a report from the texas asthma control program · the burden of asthma in texas 1 introduction...

iThe Burden of Asthma in Texas

A Report From The Texas Asthma Control ProgramApril 2007

TEXASDepartment ofState Health Services

iThe Burden of Asthma in Texas

The Burden of Asthma in Texas

2000-2005

Texas Department of State Health Services

Adult Health and Chronic Disease Group

Texas Asthma Control Program

1100 West 49th Street

Austin, Texas 78756

ii The Burden of Asthma in Texas


2000-2005Direction and Support

Jennifer Smith, MS, BSManager

Adult Health and Chronic Disease Group Texas Department of State Health Services

Philip Huang, MD, MPHMedical Director, Health Promotion Unit

Texas Department of State Health Services

Preparation and Development

Shu Lou, MD, MSEpidemiologist

Texas Asthma Control ProgramTexas Department of State Health Services

Tino Moreno, MS, BS Epidemiologist

Texas Asthma Control ProgramTexas Department of State Health Services

iiiThe Burden of Asthma in Texas

Table of ContentsINTRODUCTION (Revised July 2008) ...........................................................................1 The Asthma Burden in Texas.................................................................................1DEMOGRAPHICS............................................................................................................3 The Texas Population............................................................................................3 Race Groups..........................................................................................................4PREVALENCE..................................................................................................................8 Behavioral Risk Factor Surveillance System (BRFSS)..........................................8 Figure 1: Adult Lifetime Asthma Prevalence........................................................10 Figure 2: Adult Current Asthma Prevalence.........................................................11 Figure 3: Adult Asthma Prevalence by Gender....................................................12 Figure 4: Adult Asthma Prevalence by Race/Ethnicity.........................................13 Figure 5: Adult Asthma Prevalence by Age Group...............................................14 Figure 6: Child Asthma Prevalence by Gender....................................................15 Figure 7: Child Asthma Prevalence by Age Group...............................................16 Figure 8: Adult Asthma Prevalence by Income Level...........................................17 Figure 9: Adult Asthma Prevalence by Educational Level....................................18 Figure 10: Adult Asthma Prevalence by Body Mass Index (BMI) Level...............19 Figure 11: Adult Asthma Prevalence by Region...................................................20QUALITY OF LIFE..........................................................................................................21 Behavioral Risk Factor Surveillance System (BRFSS)........................................21 Figure 12: Adult Patients’ Urgent Care Visits.......................................................22 Figure 13: Adult Patients’ Emergency Department (ED) Visits............................23 Figure 14: Adult Patients’ Routine Checkups.......................................................24 Figure 15: Unable to Carry out Usual Activity Days.............................................25 Figure 16: Asthma Symptom Days......................................................................26 Figure 17: Sleep Disturbed Days.........................................................................27HOSPITALIZATIONS......................................................................................................28 Texas Health Care Information Collection (THCIC).............................................28 Figure 18: Hospitalization Rate by Year...............................................................29 Figure 19: Hospitalization Rate by Gender..........................................................30

iv The Burden of Asthma in Texas

Table of Contents

Figure 20: Hospitalization Rate by Gender & Year...............................................31 Figure 21: Hospitalization Rate by Race/Ethnicity.................................................32 Figure 22: Hospitalization Rate by Race/Ethnicity & Year....................................33 Figure 23: Hospitalization Rate by Age Group.....................................................34 Figure 24: Hospitalization Rate by Age Group & Year..........................................35 Figure 25: Total Asthma Hospitalization Charges..................................................36 Figure 26: Average Length of Stay (LOS) by Gender & Year...............................37 Figure 27: Average LOS by Race/Ethnicity & Year..............................................38 Figure 28: Average LOS by Age Group & Year....................................................39MORTALITY....................................................................................................................40 Texas Vital Statistics (VSU)..................................................................................40 Figure 29: Mortality Rate by Year.........................................................................41 Figure 30: Mortality Rate by Gender....................................................................42 Figure 31: Mortality Rate by Gender & Year........................................................43 Figure 32: Mortality Rate by Age Group...............................................................44 Figure 33: Mortality Rate by Age Group & Year........................................................45 Figure 34: Mortality Rate by Race/Ethnicity.........................................................46 Figure 35: Mortality Rate by Race/Ethnicity & Year.............................................47 Figure 36: Mortality Rate by Region....................................................................48HEALTHY PEOPLE 2010..................................................................................................49 Defining the Healthy People 2010 Objectives....................................................49 Figure 37: Objective 1-9a Comparison................................................................52 Table 1: Objective 24-1 Comparison....................................................................53 Table 2: Objective 24-2 Comparison....................................................................54Appendix A......................................................................................................................55Appendix B......................................................................................................................56

1The Burden of Asthma in Texas

IntroductionAsthmaisachroniclungdiseasecharacterizedbyinflammation,whichreferstotheswellingoftheinnerliningoftheairwaysthusnarrowingtheairpassage,bronchoconstriction,whichisthetighteningofthemusclessurroundingtheairways,andincreasesintheproductionofmucus.AsthmaisawidespreadpublichealthproblemthathasincreasedinthepasttwodecadesintheUnitedStates(U.S.)andTexas.

In 2006, according to the National Center for Health Statistics (NCHS), an estimated 24.3million(11.0%)oftheadultU.S.populationhadself-reportedlifetimeasthmaand16.1million(7.3%)hadself-reportedcurrentasthma.2005hospitalizationdatashowthattheasthmahospitalizationratewas16.6per10,000U.S.residents,accountingformorethan491,000hospitalizations.Therewereatotalof3,884asthmarelateddeathsintheU.S.forthesameyearwithamortalityrateof1.3per100,000residents.

InTexas,asthmaremainsoneofthemostprevalentchronicdiseasesandgrowinghealth concerns. In 2006, according to the Texas Behavioral Risk Factor Surveillance System (BRFSS), an estimated 2.1 million (12.4%) adult Texans (18 years of age or older)hadself-reportedlifetimeasthmaand1.3million(7.3%)adultTexanshadself-reported current asthma. Asthma affects more children than any other chronic disease1 and is one of the most frequent reasons for hospital admissions among children. The BRFSSindicatesthattherewereanestimated854,000(13.4%)children(0-17yearsofage)withreportedlifetimeasthmaand599,000(9.4%)childrenwithreportedcurrentasthma.GiventhelargenumbersofaffectedTexans,asthmaresultsinmajoreconomicandsocialburdens.TheasthmahospitalizationrateforTexasin2006was11.0per10,000 Texas residents, accounting for more than 25,000 hospitalizations and $391.5 millionintotalhospitalcharges.From1999to2005,therewereatotalof1,831deathsinTexasduetoasthmawithamortalityrateof1.39per100,000.

The mission of the Texas Asthma Control Program is to decrease asthma morbidity and reducethesocialandeconomicimpactofasthma.Alongwithmanypartnersacrossthestatewhohaveacommonvisionforasthmahealth,weseektoreducetheseverityofasthma symptoms, and decrease the number of emergency department hospital visits anddeathsduetoasthmathrougheducationandawarenesscampaigns.

Asthmahasamajorimpactonthehealthofthepopulationandtheburdenfallsdisproportionately on some populations. Monitoring trends in asthma morbidity and mortalityamongTexansisimportantforincreasingthelevelofknowledgeaboutthishighlyprevalentcondition.Surveillancedatahelppublichealthofficialsfocustheir


2 The Burden of Asthma in Texas

Introductionefforts to address asthma by targeting those most in need of intervention.

Dataalsoraiseawarenessabouttheeffectofasthmaonthehealthofthecommunity.Thisreportdocumentsthemagnitudeoftheproblem,andidentifiesparticularcommuni-ties, settings, and characteristics of the population at risk for developing life threatening episodes of asthma in Texas.

The Asthma Burden in Texas


DemographicsThe Texas PopulationWith an area of 268,581 square miles and a population of 22.8 million, Texas is the second largest U.S. state in both area and population. Texas has 254 counties and over one half of them are considered rural. Approximately three million people, or 16% of the population, live in rural areas.

As of 2005, the state had an estimated population of 22.8 million—an increase of 388,419 (1.7%) from the prior year and an increase of 2 million (9.6%) since the 2000 census. In all three subcategories—natural (births minus death), net immigration, and net migration—Texas has seen an increase in population. In August 2005, the U.S. CensusBureauannouncedthatTexasjoinedHawaii,NewMexicoandCaliforniaasamajority-minoritystate.AccordingtoJuly1,2004populationestimates,Texashadaminority population of 11.3 million, comprising 50.2 percent of its total population of 22.5 million.(Theminoritypopulationincludesallpeopleexceptnon-Hispanicwhites).Morethanone-thirdofTexasresidentsareofHispanicoriginwiththemajoritybeingMexican-American. Other Hispanic subgroups in Texas may include, but are not limited to, Puerto Ricans, Cubans, and El Salvadorans.

TheshiftingdemographicsofTexasareevidentwhenexaminingagegroupsbyraceand ethnicity. According to the Texas Demographer, 71% of Texas residents aged 65 or older are White and 18% are Hispanic. But the demographics shift for the younger generation: 41% of children under age 18 are White and 43% are Hispanic. The trend continues for younger age groups—39% of children under the age of 5 are White and 46% are Hispanic.

Becauseofthestate’svastsize,manyTexans,regardlessofraceandethnicity,wholive in less populated areas may be medically underserved and suffer from health disparities.AlthoughamajorityofTexansliveinurbanareas,ruralpopulationmembersareofteninneedofthesameservicesasthosewholiveinurbanizedareas.Thechallengesfortheprovisionofserviceswithintheseruralandfrontiercountiesaresimilar: lack of access to affordable health care, lack of transportation, little or no economicdevelopment,limitedfiscalresources,andlackoftrainedprofessionals.


DemographicsRace/EthnicityGroups-Whites

Thismapshowsthepercentofcountypopulationasof2005thatareWhites.Mostofthese Texas counties are concentrated in the northern and central parts of Texas.

Percent of Total County Population1.9%- 30.7%30.8%- 56.3%56.4%- 73.8%73.9%- 96.5%

Source: Center for Health Statistics (CHS), Texas Department of State Health Services, 2005


DemographicsRace/EthnicityGroups-AfricanAmericans

Thismapshowsthepercentofcountypopulationasof2005thatareAfrican-Americans.Most of these Texas counties are concentrated in the eastern part of Texas.

Percent of Total County Population0%- 3.8%3.9%- 9.3%9.4%- 17%17.1%- 34.4%



Race/EthnicityGroups-Hispanics

Demographics

Thismapshowsthepercentofcountypopulationasof2005thatareHispanics.MostoftheseTexascountiesareconcentratedinthesouthernandwesternpartsofTexas.

Percent of Total County Population1.9%- 19.3%19.4%- 37.8%37.9%- 65.6%65.7%- 97.7%



Race/EthnicityGroups-Others

Demographics

Thismapshowsthepercentofcountypopulationasof2005thatareOthers.Mostofthese Texas counties are scattered throughout Texas.

Percent of Total County Population0%- 1.1%1.2%- 2.7%2.8%- 6.6%6.7%- 12.9%



Prevalenceistheproportionofpeopleinapopulationwhohaveaspecificdiseaseatapoint in time or a given time period. Prevalence estimates are often used to describe the burden of a disease for a given population. Texas prevalence estimates of lifetime and currentasthmaarebasedontheself-reported,population-basedsurveycalledtheTexasBehavioral Risk Factor Surveillance Survey (BRFSS).

TheBRFSSisthesourceofprevalenceestimatesforawiderangeofhealthbehaviorsand risk factors for chronic diseases, infectious diseases, and other risk factors for Texas adults.TheBRFSSisastatewiderandom-digit-dialingtelephonesurveyoftheTexasadultpopulationaged18yearsandolder.Eachyear,approximately5,000-6,000randomlyselectedadultsaged18yearsandolderareinterviewedbytelephoneusingstandardizedmethods and questionnaires set by the Centers for Disease Control and Prevention. Since 1999,theTexasBRFSShasincludedtwoquestionsforassessinglifetimeandcurrentprevalence of asthma.

Thissectionpresentsdatafromthe2000through2005TexasBRFSS.Datawereanalyzedby sex, age, race/ethnicity, education, and income groups.

Lifetimeasthmaprevalenceisdeterminedbyrespondentswhoanswer“yes”tothefollowingquestion:“Haveyoueverbeentoldbyadoctor,nurseorotherhealthcareprofessionalthatyouhaveasthma?”

Currentasthmaprevalenceisdeterminedbyrespondentswhoanswer“yes”tothefollowingquestion:“Doyoustillhaveasthma?”

In2005,twoquestionswereaddedtotheTexasBRFSStodeterminecurrentasthmaprevalence among children.

Lifetimechildhoodasthmaprevalenceisdeterminedbyrespondentswhoanswer“yes”tothefollowingquestionabouttherespondents’child:“Hasadoctor,nurseorotherhealthprofessionaleversaidthatthechildhasasthma?”

Currentchildhoodasthmaprevalenceisdeterminedbyrespondentswhoanswer“yes”tothefollowingquestionabouttherespondentschild:“Doesthischildstillhaveasthma?”

Data for children are based on information provided by an adult respondent about the child living in the home. The prevalence of asthma for adults and children are then collected from thesurveyalongwithothersubgroups.Duetotheexclusionofthechild’srace/ethnicityquestion on the 2005 BRFSS survey, descriptive information on the child’s race/ethnicity is not available.

PrevalenceBehavioral Risk Factor Surveillance System (BRFSS)


Limitations of the BRFSS data:

TheBRFSSestimatesarederivedfromselfreportedinterviewswithnoverificationofhaving been diagnosed by a health care professional.

Prevalence


Figure 1. Prevalence Of Lifetime Asthma Among Adults (> 18years),Texas,2000-2005

Source: Behavioral Risk Factor Surveillance Survey (BRFSS), Texas Department of State Health Services

•TheprevalenceoflifetimeasthmainTexasadultsrangedfromalowof9.6%in2001 to a high of 12.8% in 2004.

Prevalence

9.6

11.6 11.2

12.8

11.110.5

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

2000 2001 2002 2003 2004 2005

Year

Perc

ent

%


Figure 2. Prevalence Of Current Asthma Among Adults (> 18years),Texas,2000-2005

Prevalence


•TheprevalenceofcurrentasthmainTexasadultsrangedfromalowof6.1%in2001 toahighof7.1%in2002and2004.Thereisnotasignificanttrendoverthetime period.

6.17.1 6.9 7.1 6.86.5

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

2000 2001 2002 2003 2004 2005

Year

Perc

ent

%


Figure 3. Prevalence Of Lifetime And Current Asthma Among Adults (>18years),ByGender,Texas,2000-2005


•TheprevalenceoflifetimeandcurrentasthmaamongadultTexansaresignificantly higher for females than males (p<0.05).

Prevalence

11.2

6.7

9.7

5.0

12.6

8.4

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Lifetime Current

Perc

ent %

Total Male Female


Figure 4. Prevalence Of Lifetime And Current Asthma Among Adults (> 18 years), By Race/Ethnicity, Texas, 2000-2005


•TheprevalenceoflifetimeasthmaissignifiantlyhigherforAfrican-Americans(13.8%) and Whites (12.4%) compared to Hispanics (7.2%) (p<0.05).•TheprevalenceofcurrentasthmaissignifiantlyhigherforAfrican-Americans(9.2%)comparedtoWhites(7.3%)andHispanics(4.3%)(p<0.05).ThedifferencebetweenWhitesandHispanicsisalsostatisticallysignificant(p<0.05).

Prevalence

11.2

6.7

12.4

7.3

13.8

9.2

7.2

4.3

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Lifetime Current

Perc

ent %

Total White African-American Hispanic


Figure 5. Prevalence Of Lifetime And Current Asthma Among Adults (>18years)ByAgeGroup,Texas,2000-2005


•The18-29agegrouphasthehighestlifetimeasthmaprevalence(13.0%)amongdults (p<0.05). •Theprevalenceofcurrentasthmadoesnotdiffersignificantlybyagegroup.

Prevalence

11.2

6.7

13.0

7.1

10.2

6.2

11.2

7.0

10.0

6.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Lifetime Current

Perc

ent %

Total 18-29 30-44 45-64 65+


Figure 6. Prevalence Of Lifetime And Current Asthma Among Children (<18 years) By Gender, Texas, 2005


•Bothlifetimeandcurrentasthmaprevalenceamongchildrenareslightlyhigherfor boysbutthedifferenceisnotstatisticallysignificant.

Prevalence

11.6

7.3

13.0

7.7

10.3

6.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Lifetime Current

Perc

ent %

Total Male Female


Figure 7. Prevalence Of Lifetime And Current Asthma Among Children (<18 years) By Age Group, Texas, 2005


•The0-4agegrouphasanon-significantlowerprevalenceoflifetimeasthmacompared to the older age groups among children (< 18 years). •Currentasthmaprevalencehasshownanon-significantincreaseastheagegroup becamehigher,butadeclineoccursafterthe10-14agegroup.

Prevalence

11.6

7.3

7.9

13.0

7.9

12.8

9.1

13.3

6.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Lifetime Current

Perc

ent %

Total 0-4 5-9 10-14 15-17

5.8


Figure 8: Prevalence Of Current Asthma Among Adults (> 18years)ByIncomeLevel,Texas,2000-2005


6.87.1 7.1

5.9

7.6

0.0

2.0

4.0

6.0

8.0

10.0

12.0

<$20,000 $20,000-$34,999

$35,000-$49,000

$50,000-$74,999

>$75,000

Income

Per

cent

%

•Overall,theprevalenceofcurrentasthmaamongadultsdecreasedwithincreasing household income.•Theprevalenceofcurrentasthmaamongadultsissignificantlyhigherforthosewhosehouseholdearnslessthan$20,000thanthosewhosehouseholdearns$75,000 or more (p<0.05).

Prevalence


Figure 9. Prevalence Of Current Asthma Among Adults (> 18years)ByEducationLevel,Texas,2000-2005


•Theprevalenceofcurrentasthmaamongadultsvariesbyeducationalattainment.•Theprevalenceofcurrentasthmaamongadultsissignificantlyhigherforthosewithout a high school education compared to college graduates or higher (p=0.05).

Prevalence

6.5

7.57.0

5.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0

<High School High School Some College College Graduate

Education Level

Perc

ent

%


Figure 10. Prevalence Of Current Asthma Among Adults (> 18years)ByBodyMassIndexLevel,Texas,2000-2005

* Normal: within Recommended Range: BMI< 25; Overweight: 25.0<BMI<29.9; Obese: BMI>30


•Thecurrentasthmaprevalenceissignificantlyhigherforadultswhoareobese(8.5%)thanthosewhoseBMIarewithinrecommendedrange(6.5%)(p<0.05).

Prevalence

6.9

8.5

6.5

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Within Recommended Range

Overweight Obese

BMI

Perc

ent

%


Current Asthma Prevalence Rate by Region5.6-5.75.8-6.46.5-7.47.5-8.6


•Currentasthmaprevalenceislowerinthesouthandthewestareaswhilehigherin the north central and the east areas of Texas.

PrevalenceFigure 11. Prevalence Of Current Asthma Among Adults (> 18years)ByHealthServiceRegion,Texas,2000-2005


Quality of LifeBehavioral Risk Factor Surveillance System (BRFSS) This section presents information on asthma management and quality of life, such as symptom frequency, activity limitations, and perception of disease in Texas from 2001-2005.Since2001,theTexasBRFSShasincludedquestionsusedtomea-surethelevelofasthmacontrolinrespondentswithcurrentasthma.Forthisreport,sevenquestions(oftheninequestionsintheasthmahistorymodule)wereusedtomeasurethelevelofasthmacontrolinrespondentswithcurrentasthma.Inordertoincrease the sample size, multiple years are combined so it is possible to describe thequalityoflifeanddiseasemanagementforsubpopulationswithasthma.

Todetermineasthmamanagementandqualityoflife,therespondentswhoanswer“yes”withlifetimeasthmaareasked:

Duringthepast12months,howmanytimesdidyouvisitanemergencyroomorurgent care center because of your asthma? Duringthepast12months,howmanytimesdidyouseeadoctor,nurseorotherhealthprofessionalforurgenttreatmentofworseningasthmasymptoms?

Duringthepast12months,howmanytimesdidyouseeadoctor,nurseorotherhealth professional for a routine checkup for your asthma?

Duringthepast12months,howmanydayswereyouunabletoworkorcarryoutyour usual activities?

Duringthepast30days,howmanydaysdidsymptomsofasthmamakeitdifficultfor you to stay asleep?

Duringthepast30days,howoftendidyoutakeaprescriptionasthmamedicationto prevent an asthma attack from occurring? Duringthepast30days,howoftendidyouuseaprescriptionasthmainhalerduringan asthma attack to stop it?


Figure 12. Percent Of Adults (> 18 years) With Current Asthma That Had Emergency Room Or Urgent Care Cen-terVisitsInThePast12Months,Texas,2001-2005


•NearlyaquarterofTexasadultswithcurrentasthmahadhadatleastonevisittothe emergency room or urgent care center for urgent treatment of their asthma in the past 12 months.•Thegoalofasthmatherapyistohaveminimaltonoemergencydepartmentvisitsfor asthma.

Quality of Life

Number of Visits

One 11.7%

Two or More 12.8%

None75.5%


Figure 13. Percent Of Adults (> 18 years) With Current Asthma That Had Been Seen By A Health Professional For Urgent Treatment Of Worsening Asthma Symptoms In ThePast12Months,Texas,2001-2005


•AlmostathirdofTexasadultswithcurrentasthmahadbeenseenbyahealthprofe-ssionalforurgenttreatmentofworseningasthmasymptomsinthepast12months.

Quality of Life

Number of Visits

One 15.6%

Two or More 15.5%

None68.9%


Figure 14. Percent Of Adults (> 18 years) With Current Asthma That Had Seen A Health Care Professional For A Routine Checkup Of Their Asthma In the Past 12 Months, Texas,2001-2005


•NearlyaquarterofTexasadultswithcurrentasthmahadhad2ormoreroutine asthma checkups in the past 12 months. •TheAmericanLungAssociationrecommendsthatpersonswithcurrentasthmasee ahealthcareprofessionalonaregularbasis.OverthreequartersofTexasadultswith current asthma do not meet this recommendation.

Quality of Life

Number of Checkups

One 20.0%

Two or More 24.6%

None55.4%


Figure 15. Number of Days Unable to Carry Out Usual Activities in the Past 12 Months Among Adults (> 18 years) withCurrentAsthma,Texas,2001-2005


Quality of Life

Number of Days

1-10 Days18.6%

11+ Days12.7%

None64.5%

•Themajority(64.5%)ofTexasadultswithcurrentasthmadidnotexperienceanydayswhentheywereunabletocarryoutworkorusualactivitiesduetotheirasthma.•Nearlyonethird(29.3%)ofTexasadultswithcurrentasthmaexperiencedatleastonedayayearwhentheywereunabletoworkorcarryouttheirusualactivitiesduetotheir asthma.


Figure 16. Occurrence Of Asthma Symptoms In The Past 30 Days Among Adults (> 18 years) With Current Asthma, Texas,2001-2005


•Overtwothirds(67.0%)ofTexasadultswithcurrentasthmaexperiencedasthma symptoms and 15.3% experienced daily or continuous asthma symptoms in the past 30 days. •AccordingtotheAmericanLungAssociation,thegoalofasthmatreatmentisto experience no asthma symptoms. Daily or continuous symptoms, therefore, are an indicator of poorly controlled disease.

Quality of Life

Frequency

2 or Less Days/Week

42.3%

Daily10.7%

None33.0%

Continuous4.6%

More Than 2Days/Week

9.4%


Figure 17. Sleep Disturbed Nights Due To Asthma In The Past 30 Days Among Adults (> 18 years) With Current Asthma,Texas,2001-2005


•Overonethird(36.1%)ofTexasadultswithcurrentasthmahadexperiencedsleep- disturbednightsinthepast30days.Amongthem,11.2%hadexperiencedfiveor more days of sleep disturbed nights. •AccordingtotheAmericanLungAssociation,onegoalofasthmatherapyistoexperiencenosleep-disturbingsymptoms.

Quality of Life

Number of Days

3-4 Days8.1%

None63.9%

5 Days2.3%6-10 Days

3.8%11+ Days

5.1%

1-2 Days16.8%


HospitalizationsTexas Health Care Information Collection (THCIC) Hospitalization data for asthma are obtained from the Texas Health Care Information Collection(THCIC)InpatientHospitalDischargePublicUsedatafiles.Hospitaldischarge data have been available in Texas since 1999. The data presented here are from 1999 to 2004.

Sincethereisnostandardizedcasedefinitionforanasthmahospitalization,theCouncilforStateandTerritorialEpidemiologists(CSTE)casedefinitionforaprobable asthma hospitalizationisusedinthisreport.TheCSTEdefinesanasthmahospitalizationasallnon–maternal, non–neonatal, and non–transfer hospital records listing asthma, (ICD–9–CM Code: 493.0 – 493.9) as the primary diagnosis. All inpatient hospitalizations are selectedfromthehospitalsdatasetwhenasthmawastheprimarydiagnosisaswellassecondary diagnosis for the stay.

Theratesinthisreportwereageadjustedtothe2000U.S.populationsothatvalidcomparisonscanbemadebetweenpopulationsofdifferentagedistributions.Hospitaladmissionsthatweremissinginformation(gender,age,andrace/ethnicity)wereexcluded from the analysis.

Limitations of the data:

For conditions such as asthma, an individual can be hospitalized more than once for the same condition during the study period and multiple hospitalizations cannot be distinguishedfromthisdatasourcesincethedatahasbeende-identified.Also,theseestimates underestimate the true rate of hospitalizations for asthma because some Texas hospitals are exempted from the reporting requirement.


Figure18.Age-adjustedRatesOfAsthmaHospitalizationPer10,000TexasResidentsByYear,Texas,1999-2004

Source: Texas Health Care Information Collection (THCIC), Texas Department of State Health Services

•TheasthmahospitalizationratesforTexasrangedfrom10.7per10,000to12.1per 10,000andtherewasnotaconsistenttrendnotedduringthisperiod.•Theasthmahospitalizationratein2004(11.5per10,000)wasslightlylowerthanthe previous year.

Hospitalizations

11.010.7

11.812.1

11.511.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

1999 2000 2001 2002 2003 2004

Year

Rat

e pe

r 10,

000


Figure 19. Rates Of Asthma Hospitalization Per 10,000 ResidentsByGender,Texas,1999-2004


•Asthmahospitalizationrateswerehigheramongfemales(13.5per10,000population) than males, (9.2 per 10,000 population).

Hospitalizations

9.2

13.5

11.5

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Total Male Female

Gender

Rat

e pe

r 10,

000


Figure 20. Rates Of Asthma Hospitalization Per 10,000 ResidentsByGenderAndYear,Texas,1999-2004


•Between1990and2001,asthmahospitalizationratesdecreasedbutincreased through2003,followedbyanotherdecreasein2004formales,females,andall persons combined.

Hospitalizations

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

1999 2000 2001 2002 2003 2004

Year

Rat

e pe

r 10,

000

Total Male Female


Figure21.Age-adjustedRatesOfAsthmaHospitalizationPer10,000ResidentsByRace,Texas,1999-2004

•TheasthmahospitalizationrateamongAfrican-Americanswasmorethantwotimes higher than Whites and Hispanics in Texas (p<0.05). .

Hospitalizations

9.8

22.0

9.7

11.5

0.0

4.0

8.0

12.0

16.0

20.0

24.0


Race

Rat

e pe

r 10,

000

* Data for other race/ethnic group does not present here because the sample size is too small to compute for comparison.



Figure22.Age-adjustedRatesOfAsthmaHospitalizationPer10,000ResidentsByRaceAndYear,Texas,1999-2004


•Between1999and2004,therewasanoverallincreaseinasthmahospitalization ratesinTexasforAfrican-AmericansandtheOthergroup.•TherewasnosignificanttrendamongWhiteandHispanicgroupsduringthisperiod.

Hospitalizations

0.0

5.0

10.0

15.0

20.0

25.0

30.0

1999 2000 2001 2002 2003 2004

Year

Rat

e pe

r 10,

000

Total White African-American Hispanic Others


Figure23.Age-adjustedRatesOfAsthmaHospitalizationPer10,000ResidentsByAgeGroup,Texas,1999-2004


•Thehighestage-specificasthmahospitalizationratewasamongchildrenages0to4 years(36.6per10,000population),whilethelowestwasamongyoungadultsaged 15 to 34 years (4.4 per 10,000 population).•Theasthmahospitalizationrateincreasedafterage34.

Hospitalizations

36.6

18.2

9.7

4.4

9.1

17.7

11.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Total 0-4 5-9 10-14 15-34 35-64 65+

Age Group

Rat

e pe

r 10,

000


Figure24.Age-adjustedratesOfAsthmaHospitalizationPer 10,000 Residents By Age Group And Year, Texas, 1999-2004


•Althoughanotabledeclineoccuredoverthetimeperiod,the0-4agegrouphadthe highest rates of asthma hospitalizations each year compared to all other age groups.•The65andolderagegrouphasshownanincreaseinhospitalizationratesthrough 2003withadeclinein2004.

Hospitalizations

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

1999 2000 2001 2002 2003 2004

Age Group

Rat

e pe

r 10,

000

Total 0-4 5-9 10-14 15-34 35-64 65+


Figure 25. Total Charges For Asthma Hospitalization By Year,Texas,1999-2004


•The2004totalchargesforasthmahospitalizationsinTexaswasover$353million.

Hospitalizations

93.4

222.9

280.1

342.7 353.8

41.6

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

400.0

1999 2000 2001 2002 2003 2004

Year

Tota

l Cha

rges

(Mill

ion

$)


Figure 26. Average Length Of Stay (LOS) For Asthma HospitalizationsByGenderAndYear,Texas,1999-2004


•TheaverageLOSforanasthmahospitalizationincreasedslightlybetween1999and 2001 but remained constant thereafter for males, females, and all persons combined.

Hospitalizations

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

1999 2000 2001 2002 2003 2004

Year

Ave

rage

Num

ber o

f Day

s

Total Male Female


Figure 27. Average Length Of Stay (LOS) For Asthma HospitalizationsByRaceAndYear,Texas,1999-2004


•Between1999and2004,theaverageLOSwashighestforWhites,andtheaverage LOS increased from 3.3 to 3.8 days. •TheaverageLOSforHispanicsincreasedfrom1999to2001,butdeclinedin2004.

Hospitalizations

2.0

2.2

2.4

2.6

2.8

3.0

3.2

3.4

3.6

3.8

4.0

1999 2000 2001 2002 2003 2004

Year

Ave

rage

Num

ber o

f Day

s

Total White African-American Hispanic Other


Figure 28. Average Length Of Stay (LOS) By Age Group AndYear,Texas,1999-2004


•TheaverageLOSforanasthmahospitalizationinTexasgenerallyincreasedwithage.•TheaverageLOSforanasthmahospitalizationincreasedfrom1999to2001,and stayed almost constant thereafter for all age groups.

Hospitalizations

2.0

2.4

2.8

3.2

3.6

4.0

4.4

4.8

5.2

5.6

6.0

1999 2000 2001 2002 2003 2004

Year

Ave

rage

Num

ber o

f Day

s

Total 0-4 5-9 10-14 15-34 35-64 65+


MortalityTexas Vital Statistics Unit (VSU) Forthepurposeofthisreport,anasthmadeathisdefinedasanydeathforwhichasthmawaslistedastheunderlyingcause.Deathsoccurringthrough1998wereclassifiedaccordingtoICDVersion9withICD-9codesof493.0to493.9.Deathsoccurringin1999andlaterareclassifiedaccordingtoICDVersion10withICD-10codes of J45 and J46.

Mortality data are obtained from the Texas DSHS Vital Statistics Unit. The data representedhereisfrom1995-2005.Someanalysesonlyincludedatafrom1999to2005 because of the incomparable issue caused by the changing of ICD codes.

Forthisreport,age-adjustedasthmamortalityratesarecalculatedandpresentedper1,000,000population.Ratesareageadjustedsothatvalidcomparisonscanbemadebetweenpopulationsofdifferentagedistributions.Mortalityratesfordemographicunitswithasmallnumberofevents(lessthan5events)orasmallpopulationsize(lessthan5,000 population) are not calculated because these rates are statistically unstable.

Limitations of the data:

Themortalitydatafrom1999andlatercannotbedirectlycomparedwiththedatafrompreviousyearsduetotheICD-9toICD-10codingchange.Also,thepersonwhocompletesthe“CauseofDeath”informationontheTexasCertificateofDeathdetermines the data coding.


Figure29.Age-adjustedAsthmaMortalityRatePer1,000,000ByYear,Texas,1995-2005

Source: Texas Vital Statistics Unit (VSU), Texas Department of State Health Services

•Therewasadecreasingtrendintheasthmamortalityratefrom1995to2005for Texas, although it increased slightly in 2005.

Mortality

23.3

21.1 20.7

17.114.6 14.7 13.3 13.4

11.513.2

23.5

0.0

4.0

8.0

12.0

16.0

20.0

24.0

28.0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Rat

e pe

r 1,0

00,0

00


Figure30.Age-adjustedAsthmaMortalityRatePer1,000,000ByGender,Texas,1999-2005


•Asthmamortalityratesweresignificantlyhigheramongfemales(16.7per1,000,000 population) than males (10.3 per 1,000,000 population) (p<0.05).

Mortality

10.3

16.7

13.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Total Male Female

Gender

Rat

e Pe

r 1,0

00,0

00


Figure31.Age-adjustedAsthmaMortalityRatePer1,000,000ByGenderAndYear,Texas,1995-2005


•OveralltherewasasignificantdownwardtrendinTexasasthmamortalityratesbetween1995to2004formales,females,andallpersonscombined,althoughanincreasewasnotedin2005.

Mortality

0.0

4.0

8.0

12.0

16.0

20.0

24.0

28.0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Rat

e pe

r 1,0

00,0

00

Total Male Female


Figure32.Age-adjustedAsthmaMortalityRatePer1,000,000ByAgeGroup,Texas,1999-2005


•Asthmamortalityratesincreasedwithincreasingagefrom1999to2005.•Thehighestasthmamortalityratewasamongadults65yearsofageorolder(62.4per 1,000,000 population) (p<0.05).

Mortality

1.2 1.94.3 3.1

12.0

62.4

13.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Total 0-4 5-9 10-14 15-34 35-64 65+

Age Groups

Rat

e Pe

r 1,0

00,0

00


Figure33.Age-adjustedAsthmaMortalityRatePer1,000,000ByAgeGroupAndYear,Texas,1995-2005


•Therewasa52.0percentdecreaseinasthmamortalityratesamongadultsaged65 and older over the time period 1995 to 2004. •In2002and2003,the10-14agegroupshowedanincreaseinasthmamortalityrates compared to 2001.

Mortality

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Rat

e pe

r 1,0

00,0

00

Total 10-14 15-34 35-64 65+


Figure34.Age-adjustedAsthmaMortalityRatePer1,000,000ByRace,Texas,1999-2005


•ThemortalityrateforAfrican-Americans,1999to2005,wasalmostthreetimeshigher than the rate for Whites and four times higher than the rate for Hispanics (p<0.05).

Mortality

12.8

33.1

8.6

13.413.9

0.0

4.0

8.0

12.0

16.0

20.0

24.0

28.0

32.0

36.0

40.0

Total White Arican-American

Hispanic Others

Race

Rat

e Pe

r 1,0

00,0

00


Figure35.Age-adjustedAsthmaMortalityRatePer1,000,000ByRace/EthnicityAndYear,Texas,1995-2005


•Asthmamortalityratesdecreasedfrom1995to2004forallrace/ethnicitygroups.TheAfrican-Americangrouphadthelargestdecrease(21.9%)from47.1to25.2per 1,000,000 population.•Therewasanincreaseinasthmamortalityratesforallracegroupsfrom2004to 2005.TheAfrican-Americangrouphadthelargestincrease(12.2%)from25.2to37.4 per 1,000,000 population.

Mortality

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

55.0

60.0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Rat

e pe

r 1,0

00,0

00



Figure36.Age-adjustedAsthmaMortalityRatePer1,000,000ByHealthServiceRegion,Texas,1999-2005


•Duringthisperiod,thehighestasthmamortalityratewasseeninRegion1witharate of 17.8 per 1,000,000.•ThelowestasthmamortalityrateintheTexaswasseeninRegion8witharateof11.0 per 1,000,000.

Mortality

17.8 17.5

14.6

16.3 16.5

12.5

14.6

11.0

15.7

13.3

11.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Total 1 2 3 4 5 6 7 8 9 10 11

Health Service Region

Rat

e Pe

r 1,0

00,0

00 13.9


HealthyPeople2010(HP2010)providesaframeworkfordiseasepreventionfortheUnitedStates.HP2010setsnationalhealthobjectivesdesignedtoidentifythemostsignificantpreventablethreatstohealth,establishnationalgoalstoreducethesethreats, and to promote and maintain the health of all Americans.

Eachgoalisachievedbymeetingseveralmeasurableobjectives.ThissectionpresentshowTexasratescomparetotheHP2010objectivesgoalsforasthma.

The Healthy People 2010 Objectives Related to Asthma Outcomes, Management, and Quality of Life:

1-9a.Reducehospitalizationratesforthreeambulatory-care-sensitiveconditions:pediatric asthma, uncontrolled diabetes, and immunization preventable pneumonia and influenza.

Target: 17.3 asthma hospitalizations per 10,000, less than 18 years of age

24-1. Reduce asthma deaths.

Targets: 1 per 1,000,000, Ages 0 to 4 years

1 per 1,000,000, Ages 5 to 14 years

2 per 1,000,000, Ages 15 to 34 years

9 per 1,000,000, Ages 35 to 64 years

60 per 1,000,000, Ages 65 years or older

24-2. Reduce hospitalizations for asthma.

Targets: 25 per 10,000, Ages 0 to 4 years

7.7 per 10,000, Ages 5 to 64 years*

11 per 10,000, Age 65 years or older*

*Ageadjustedtothe2000U.S.standardpopulation.

DefiningtheHealthyPeople2010Objectives

Healthy People 2010


24-3. Reduce emergency department visits for asthma.

Targets: 80 per 10,000, Ages 0 to 4 years

50 per 10,000, Ages 5 to 64 years

15 per 10,000, Ages 65 years or older

24.4.Reduceactivitylimitationsamongpersonswithasthma.

Target: 10%*


24.5. Reducethenumberofschoolorworkdaysmissedbypersonswithasthmaduetoasthma.

Target: Notargetidentified;Objectivestillunderdevelopment

24.6.Increasetheproportionofpersonswithasthmawhoreceiveformalpatienteducation,includinginformationaboutcommunityandself-helpresources,asanessential part of the management of their condition.

Target: 30%*


24-7.Increasetheproportionofpersonswithasthmawhoreceiveappropriateasthmacare according to the National Asthma Education and Prevention Program (NAEPP) Guidelines. Measuredaspersonswithasthmawhoreceive:- writtenasthmamanagementplansfromahealthcareprovider, - instructiononhowtouseaprescribedinhalerproperly, - education about recognizing early signs & symptoms of asthma episodes and howtorespondproperly,withlessonsonpeakflowmonitoringforthoseusing daily therapy, - medication regimens that prevent the need for more than 1 canister of short acting inhaled beta agonists per month for relief of symptoms, - follow-upmedicalcareforlong-termmanagementafterahospitalizationdueto asthma, - assistancewithassessingandreducingexposuretoenvironmentalriskfactors. Target: Notargetidentified;Objectivestillunderdevelopment


Note:

Objective 24-3: Texas does not have data to compute asthma emergency department visits to compare to Healthy People 2010 targets.

Objective 24-4: Texas does not have data to compute the proportion of all persons withasthmathatvisitexperienceactivitylimitationstocomparetoHealthyPeople2010targets.

Objective 24-5:Thisobjectivedoesnothaveadevelopmentalobjectiveoranobjectivetarget,thereforenocomparisionscanbemadewithTexasandHealthyPeople2010targets.


Figure 37: Rate (per 10,000) of Asthma Hospitalization Compared to Healthy People 2010 Target for Objective 1-9a, for Children (<18 Years) , Texas, 1999-2004

Data Source: Texas Health Care Information Collection (THCIC), Department of State HealthServices,1999-2004

Healthy People 2010

•From1999to2004,therewasaoveralldeclineinasthmahospitalizationratesamong children in Texas, although rates have still not achieved the Healthy People 2010 target rate of 17.3.

19.919.4

17.4

19.117.7 17.9

10.0

12.0

14.0

16.0

18.0

20.0

22.0

24.0

26.0

28.0

30.0

1999 2000 2001 2002 2003 2004

Year

Rat

e pe

r 10,

000

Target(17.3) Texas

17.3


Table 1: Rate (per 1,000,000) of Asthma Mortality by Age Group Compared to Healthy People 2010 Targets for Objective 24-1, Texas, 1999 to 2004

Data Source: Texas Vital Statistics Units (VSU), Department of State Health Services, 1999-2004

Healthy People 2010

•Foradults,65yearsandolder,asthmamortalityratesfrom2002to2004metthe HealthyPeople2010targetrateof60per1,000,000whileallotheragegroupsdidnot achieve their Healthy People 2010 target.

Rate Count Rate Count Rate Count Rate Count Rate Count1999 0.0 * 4.4 14 4.6 28 14.3 102 76.2 1532000 0.0 * 2.4 8 2.4 15 11.7 88 71.9 1492001 0.0 * 2.1 7 2.5 16 13.0 101 67.4 1422002 0.0 * 2.7 9 4.2 28 11.9 95 56.1 1202003 0.0 * 5.4 18 2.2 15 12.1 98 58.0 1262004 0.0 * 2.7 9 3.8 26 9.6 80 49.6 110Target 1.0 1.0 2.0 9.0 60.0

35 to 64

Years65+ Years

0 to 4

Years

5 to 14

Years

15 to 34

Years

*Mortalitycountwastoosmalltocalculateanage-specificmortalityrate.


Table 2: Rate (per 10,000) of Asthma Hospitalization by Age Group Compared to Healthy People 2010 Targets for Objective 24-2, Texas, 1999 to 2004

Data Source: Texas Texas Vital Statistics Units (VSU), Department of State Health Services,1999-2004

Healthy People 2010

•Since1999,annualasthmahospitalizationratesforthe5-64yearoldagegroupwere belowtheHealthyPeople2010targetrateof7.7,whilethe0-4and65+agegroups did not achieve their Healthy People 2010 target rates of 25.0 and 11.0, respectively.

Rate Count Rate Count Rate Count1999 35.9 6,104 6.7 14,753 15.3 3,0752000 39.0 6,343 6.0 13,755 14.0 2,9052001 36.9 6,098 5.6 13,216 16.3 3,4452002 38.6 6,520 6.3 15,175 17.8 3,8042003 35.0 6,111 6.3 15,398 22.0 4,7822004 34.2 6,160 6.0 14,831 20.0 4,445Target 25.0 7.7 11.0

65+ Years0 to 4 Years 5 to 64 Years


Appendix A. Technical Notes

Acronyms

BMI Body Mass IndexBRFSS Behavioral Risk Factor Surveillance SystemCDC Centers for Disease Control and PreventionDSHS Texas Department of State Health ServicesHEDIS Health Plan Employer Data and Information SetLOS Length of StayTHCIC Texas Health Care Information CollectionVSU Vital Statistics Unit

Report Terminology

Age-Adjusted Rate -Anage-adjustedrateisaweightedaverageofagegroupspecificrates in the population under study.

Confidence Interval-Aconfidenceintervalisameasureoftheprecisionofanesti-mate.Thewidertheinterval,thelessprecisetheestimate.Theintrepretationofthe95%meansthereisa95%chancethatthetruevalueoftheestimatelieswithintherange of the interval.

Current Asthma Prevalence-TheproportionoftheTexaspopulationthatreportscurrently having asthma. The current asthma population is a subset of the population thathaseverbeendiagnosedwithasthma.

Lifetime Asthma Prevalence - The proportion of the Texas population that has ever beendiagnosedwithasthma.

Prevalence - Prevalenceistheproportionofpeopleinapopulationwhohaveaspecificdisease at a point in time or a given time period.


Appendix B. Data SourcesName: Texas Behavioral Risk Factor Surveillance System

Acronym: BRFSS

Purpose: The Texas BRFSS is a source of estimates of the prevalence of certain health behaviors,conditions,andpracticesassociatedwithleadingcausesofdeath.

History: Texas has conducted the BRFSS survey since 1985. Asthma related questions wereaddedtotheTexassurveyin1999.

Methodology:Annualestimatesarebasedondatacollectedfromarandom-digitdialtelephone survey of a sample of Texas households. The data is a population based rep-resentativesampleofTexasresidents.Thedataisweightedtorepresentestimatesforthegeneraladultpopulation.BRFSSinterviewersuseaComputerAssistedTelephoneInterviewing(CATI)system,whichprovidestheinterviewerwithprompts.Theinter-viewertypestherespondent’sresponsesdirectlyontothecomputerscreen,providingqualitycontrolandminimizinginterviewererror.

Population:Arecordisacompletedtelephoneinterview.TheselectedrespondentmustbeaTexasresident,18yearsofageorolderwholivesinaprivateresidenceandhasatelephone.Onerandomlyselectedadultfromahouseholdisinterviewed.

AsthmaData:TheBRFSShastwoquestionsdedicatedtoestimatingasthmapreva-lence for the general population of adults. In additions to the core questions, the Texas BRFSShasincludedtheasthmamodulequestionswhichincludeinformationaboutchild prevalence, adult history, and management/control.

Additional Information: For more information about the BRFSS, please visit:http://www.cdc.gov/brfss/


Appendix B. Data SourcesName: Texas Health Care Information Collection

Acronym: THCIC

Purpose: The THCIC is a source of hospital admissions and billing charges from all state licensed hospitals.

History:TheTexasHealthCareInformationCouncil(THCIC)wascreatedbyChapter108oftheTexasHealthandSafetyCode(THSC)andwasresponsible,underSections108.011 through 108.0135, for collecting hospital discharge data from all state licensed hospitals except those that are statutorily exempt from the reporting requirement.

Methodology: The THCIC receives hospital discharge data from all state licensed hospitals quarterly. At the end of each year, the compiled data are available for pur-chaseinaPublicUseDataFile(PUDF).ThePUDFcontainspatient-levelinformationfor inpatient hospital stays. These data are extracted from DSHS’s Hospital Discharge Database(HDD).DatanotavailableinthePUDF,excludingconfidentialdataprotectedby§108.0135,HealthandSafetyCode,areavailableforresearchpurposeswiththeap-provaloftheTHCICScientificReviewPanel(SRP).

AsthmaData:ThePUDFcoversbothadultandchildTexanswhohaveaninpatienthospitalization due to asthma. Information such as, but not limited to demographic, av-erage length of stay, and hospital charges are included in the system.

Additional Information: For more information about the THCIC, please visit:http://www.dshs.state.tx.us/thcic/


Appendix B. Data SourcesName: Texas Center for Health Statistics Vital Statisticas Unit

Acronym: VSU

Purpose: The VSU is a source of demographic data on births, deaths, fetal deaths, abortions, marriages, and divorces. The team also responds to statistical data requests and develops the Texas Vital Statistics Annual Report.

Methodology: Each year, the Vital Statistics Unit (VSU) and the Center for Health Sta-tistics (CHS) coordinate their efforts to collect, enter, and edit vital statistics data for Texas. After the data are edited, staff perform analyses and create tables on various topics to produce the Texas Vital Statistics Annual Report.

Population: The Texas Vital Statistics includes records for births or deaths that have oc-curred in Texas from 1903 to the present.

Asthma Data: Asthma mortality data are obtained from the information on the Texas CertificateofDeathaccordingtotheappropriateICD-9code.

Additional Information: For more information about the VSU, please visit: http://www.dshs.state.tx.us/CHS/VSTAT/


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