significant public health threat in the United States. Adverse health impacts associated with wildfires occur near the burn area as well as in places far downwind due to wildfire smoke exposures. Health effects associated with exposure to particulate matter arising from wildfires can range from mild eye and respiratory tract irritation to more serious outcomes such as asthma exacerbation, bronchitis, and decreased lung function. Real-time operational forecasts of wildfire smoke concentrations are available but they are not readily integrated with information on vulnerable populations necessary to identify at-risk communities during wildfire smoke episodes. Efforts are currently underway at the Centers for Disease Control and Prevention (CDC) to develop an online tool that utilizes short-term predictions and forecasts of smoke concentrations and integrates them with measures of population-level vulnerability for identifying at-risk populations to wildfire smoke hazards. The tool will be operationalized on a national scale, seeking input and assistance from several academic, federal, state, local, Tribal, and Territorial partners. The final product will then be incorporated into CDC's National Environmental Public Health Tracking Network (http://ephtracking.cdc.gov), providing users with access to a suite of mapping and display functionalities. A real-time vulnerability assessment tool incorporating standardized health and exposure datasets, and prevention guidelines related to wildfire smoke hazards is currently unavailable for public health practitioners and emergency responders. This tool could strengthen existing situational awareness competencies, and expedite future response and recovery efforts during wildfire episodes. |
Coordinated federal actions are needed to reduce racial and ethnic disparities in childhood asthma
Ashley PJ , Freemer M , Garbe P , Rowson D . J Public Health Manag Pract 2017 23 (2) 207-209 The New York State Healthy Neighborhoods Program, as described in the accompanying articles, is an innovative program that addresses a number of the priority actions identified in the Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities (Action Plan), which was released in May 2012.1 The Action Plan was developed by a federal interagency working group under the auspices of the President's Task Force on Environmental Health Risks and Safety Risks to Children. The objective of the task force is to identify priority issues within its purview that, at the federal level, can more effectively be addressed through coordinated interagency efforts, recommend and implement interagency actions, and communicate information to protect children from risks. Because of the relevance of environmental exposures and the importance of asthma as a childhood illness, the task force selected asthma as one of its focus areas. | Disparities in childhood asthma are evidenced by a disproportionate rate of disease, worse asthma outcomes, and higher needs for acute medical care in some racial and ethnic minority populations. The prevalence of asthma among US children is 8.6%; however, the prevalence among black, non-Hispanic children is 13.4%.2 Children living in poverty also have a higher asthma prevalence at 10.4%. Furthermore, black children have a higher risk of mortality and a higher rate of emergency department visits for asthma than white or Hispanic children. Asthma is also a leading cause of missed school days, thus presenting a significant barrier to children's successful achievement of academic milestones. | The Action Plan is founded on the following principles, aimed at aligning federal efforts to address asthma disparities: | Collaborating across federal agencies, other levels of government, and community partners. | Utilizing federal resources and optimizing their impact through synergies. | Emphasizing activities that address the preventive factors that impact asthma disparities. |
Outdoor PM2.5, ambient air temperature, and asthma symptoms in the past 14 days among adults with active asthma
Mirabelli MC , Vaidyanathan A , Flanders WD , Qin X , Garbe P . Environ Health Perspect 2016 124 (12) 1882-1890 BACKGROUND: Relationships between air quality and health are well-described, but little information is available about the joint associations between particulate air pollution, ambient temperature, and respiratory morbidity. OBJECTIVES: To evaluate associations between concentrations of particulate matter ≤2.5 microns in diameter (PM2.5) and exacerbation of existing asthma and modification of the associations by ambient air temperature. METHODS: Data from 50,356 adult 2006-2010 Asthma Call-back Survey respondents were linked by interview date and county of residence to estimates of daily averages of PM2.5 and maximum air temperature. Associations between 14-day average PM2.5 and the presence of any asthma symptoms during the 14 days leading up to and including the interview date were evaluated using binomial regression. We explored variation by air temperature using similar models, stratified into quintiles of the 14-day average maximum temperature. RESULTS: Among adults with active asthma, 57.1% reported asthma symptoms within the past 14 days and 14-day average PM2.5 ≥7.07 microg.m-3 was associated with an estimated 4 to 5% higher asthma symptom prevalence. In the range of 4.00 to 7.06 microg.m-3 of PM2.5, each microg.m-3 increase was associated with a 3.4% (95% confidence interval: 1.1, 5.7) increase in symptom prevalence; across categories of temperature from 1.1 to 80.5 degrees F, each microg.m-3 increase was associated with increased symptom prevalence (1.1-44.4 degrees F: 7.9%; 44.5-58.6 degrees F: 6.9%; 58.7-70.1 degrees F: 2.9%; 70.2-80.5 degrees F: 7.3%). CONCLUSIONS: These results suggest that each unit increase in PM2.5 may be associated with an increase in the prevalence of asthma symptoms, even at levels as low as 4.00 to 7.06 microg.m-3. |
Using the exhibited generalization approach to evaluate a carbon monoxide alarm ordinance
Chen HT , Yip F , Lavonas EJ , Iqbal S , Turner N , Cobb B , Garbe P . Eval Program Plann 2014 47c 35-44 Current interests in enhancing the focus of external validity or transferability call for developing practical evaluation approaches and illustrating their applications in this area for meeting the need. This study takes the challenge by introducing an innovative evaluation approach, named the exhibited generalization approach, and applying it in evaluating the carbon monoxide (CO) alarm ordinance passed by Mecklenburg County, North Carolina. The stakeholders specifically asked evaluators to determine the answers to the following two questions: (1) Does the alarm ordinance work? (2) What generalizable information can the Mecklenburg experience provide to other jurisdictions trying to decide if the alarm ordinance's planning, implementation, adoption, and outcomes are transferable to their communities? This study illustrates how to apply the exhibited generalization approach to provide the stakeholders with answers to these questions. Our results indicate that the alarm ordinance was effective in increasing CO alarm ownerships and reducing CO poisoning cases. The evaluation provides potential users and other interested parties with the necessary information on contextual factors and the causal mechanism underlying the CO alarm ordinance, so that these parties and users could decide whether the Mecklenburg alarm ordinance would be transferable to their own communities. Discussions include implications of this study for contributing in further advancing evaluation theory in addressing transferability or external validity issues. |
Racial and ethnic disparities in current asthma and emergency department visits: findings from the National Health Interview Survey, 2001-2010
Oraka E , Iqbal S , Flanders WD , Brinker K , Garbe P . J Asthma 2013 50 (5) 488-496 OBJECTIVES: Racial/ethnic disparities in current asthma prevalence and medical care are a major public health concern. We examined the differences in asthma prevalence and morbidity among major racial/ethnic populations in the U.S. METHODS: We analyzed data from the 2001-2010 National Health Interview Survey for adults (≥18 years) and children and adolescents (<18 years). Outcome variables were current asthma prevalence, at least one attack in the past 12 months, and at least one asthma-related emergency department/urgent care center (ED/UCC) visit in the past 12 months. We used multivariate logistic regression to calculate model-adjusted prevalence and risk ratios (ARR). RESULTS: In our study, 9.0% children and 7.2% adults had current asthma. Non-Hispanic black and Puerto Rican children were more likely to have current asthma (ARR 1.46, 1.66, respectively) and to visit the ED/UCC (ARR 1.61, 1.67, respectively) than non-Hispanic whites. American Indian/Alaskan Native children were more likely to have current asthma (ARR 1.76) than non-Hispanic whites. Mexican/Mexican American children and adults had lower prevalence of current asthma but higher ED/UCC use (adults only) than non-Hispanic whites. Among adults, Puerto Ricans and American Indian/Alaskan Natives were more likely to have current asthma (ARR 1.60, 1.39, respectively) than non-Hispanic whites, and all studied racial/ethnic groups except Asians were more likely to have visited the ED/UCC than non-Hispanic whites. Adults and children who received emergency care for asthma in the past 12 months more frequently received multiple components of asthma management and control (e.g., taking long-term medication, having an asthma management plan) compared to those without emergency care. CONCLUSIONS: Racial/ethnic differences in current asthma prevalence, asthma attacks, and increased utilization of emergency room visits for asthma among minorities persist among children and adults. Appropriate and effective asthma management and education may lead to better asthma control and reduce emergency care utilization. |
Obstructive lung disease and exposure to burning biomass fuel in the indoor environment
Diette GB , Accinelli RA , Balmes JR , Buist AS , Checkley W , Garbe P , Hansel NN , Kapil V , Gordon S , Lagat DK , Yip F , Mortimer K , Perez-Padilla R , Roth C , Schwaninger JM , Punturieri A , Kiley JP . Glob Heart 2012 7 (3) 265-270 It is estimated that up to half of the world’s population burns biomass fuel (wood, crop residues, animal dung and coal) for indoor uses such as cooking, lighting and heating. As a result, a large proportion of women and children are exposed to high levels of household air pollution (HAP). The short and long term effects of these exposures on the respiratory health of this population are not clearly understood. On May 9–11, 2011 NIH held an international workshop on the "Health Burden of Indoor Air Pollution on Women and Children," in Arlington, VA. To gather information on the knowledge base on this topic and identify research gaps, ahead of the meeting we conducted a literature search using PubMed to identify publications that related to HAP, asthma, and chronic obstructive pulmonary disease (COPD). Abstracts were all analyzed and we report on those considered by the respiratory sub study group at the meeting to be most relevant to the field. Many of the studies published are symptom-based studies (as opposed to objective measures of lung function or clinical examination etc.) and measurement of HAP was not done. Many found some association between indoor exposures to biomass smoke as assessed by stove type (e.g., open fire vs. liquid propane gas) and respiratory symptoms such as wheeze and cough. Among the studies that examined objective measures (e.g. spirometry) as a health outcome, the data supporting an association between biomass smoke exposure and COPD in adult women are fairly robust, but the findings for asthma are mixed. If an association was observed between the exposures and lung function, most data seemed to demonstrate mild to moderate reductions in lung function, the pathophysiological mechanisms of which need to be investigated. In the end, the group identified a series of scientific gaps and opportunities for research that need to be addressed to better understand the respiratory effects of exposure to indoor burning of the different forms of biomass fuels. |
First things first: protecting children with asthma from infection with influenza
Garbe PL , Callahan DB , Lu PJ , Euler GL . Am J Respir Crit Care Med 2012 185 (12) i-ii Currently in the U.S., approximately 7 million children (9.4%) have asthma (1), making it the most prevalent serious chronic illness among U.S. children. Clinically, the association of viral respiratory infections and asthma exacerbations has been understood for decades. More recently, infections with particular viruses have been identified as being particularly risky: respiratory syncytial virus, rhinovirus, and influenza virus are notable examples. In the spring of 2009, a new influenza virus (A(H1N1)pdm09 [2009 H1N1]) with pandemic potential was isolated from patients in the U.S. and around the world (2). Early data indicated that certain comorbid medical conditions increased the risk for hospitalization and intensive care unit admission (3). Persons with asthma appeared to bear a disproportionate risk, and local and state health departments along with Centers for Disease Control and Prevention (CDC) developed and disseminated guidance early in the outbreak for persons with asthma and their health care providers. Early diagnosis and use of antiviral medication, along with public health practices like self-distancing and hand-washing, were emphasized. Persons with comorbid conditions (including asthma) were prioritized to receive vaccine once it became available. These recommendations, however, were more re-iterations of existing practices and policies rather than de novo interventions. As was consistent with previous recommendations, vaccination of persons with asthma was to prevent influenza because of the risk of increased disease severity, rather than increased risk of becoming infected with influenza virus. Analysis of existing data did not, at that point in time, support (nor refute) an increased risk of infection among persons with asthma. |
Evidence-based health: necessary but not sufficient
Herman E , Garbe P . Prev Chronic Dis 2012 9 E28 As public health practitioners from the National Asthma Control Program (NACP) of the Centers for Disease Control and Prevention, we read the essay "From Evidence-Based Medicine to Evidence-Based Health: the Example of Asthma" (1) with great interest. We agree with the authors' hypothesis that evidence-based clinical medicine must be supplemented by asthma self-management support "that extends beyond the clinic" and "by interventions that change elements of the environment in which patients live." As the authors note, this concept is not new. Indeed, it underlies the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (2). | A recent article (3) describes remarkable progress not only in understanding the pathophysiology of asthma and in producing new medications for its control but also in a public health response "to support patient- and community-level interventions and to assess the effect of the environment on asthma." The NACP has greatly expanded population-level asthma surveillance of asthma prevalence, illness, and death (4). The NACP also supports 34 states, Washington, DC, and Puerto Rico "to build and sustain programs that translate evidence-based practice into interventions." Furthermore, the Task Force on Community Preventive Services recently conducted and published a systematic review of the effectiveness of home-based, multi-trigger, multicomponent interventions in improving asthma control (5). The NACP is working through state asthma programs to implement those interventions. | Much work remains to be done to achieve evidence-based health (as defined by Moskowitz and Bodenheimer), particularly among racial/ethnic minorities, who have a disparately high prevalence of and morbidity from asthma. The authors note 3 necessary actions: linking clinical teams with community resources to address asthma triggers in housing, advocating for better housing and cleaner air, and convincing insurers to reimburse for essential educational and community health services. We suggest that these actions, although necessary, are not sufficient to decrease the burden of asthma at a population level. |
Unhealthy air quality - United States, 2006-2009
Yip FY , Pearcy JN , Garbe PL , Truman BI . MMWR Suppl 2011 60 (1) 28-32 Particulate matter and ozone are two well-characterized air pollutants that can affect health and are monitored by the U.S. Environmental Protection Agency (EPA). Particulate matter (solid or liquid particles suspended in the air) varies widely in size and chemical composition and can include smoke, fumes, soot, and combustion by-products, as well as natural particles (e.g., windblown dust, pollen, and sea salt) (1,2). Particulate matter therefore represents a complex class of air pollutants that differ from other gaseous air pollutants (e.g., ozone). The transport and effect of particulate matter, both in the atmosphere and in the human respiratory tract, are governed principally by particulate size, shape, and density. Individual particles are characterized by their equivalent aerodynamic diameter: coarse particulate matter (2.5--10 µm); fine particulate matter, or PM2.5 (0.1--2.5 µm); and ultrafine particulate matter (<0.1 µm). Ozone is a gas that occurs naturally in the stratosphere, approximately 10--30 miles above the earth's surface, protecting the earth from the sun's ultraviolet rays. Ozone also exists at ground level and is the primary component of smog. At ground level, ozone is created when specific pollutants react in the presence of sunlight. In urban areas, vehicular and industrial emissions are chief contributors to ozone production. Ground-level ozone adversely affects health and damages the environment. | | The association between outdoor particulate matter concentrations and acute and chronic adverse health outcomes includes premature death, lung cancer, exacerbation of respiratory and cardiovascular disease, and increased risks for cardiovascular morbidity (e.g., myocardial infarction and arrhythmia) (1--6). Data indicate that fine particulate matter is the size fraction most strongly associated with these observed health effects (1--7). Populations most susceptible to these exposures include older adults and children, as well as persons with heart and lung disease. National Ambient Air Quality Standards (NAAQS) were set forth in the Clean Air Act Amendments of 1970* requiring EPA to set air quality standards for specific pollutants, such as PM2.5 and ozone, to protect the health of the general public, as well as that of sensitive populations. States that do not meet the standards are subject to additional regulatory requirements and must develop a state implementation plan to meet the standards. State implementation plans might include control requirements and limits on emissions. In 2006, on the basis of increasing evidence of the effects of PM2.5 on human health, EPA revised its 24-hour NAAQS from 65 µg/m3 to 35 µg/m3. Throughout the United States, PM2.5 concentrations have been decreasing; more counties were in compliance with national pollution standards as of 2008 compared with previous years (8). During 2001--2008, the average annual and 24-hour PM2.5 concentrations declined by 17% and 19%, respectively (8). |
Evaluating home-based, multicomponent, multi-trigger interventions: your results may vary
Wilce MA , Garbe PL . Am J Prev Med 2011 41 S52-4 In public health, we operate in a world of tight resources, making the best decisions possible to maximize benefits to people with asthma, their families, and our communities. The use of evidence-based interventions is an effective way to build on experience by implementing interventions that have shown previous effectiveness. The systematic review published in this supplement to the American Journal of Preventive Medicine was completed in order to identify effective asthma interventions for reducing asthma morbidity in a community setting.1, 2, 3 The plan is to use the information to guide funded programs on how to best allocate their resources, as well as to direct our own research and evaluation efforts at the national level. Home-based asthma interventions were chosen for the review in order to focus on efforts to reduce indoor asthma triggers because this type of intervention is used more and more at the state level, and there is not much information summarizing the effectiveness of these interventions on a community level. | The two Guide to Community Preventive Services (Community Guide) reviews2, 3 together are invaluable resources to help us make the right decisions for our programs and, ultimately help people with asthma and their families. These Community Guide reviews are exciting: They give us evidence that home-based environmental interventions can improve the lives of children with asthma and their families. Moreover, moderate-intensity interventions can be cost effective. |
Assessing community-based approaches to asthma control: the Controlling Asthma in American Cities Project
Herman EJ , Garbe PL , McGeehin MA . J Urban Health 2011 88 Suppl 1 1-6 More than 30 million people in the USA have been diagnosed with asthma during their lifetime. Of the 20 million US residents who currently have asthma, 12 million have had an asthma episode or attack during the past year. Asthma affects people of all races, both sexes, and all ages, and in every region of the USA. However, asthma occurs more often among children, women and girls, African Americans, Puerto Ricans, people in the Northeast, those living below the federal poverty level, and those with particular work-related exposures. Asthma death rates rose between 1980 and 1996 among both sexes and most age and ethnic groups, but have declined since 2000. Women and girls account for nearly 64% of asthma deaths overall, although, among children, more boys than girls die each year. Many of the 4,000 asthma-related deaths that occur annually could be avoided with proper treatment and care.1 | The burden of asthma in the USA has increased greatly over the last 25 years and affects our nation and health system in more ways than limited and lost lives. Asthma leads to almost 13 million outpatient physician visits and two million emergency department visits each year. Asthma is a leading cause of school absenteeism with children missing almost 14 million school days per year due to asthma.2 Asthma is the fourth leading cause of work absenteeism and diminished work productivity among adults, resulting in nearly 12 million missed or less productive workdays each year.2 The estimated annual cost of asthma for 2006 was over $32 billion, including nearly $28 billion in direct health care costs and $4.5 billion for indirect costs such as lost earnings due to illness or death.3 |
Carbon monoxide-related hospitalizations in the U.S.: evaluation of a web-based query system for public health surveillance
Iqbal S , Clower JH , Boehmer TK , Yip FY , Garbe P . Public Health Rep 2010 125 (3) 423-32 OBJECTIVE: Carbon monoxide (CO) poisoning is preventable, yet it remains one of the most common causes of poisoning in the U.S. In the absence of a national data reporting system for CO-poisoning surveillance, the burden of CO-related hospitalizations is unknown. Our objective was to generate the first national estimates of CO-related hospitalizations and to evaluate the use of a Web-based query system for public health surveillance. METHODS: The Healthcare Cost and Utilization Project's (HCUP's) 2005 Nationwide Inpatient Sample (NIS) data were used for CO-related hospitalization estimates. Data for confirmed, probable, and suspected cases were generated using the HCUPnet Web-based query system. We used data from 1993 through 2005 NIS to describe trends in CO-related hospitalizations. We used the Centers for Disease Control and Prevention's surveillance evaluation guidelines to evaluate the system. RESULTS: In 2005, there were 24,891 CO-related hospitalizations nationwide: 16.9% (n=4,216) were confirmed, 1.1% (n=279) were probable, and 81.9% (n=20,396) were suspected CO-poisoning cases. Of the confirmed cases (1.42/100,000 population), the highest hospitalization rates occurred among males, older adults (aged > or = 85 years), and Midwestern residents. CO-related hospitalization rates declined from 1993 through 2000 and plateaued from 2001 through 2005. The simplicity, acceptability, sensitivity, and representativeness of the HCUPnet surveillance system were excellent. However, HCUPnet showed limited flexibility and specificity. CONCLUSIONS: Nationwide, the burden of CO exposure resulting in hospitalization is substantial. HCUPnet is a useful surveillance tool that efficiently characterized CO-related hospitalizations for the first time. Public health practitioners can utilize this data source for state-level surveillance. |
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