1. Focus Area 24 Respiratory Diseases Progress Review June 29, 2004

2. Burden of Respiratory Diseases Prevalence (self or proxy-reported) 3.6 million children 22 million adults Annual Burden (estimated) 20 million physician and outpatient visits 3.5 million hospital emergency visits 1.2 million hospitalizations 124,000 deaths

3. Children under 5 years Children 5-14 years Adolescents and adults 15-34 years Adults 35-64 years Adults 65 years and over 24-1 Deaths from Asthma Children under 5 years Children and adults 5-64 years Adults 65 years and over 24-2 Hospitalizations for Asthma 24-4 Activity Limitations 24-5 School or Work Days Lost 24-6 Patient Education 24-7 Appropriate Asthma Care Written asthma management plans Persons with prescribed inhalers who …….receive instruction Education about recognizing early signs Medication regimens Followup medical care Assistance with assessing ….…environmental risks 24-8 Surveillance Systems Children under 5 years Children and adults 5-64 years Adults 65 years and over 24-3 Hospital Emergency Department Visits for Asthma Asthma Cannot assess (limited data) Getting worse Improving Little or no change Respiratory Diseases Objectives

4. 24-9 Activity Limitations due to Chronic Lung and Breathing Problems 24-10 Deaths from COPD Seek medical evaluation Receive follow-up care 24-11 Medical Evaluation and Followup Chronic Obstructive Pulmonary Disease (COPD) Obstructive Sleep Apnea (OSA) 24-12 Vehicular Crashes Related to Excessive Sleepiness Cannot assess (limited data) Getting worse Improving Little or no change Respiratory Diseases Objectives

5. COPD 24-9.Activity limitations 24-10.Deaths Asthma 24-1.Deaths 24-2.Hospitalizations 24-4.Activity limitations 24-5.School or work days lost 24-6.Patient education Highlighted Objectives

6. Asthma Facts Chronic condition occurring among both children and adults 74% increase in self-reported asthma from 1980 to 1996 85% increase in physician visits from 1980 to 1999 18 days of school or work lost due to asthma per person with asthma 75 emergency department visits and 18 hospitalizations for asthma per 10,000 population Evidence of some declines in recent years (except young children)

7. 0 20 40 60 80 Deaths per Million Under 5 years 5-14 years 15-34 years 35-64 years 65 years and over 1999 2001 2010 Target Obj. 24-1a-e Source: National Vital Health Statistics System, NCHS, CDC. Asthma Deaths Age-adjusted death rate per million

8. Deaths per Million Note: Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons were asked to select only one race; selection of more than one race was not an option. Source: National Vital Health Statistics System, NCHS, CDC. Asian or Pacific Islander Black White Hispanic Female Male 0 10 20 30 40 50 2010 Target Obj. 24-1d Asthma Deaths Ages 35 – 64 Years 1999 2001

9. Hospitalizations per 10,000 Asthma Hospitalizations Note: Data for ages 5-64 and 65 and over are age-adjusted to the 2000 standard population. Source: National Hospital Discharge Survey, NCHS, CDC. Under 5 years 5-64 years 65 years and over 0 20 40 60 80 1998 2001 2010 Target Obj. 24-2a-c

10. Hospitalizations per 10,000 Ages 65 Years and Over Note: Data are age adjusted to the 2000 standard population. Black and white include persons of Hispanic or non-Hispanic origin. Persons were asked to select only one race category; selection of more than one race category was not an option in 1998. In 2001, persons reported one or more races. Data by race are shown for persons who reported one racial group. Source: National Hospital Discharge Survey, NCHS, CDC. Black White Female Male 0 10 20 30 40 Obj. 24-2c 2010 Target Asthma Hospitalizations 1998 2001

11. Percent Note: Data are age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. In 1997, persons reported one or more races and identified one race as best representing their race. Data by single race category are for persons who reported only one racial group. Source: National Health Interview Survey, NCHS, CDC. Total Asian or Pacific Islander Black White Hispanic 0 5 10 15 20 Activity Limitations Among Persons with Asthma 1997 2002 Obj. 24-4 2010 Target

12. Percent Note: Data are age adjusted to the 2000 standard population. Source: National Health Interview Survey, NCHS, CDC.. Female Male Poor Near poor Middle/high income 0 10 20 30 Activity Limitations Among Persons with Asthma 1997 2002 Obj. 24-4 2010 Target

13. School or Work Days Lost Among Persons with Asthma, 2002 Number of Days Lost Total Black White Hispanic Female Male 0 10 20 30 40 Note: Data are age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons reported one or more races. Data by single race category are for persons who reported only one racial group. Source: National Health Interview Survey, NCHS, CDC. Obj. 24-5

14. Patient Education Among Adults with Asthma Percent Total Black White Hispanic Female Male 0 10 20 30 2010 Target Note: Data are for ages 18 and over and age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons reported one or more races. Data by single race category are for persons who reported only one racial group. Source: National Health Interview Survey, NCHS, CDC. Obj. 24-6 1998 1999

15. Chronic Obstructive Pulmonary Disease (COPD) Facts Prevalence - COPD is under-diagnosed 10 million adults reported physician-diagnosed COPD 24 million adults have evidence of impaired lung function according to NHANES III Annual Burden (estimated) 8 million physician and outpatient visits 1.5 million hospital emergency visits 726,000 hospitalizations 119,000 deaths Increasing trend in recent decades with some evidence of recent declines

16. Estimated Prevalence of COPD 1988 - 94 Note: NHIS and NHANES data are based on self-reports. Mild and moderate COPD is defined by spirometric ratio of FEV 1 (forced expiratory volume in 1 second) to FVC (forced vital capacity) less than 70%. Source: Mannino, et al. MMWR 2002 / 51(SS06);1-16. Per 100,000 Percent 50 40 30 20 10 0 25-44 45-54 55-64 65-74 75+ Age group

17. Note: COPD is defined as ICD-9 codes 490-492 and 496 for 1980 data and ICD-10 codes J40-J44 for 2000 data, and excludes asthma. Data are age adjusted to 2000 standard population Source: Mannino, et al. MMWR 2002 / 51(SS06);1-16. Per 100,000 Female Male Deaths per 100,000 100 80 60 40 20 0 COPD Deaths Ages 25 Years and Over

18. COPD Deaths American Indian Asian or Pacific Islander Black White Hispanic Note: COPD is defined as ICD-10 J40-J44, and excludes asthma. Data are for ages 45 years and over and age adjusted to 2000 standard population. American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons were asked to select only one race; selection of more than one race was not an option. Source: National Vital Statistics System, NCHS, CDC. 2010 Target Deaths per 100,000 0 50 100 150 200 Obj. 24-10 1999 2001

19. Percent Note: Data are for ages 45 years and over and age adjusted to the 2000 standard population. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons reported one or more races. Data by single race category are for persons who reported only one racial group. Source: National Health Interview Survey, NCHS, CDC. Total Black White Hispanic 0 1 2 3 4 5 2010 Target 1997 2002 Obj. 24-9 Activity Limitations Due to Chronic Lung and Breathing Problems

20. Percent Note: Data are for ages 45 years and over and age adjusted to the 2000 standard population. Source: National Health Interview Survey, NCHS, CDC. Female Male Poor Near poor Middle/high income 0 1 2 3 4 5 6 7 2010 Target 1997 2002 Obj. 24-9 Activity Limitations Due to Chronic Lung and Breathing Problems

21. Progress review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm