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Running head: Asthma Mortality Rates in the United States

Asthma: Mortality Rates in the United States, African Americans


And Non-Hispanic Whites Americans

By:
Bosede Adedire, Angela Long, Christiana Ikome & Evangeline Okechukwu

Presented to:
Dr. Emmanuel Obiako

In partial fulfillment of the requirements of


Nursing 520 - Epidemiology

Coppin State University


Spring 2013

Asthma Mortality Rates in the United States

Asthma is an illness that is considered to be one of the main health care problems seen in
the western world that is increasing in prevalence (Ruggeri, Bragato, Colombo, Valla, & Matteo,
2012, p. 1). According to Patrawalla et al., 2012, Asthma affects more than 17 million American
adults (Patrawalla et al., 2012. p.1). Asthma is estimated to be a disease that affects 4% to 7 %
of the worlds population and that may be an underestimate due to difficulty in differentiating
between asthma and other medical conditions such as chronic obstructive pulmonary disease
(COPD) or bronchitis (Ruggeri et al., 2012, p. 376). Asthma being underdiagnosed, it is being
under treated and causing a major healthcare crisis that results in loss days of work for adults,
lost days of school for children, lost time playing sporting activities, increased emergency room
visits, and increased inpatient days. Asthma costs the healthcare system more than $20 billion
dollars a year despite guideline treatment strategies (Patrawalla et al., 2012, p. 1).
There have been different definitions used to describe asthma as a health problem. One
definition describes asthma as a very common chronic disorder that affects the airways
(Moorman, Akinbami, & Bailey, 2012, p. 8). Another definition describes asthma as an
obstruction of the airways which can be caused by inflammation or narrowing of the airways in
the lungs or airway hyperactivity caused by an exposure (Moorman et al., 2012, p. 8). Asthma
has also been defined as a complex interaction of airway obstruction, bronchial hyper
responsiveness and underlying inflammation (McCance, Huether, Brashers, & Rote, 2010, p.
1283). McCance et al., (2010) added that mast cells, eosinophil and neutrophils contribute to the
inflammatory response along with T- lymphytes, macrophages and damaged epithial cells
(McCance , 2010, p. 1283). Asthma affects all ages and about half of all cases are identified in
early childhood and another 30% being identified before 40 years old (McCance, 2010, p. 1283).

Asthma Mortality Rates in the United States

Furthermore, asthma has been described as a familial disease which more than 100
genes have been identified that may play a role in the susceptibility and pathogenesis of asthma
(McCance, 2010, p. 1283). Moreover, not all people experience all the signs and symptoms of
asthma, however, signs and symptoms of an asthma attack could include expiratory wheezing,
nonproductive coughing, shortness of breath, pain, chest tightness, prolonged expiration,
tachycardia, dyspnea and tachypnea (Moorman et al., 2012, p. 8). Some airborne allergens such
as pollen, mold, animal dander, dust mite and cockroach allergens can be a trigger to cause an
asthma attack or exacerbation (Moorman et al., 2012, p. 8).
Similarly, some occupational exposures that are sensitizing chemicals or dusts,
airborne irritants such as smoking tobacco or cigarettes are also exposures (Moorman et al.,
2012, p. 8). Risk factors also include urban residence, addition family history, recurrent
respiratory viral infections and obesity (McCance , 2010, p. 1283). When an attack begins, the
signs and symptoms that results from airway resistance may be different for different people.
This airway obstruction increases resistance to airflow and decreases flow rates, especially
expiratory airflow which cause air trapping, hyperinflation distal to the obstruction, and increase
work of breathing (McCance , 2010, p. 1284). As the obstruction becomes more serious the
alveoli become inadequately ventilated which can lead to respiratory failure (McCance , 2010, p.
1284). Asthma has no cure nor neither is it preventable, (as cited by Moorman et al., 2012, p. 8);
an asthma attack can range from a nuisance to a life threatening event which can cause death.
According to the U.S Census bureau, asthma affects more than 22 million people in the
United States and has become a major global health problem affecting more than 300 million
people worldwide (http://www.health.ny.gov/statistics/ny_asthma/read.htm). Reports from the
National Center for Health Statistics (NCHS) re-emphasize other findings that indicate that

Asthma Mortality Rates in the United States

asthma is on the rise in the United States as a whole, and it is the major cause of decrease
economic productivity from missed days of work by adults and time loss from academic
preparedness for students (http://www.cdc.gov/nchs/asthma/nhsr.htm). Additional findings
report that approximately 10.2 million (13.9%) U.S. children less than 18 years of age were
diagnosed with asthma at some point in their lifetime, and an estimated 7.1 million (9.7%)
children currently have asthma (http://www.cdc.gov/nchs/asthma/nhsr.htm). Additionally, an
estimated 29.7 million (13.2%) U.S. adults had been diagnosed with asthma during their
lifetime, and an estimated 17.5 million (7.7%) adults currently have asthma which results into
four hundred and fifty six thousand hospitalizations nationwide (http://www.cdc.gov/asthma).
The burden of asthma on the economy is not far-fetched, from monetary loss due to
rising hospitalization to increase number of asthma prevalence which invariably put the
economy at a point where more is being spent taking care of the sick which kicks the economy
out of balance. Despite the rising cost of health care from asthma management, treatment and
research has not been able to find a cure or means to prevent asthma. Asthma costs in the US
grew from about $53 billion in 2002 to about $56 billion in 2007, about a 6% increase
(http://www.cdc.gov/asthma), which could probably go towards other productive needs in the
economy.
According to the Asthma and Allergy Foundation of America, asthma affects many
Americans daily (Asthma and Allergy Foundation of America, 2013). Every day in U.S., about
forty-four thousand people have asthma attacks, about thirty-six thousand kids miss school,
about twenty seven thousand adults miss work, about four thousand seven hundred people end
up in the emergency room, about one thousand two hundred people end up admitted to the

Asthma Mortality Rates in the United States

hospital and about nine people die on daily basis (Asthma and Allergy Foundation of America,
2013).
Data from the 2010 census shows that the population of the United States has been
growing, increasing from about a population of 281,421,906 in 2000 to over 300 million ten
years later, making the U. S the third largest country in the world coming after China and
India (http://www.cdc.gov/minorityhealth/populations/REMP/black.html). The U.S. census
bureau expects the U.S population to grow further over the next few decades. According to a
report by the population reference bureau on the state of growth of the U.S. population in 2006,
it was explained that each 100 million has been added more quickly over the years than the last,
it took the United States more than 100 years to reach 200 million in 1967; Less than 40 years
later, it reached the projected number in the 300-million mark, which has been projected to pass
400 million within another 37 years
(http://www.census.gov/popest/data/intercensal/national/nat2010.html).
The growing U.S population is made up of different ethnicities, however, for the purpose
of this assignment, the total population of the U.S., the African American population and NonHispanic white Americans population shall be examined. As shown on Appendix B of this
paper, the population of African Americans in 2000 was estimated at 35.8 million, making up
about 12.7% of the total U.S. population. In that same year, the population of Non-Hispanic
White Americans was estimated at about 195.7 million, making up 69.5% of the total U.S
population, reflecting that over half of the U.S population is made up of Non- Hispanic
Americans. Similarly, in 2003, the population of African American was estimated at 37.1
million, which indicates a 12.8% of the U.S population. A slight increase of 0.1% was noted
from 2001-2003. The population growth of Non-Hispanic Whites on the other hand, had a

Asthma Mortality Rates in the United States

contrasting growth rate, compared to that of African-Americans as the Non-Hispanics within the
same period under review witnessed a population increase from about 195.1 million in 2000 to
about 196.1 million in 2003. Although the data in the report shows that there was an increase in
population for both African Americans and Non-Hispanic Whites, it is worth noting that the
report highlighted a decrease in rate of growth of about 2.2% on the Non-Hispanic White
American population. One of the explanations for the decrease in growth rate for the NonHispanic White Americans was attributed to the decline of low birth rates for the Non-Hispanic
White Americans (http://www.census.gov/popest/data/intercensal/national/nat2010.html).
The growth rate of Non-Hispanic population though steadily declining over the years as
shown from reported data, still out-grows the recorded growth of African Americans. On the
contrary, African Americans population has had slight increases from 2000 through 2010 but
increases in this population is not comparable to the number of Non- Hispanic White Americans,
whose population is over 60% of the total U.S population. As shown on the data, NonHispanics were 66% of the total U.S population in 2006, and 63.8% in 2010, Although this
population shows declining rates, it grossly out-weighs the total number of African Americans
during the period examined.
Mortality rate for asthma is a serious problem that Americans are facing. For instance,
Data from the National Asthma and allergy Foundation reveals that about nine Americans die
from asthma attacks daily, which accounts for approximately three thousand three hundred
asthma deaths each year (Asthma and Allergy Foundation of America, 2013).
Asthma is also noted to be a contributing factor to as many as seven thousand deaths
yearly (Asthma and Allergy Foundation of America, 2013). This means that the primary cause of
death is another disease but Asthma played a secondary role in the death. The Asthma
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Asthma Mortality Rates in the United States

foundation further notes that the overall Asthma death rates have increased more than 50% since
1980 in all genders, age groups and ethnic groups (Asthma and Allergy Foundation of America,
2013).

Data from the Asthma and Allergy Foundation further reveal that African Americans die

from Asthma three times more than white Non-Hispanic Americans, with African American
women having the highest Asthma mortality rate of all groups. African American women die
from asthma at a rate 2.5 higher than white Non-Hispanic American women (Asthma and Allergy
Foundation of America, 2013.
The Centers for Disease Control and Prevention has tracked asthma deaths for the last ten
years and released a report which the American Lung Association has published on their website
for public viewing and access. The Census bureau and CDC work together to produce these
reports and data as accurately as possible. Appendix A, Table 1 and 2, Appendix C, Table 1 and
2, Appendix D, Figure 1 and 2, are tables and graphical representations with details on asthma
death rates for the US as a whole, African-Americans and Non-Hispanic White Americans.
Appendix B shows the rate of population growth for the US, African Americans and NonHispanic whites.

Asthma Mortality Rates in the United States

References
American lung Association. (2012). Trends in Asthma Morbidity and Mortality. American Lung
Association Epidemiology and Statistics Unit, p. 1-28. http://www.lung.org.
Asthma and Allergy Foundation of America. (2013, April 09). Retrieved April 09, 2013, from
http://www.aafa.org
Centers for Disease Control and Prevention. (2010). Minority population division. Retrieved
From: http://www.cdc.gov/minorityhealth/populations/REMP/black.html
Centers for Disease Control and Prevention, national asthma control program. (2013). Retrieved
from http://www.cdc.gov/asthma
Cetlin, A., Gutierrez, M., Bettiol, H., Barbieri, M., & Vianna, E. (2012). Influence of asthma
definition on asthma-obesity relationship. BMC Public Health, 1-9.
doi.org/10.1186/1471-2458-12-844
Gordis. L. (2009). Epidemiology. 4 th edition. Philadelphia. Saunders Elsevier
McCance, K., Huether, S., Brashers, V., & Rote, N. (2010). Pathophysiology: The Biologic Basis
for Disease in Adults and Children (6th ed.). Missouri: Mosby Inc.
Moorman, J., Akinbami, L., & Bailey, C. (2012). National surveillance of asthma: United States,
2001-2010. Retrieved from www.cdc.gov
Moorman, J., Akinbami, L., & Bailey, C. (2012). National surveillance of asthma: united states,
2001-2010. National Center for Health Statistics Centers for Disease Control and
Prevention, 3(35), 1-67. Retrieved from www.cdc.gov
National Asthma Education and Prevention Program. (2009). Asthma comprehensive treatment
Management. Retrieved from: http://www.naepp+ASTHMA+site:www.nhlbi.nih.gov
Patrawalla, P., Kazeros, A., Rogers, L., Shao, Y., Liu, M., Fernandez-Beros, M., Reibman, J.
(2012). Application of the asthma phenotype algorithm from the severe asthma research
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Asthma Mortality Rates in the United States

program to an urban population. PLOS One, 7(9), 1-7. doi.org/10.1371/


journal.pone.0044540
Porth, C. & Matfin, G. (2009). Pathophysiology: Concepts of altered health states
(8th ed.). Philadelphia: J.B. Lippincott-Raven.
Qamar, N., Pappalardo, A., Arora, V., & Press, V. (2011, March 6). Patient-centered care and its
effect on outcomes in the treatment of asthma. Patient Related Outcome Measures, 2(2),
81-109. doi.org/10.2147/PROM.S12634
Ruggeri, I., Bragato, D., Colombo, G., Valla, E., & Matteo, S. (2012). Cost and appropriateness
of treating asthma with fixed-combination drugs in local health care units in Italy. Clinico
economics and Outcomes Research, 4(4), 375-382. doi.org/10.2147/ CEOR.S36499
United States Census Bureau. (2012). Asthma prevalence and incidence nationwide
Retrieved from http://www.census.gov/dem/figures/asthma
United States Census Bureau. (2012). Population division: National inter central
estimates. Retrieved from:
http://www.census.gov/popest/data/intercensal/national/nat2010.html

Asthma Mortality Rates in the United States


10

Appendix A
ASTHMA MORTALITY DATA
Table 1: US Population as a whole
YEAR
TOTAL POULATION IN
MILLIONS
2000
4,657
2001
4,487
2002
4,269
2003
4,009
2004
3,816
2005
3,884
2006
3,613
2007
3,447
2008
3,397
2009
3,396
2010
3,388
Source: American Lung Association, September 2012
Source: Centers for Disease Control and Prevention. National Center for Health Statistics.

Table 2: African-Americans Vs Non- Hispanic Whites


AFRICAN
NON-HISPANIC
AMERICAN
WHITES
YEAR
POPULATION IN
POPULATION IN
MILLIONS
MILLIONS
2000
3,011
1,134
2001
2,836
1,145
2002
2,720
1,083
2003
2,589
1,019
2004
2,377
1,019
2005
2,475
1,002
2006
2,246
943
2007
2,151
893
2008
2070
892
2009
2,012
905
2010
2016
910
Source: American Lung Association, September 2012
Source: Centers for Disease Control and Prevention. National Center for Health Statistics

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Appendix B
US Census data for 10 years: US as a whole, African Americans and Non-Hispanic whites.
(2000 2010)

YEAR

2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010

US POPULATION IN

AFRICAN AMERICAN

POPULATION

MILLIONS

POPULATION IN

Non-HISPANIC WHITE

MILLIONS

AMERICANS

35,814,706
36,263,029
36,684,650
37,066,096
37,510,582
37,961,688
38,443,048
38,935,533
39,429,414
39,902,270
40,250,635

195,701,752
195,974,813
196,140,540
196,232,760
196,620,983
196,620,983
196,832,697
197,011,394
197,183,535
197,274,549
197,318,956

281,421,906
284,970,000
287,630,000
290,110,000
292,810,000
295,520,000
298,380,000
301,230,000
304,090,000
306,770,000
309,350,000

Appendix C
Table 1: MORTALITY RATES PER 100.000 FOR THE US AND AFRICAN AMERICANS

YEAR

NUMBER OF DEATHS FROM

NUMBER OF DEATHS FROM

ASTHMA

ASTHMA AFRICAN AMERICANS

US POPULATION
POPULATI
NUMBER
MORTALIT
ON USA

POPULATI

NUMBER

MORTALIT

OF DEATH

Y RATE

ON

OF DEATH

Y RATE

USA

PER

AFRICAN

AFRICAN

PER
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Asthma Mortality Rates in the United States


12
100.000

AMERICAN

AMERICA

100,000

2000

281,421,90

4,487

1.6

S
35,814,706

N
2,836

1.3

2001

6
284,970,00

4,269

1.5

36,263,029

2,720

1.2

2002

0
287,630,00

4,090

1.4

36,684,650

2,589

1.3

2003

0
290,110,00

4,099

1.4

37,066,096

2,377

1.0

2004

0
292,810,00

3,816

1.3

37,510,582

2,475

1.0

2005

0
295,520,00

3,884

1.3

37,961,688

2,246

0.9

2006

0
298,380,00

3,613

1.2

38,443,048

2,151

0.9

2007

0
301,230,00

3,447

1.1

39,935,533

2,070

0.8

2008

0
304,090,00

3,397

1.0

39,429,414

2,012

0.8

2009

0
306,770,00

3,388

1.1

39,902,270

2,140

0.7

2010

0
309,350,00

3447

1.1

40,250,635

2,080

0.7

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Table 2: MORTALITY RATES PER 100.000 FOR THE NON-HISPANIC WHITES


NUMBER OF DEATHS FROM ASTHMA NON-HISPANIC WHITES

YEAR

2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010

POPULATION

NUMBER OF

MORTALITY RATE

NON-HISPANIC

DEATHS

PER 100.000

WHITE AMERICANS

NON-HISPANIC

195,701,752
195,974,813
196,140,540
196,232,760
196,620,983
196,620,983
196,832,697
197,011,394
197,183,535
197,274,549
197,318,956

AMERICANS
1,134
1,145
1083
1,019
1,001
1,002
943
893
892
905
899

0.4
0.4
0.4
0.4
0.3
0.3
0.3
0.3
0.3
0.3
0.3

Appendix D

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Asthma Mortality Rates in the United States


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Figure 1: Mortality Rates per 100,000 for the US, African


Americans and Non Hispanic Whites
5,000
4,500

4,487

4,269

4,090 4,099

4,000

3,816 3,884

3,613

3,447 3,397 3,388 3,447


NUMBER OF DEATH AFRICAN AMERICAN

3,500
NUMBER OF DEATHS US AMERICANS
3,000 2,836 2,720

2,589

2,500

2,377 2,475

2,000

2,246 2,151
2,070 2,012 2,140 2,080

1,500
NUMBER1,134
OF DEATHS
1,145NON-HISPANIC
1,083 1,019 AMERICANS
1,001 1,002 943
1,000

893

892

905

899

500
0
YEAR 2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

14

Asthma Mortality Rates in the United States


15

Figure 2: Mortality Rates per 100,000 for the US, African


Americans and Non Hispanic Whites
5,000
4,500
4,000

4,487

4,269

3,500
3,000
2,500

2,836 2,720

2,000

4,090 4,099
NUMBER OF DEATHS
3,884
AMERICANS
3,816 US
3,613
3,447 3,397 3,388 3,447
2,589
2,475
2,377
NUMBER
OF DEATH AFRICAN
AMERICAN
2,246 2,151
2,070

2,012

2,140 2,080

1,500
1,000
500

1,134 1,145 1,083 1,019


1,001 1,002 943
892 905
NUMBER OF DEATHS NON-HISPANIC893
AMERICANS

0
YEAR 2000

2001

2002

2003

2004

2005

2006

2007

2008

899

2009

2010

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