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Asthma Attacks Among Persons with Current Asthma — United States, 2001–2010

Jeanne E. Moorman, MS

Cara J. Person, MPH

Hatice S. Zahran, MD

Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC


Corresponding author: Jeanne Moorman, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC. Telephone: 770-488-3726; E-mail: zva9@cdc.gov.

Introduction

Asthma is a chronic inflammatory disorder of the airways that is characterized by episodic and reversible airflow obstruction, airway hyper-responsiveness, and underlying inflammation. Common asthma symptoms include wheezing, coughing, and shortness of breath (1). With correct treatment and avoidance of exposure to environmental allergens and irritants that are known to exacerbate asthma, the majority of persons who have asthma can expect to achieve optimal symptom control (2).

Multiple reports published previously provide detailed surveillance information on asthma (1,3–8). A 1987 report that included asthma surveillance data for 1965–1984 identified differences among certain demographic groups by age, sex, and race/ethnicity (5). Subsequent asthma surveillance reports confirmed these differences and documented that the differences have persisted over time (1,3,4,6). These reports indicate that population-based asthma prevalence rates, emergency department visit rates, and hospitalization rates were higher among blacks than among whites, higher among females than among males, higher among children (aged 0–17 years) than among adults (aged ≥18 years), and higher among males aged 0–17 years than among females in the same age group. In addition, more detailed analysis of ethnicity data demonstrated that asthma health outcomes differed among Hispanic groups. Hispanics of Puerto Rican descent (origin or ancestry) had higher asthma prevalence and death rates than other Hispanics (e.g., Hispanics of Mexican descent), non-Hispanic blacks, and non-Hispanic whites (7,8).

Current asthma prevalence rates among the demographic groups for the years covered in this report were similar to those in previous CDC reports (1,3,4,6). During 20062010, an estimated 8.0% of the U.S. population had current asthma. Asthma prevalence varied by demographic group: 6.9% among males, 9.0% among females, 9.4% among children, 7.6% among adults, 7.9% among whites, 10.5% among blacks, 10.8% among American Indians/Alaska Natives, 5.0% among Asians, 14.4% among multi-race/other-race persons, 15.9% among Puerto Ricans, and 5.4% among Mexicans.

This report is part of the second CDC Health Disparities and Inequalities Report (CHDIR). The 2011 CHDIR (9) was the first CDC report to assess disparities across a wide range of diseases, behavior risk factors, environmental exposures, social determinants, and health-care access. The topic presented in this report is based on criteria that are described in the 2013 CHDIR Introduction (10). This report provides information regarding asthma attacks among persons with current asthma that supplements information about current asthma prevalence provided in the 2011 CHDIR (4). The purposes of this report are to discuss and raise awareness of differences in asthma attacks among persons with current asthma and to prompt actions to reduce these disparities.

Methods

To examine whether disparities in asthma attacks exist among persons with current asthma by selected demographic characteristics, CDC analyzed data from the 2001–2010 National Health Interview Survey (NHIS). NHIS is an annual, in-person survey of the civilian, noninstitutionalized U.S. population based on a multistage sampling of households (11). An adult family member is selected to act as a proxy respondent for children aged 0–17 years. NHIS includes several questions about asthma. The first question, "Have you ever been told by a doctor or other health professional that you had asthma?" has been used as a lifetime prevalence measure for asthma since 1997. A second question, "Do you still have asthma?" was added in 2001. Respondents are considered to have current asthma if they answer "yes" to both of these questions. A response of "yes" to a third question, "During the past 12 months, have you had an episode of asthma or an asthma attack?" indicates an attack in the past year and was used in this analysis as an indicator of symptom control (1,3,4,6).

The percentage of persons with current asthma who reported an asthma attack in the past year, crude prevalence ratios, and adjusted prevalence ratios were estimated for selected demographic characteristics: race/ethnicity, sex, age (children aged 0–17 years, adults aged ≥18 years, and eight age groups), educational attainment for adults, place of birth, geographic region, and federal poverty level (FPL). Estimated percentages with standard errors and prevalence ratios with 95% confidence intervals (CIs) are presented for 2006–2010. Estimated percentages with standard errors for more limited demographic groups are presented for both 2001–2004 and 2006–2010 for a historical comparison. Race/ethnicity is categorized on the basis of the respondents' self-reported race and ethnicity. Non-Hispanic race groups include white, black, American Indian/Alaska Native, Asian, and other or multiple races. Persons of Hispanic ethnicity might be of any race or combination of races. Hispanic subgroups include Puerto Rican, Mexican, and other Hispanic. FPL is based on U.S. Census Bureau poverty thresholds. The poverty threshold is based on the size of the family and the ages of family members. Income divided by the poverty threshold is called the "income-to-poverty ratio" (12).

Multiple years of survey data were combined to provide stable estimates for relatively small respondent groups. If the relative standard error was >30%, or if the sample size (denominator) was <50, estimates were considered unreliable and were suppressed. Analysis software was used to account for the complex survey design, and sample weights were used to produce national estimates. A multivariate (binary response) logistic regression model was used to determine the association (adjusted prevalence ratio [APR]) between reporting an asthma attack in the past year and demographic variables including age, sex, race/ethnicity, educational attainment, FPL, place of birth, and geographic region. A univariate logistic regression model was used to determine the association (crude prevalence ratio) between an asthma attack and each variable separately. The Wald chi-square test statistic was used for all logistic regression models to test for an association between the dependent variable (asthma attack status) and independent variables of interest. Chi-square tests and z-tests were used to test for demographic group and time period differences. All statistical tests were 2-sided, with p<0.05 denoting statistical significance. Comparative terms used to describe findings in this report (e.g., "higher" and "similar") indicate the results of statistical testing at p<0.05.

Results

During 2006–2010, reported attacks among those with current asthma were higher for females (53.5%) than for males (48.8%) (Table 1). The difference in reporting an asthma attack by sex was not statistically significant among children (adjusted prevalence ratio [APR]: 1.1) but was significant among adults (APR: 1.4) after adjusting for age, race/ethnicity, educational attainment, federal poverty level, place of birth, and geographic region (Table 2). Overall, asthma attacks were reported more frequently for children (56.1%) than for adults (49.6%) (Table 1). Asthma attacks were reported more frequently for children aged 04 years (APR: 1.9) and 5–11 years (APR: 1.3) than for children aged 12–17 years (Table 2). Among adults, persons aged 1834 (APR: 1.4), 3544 (APR: 2.0), 4554 (APR: 1.9), and 5564 years (APR: 1.6) were more likely to report asthma attacks than persons aged ≥65 years. Regardless of age, persons with asthma living in the West (54.5%) and the South (53.1%) were more likely to report asthma attacks than persons living in the Midwest (49.4%) and the Northeast (47.8%) (Table 1). The differences in reporting an asthma attack between the South and West regions compared with the reference region (Northeast) remained statistically significant after adjusting for covariates (Table 2). No significant interaction terms or multicollinearity effects were identified among any of the variables in the final model.

For children, reporting an asthma attack did not differ significantly by poverty level (range: 56.3% [FPL <100%]–57.8% [FPL ≥450%]) (Table 1). However, for adults, reporting an asthma attack did differ significantly by poverty level. Adults with incomes <100% of FPL (53.9%; APR: 1.4) and adults with incomes of 100%–249% of FPL (50.1%; APR: 1.2) were more likely to report asthma attacks than adults with incomes ≥450% of FPL (48.9%) (Tables 1 and 2). Among persons with incomes <100% of FPL, asthma attacks did not differ significantly by race/ethnicity, sex, age, level of education, place of birth, or geographic region (Table 1). However, subgroup differences in reported asthma attacks were observed among persons with higher income levels (100%–249% of FPL, 250%449% of FPL, and ≥450% of FPL). In the three higher income groups, asthma attacks were reported more frequently among females, children, and persons living in the West than among males, adults, and persons living in the Northeast, respectively (Table 1). Notable changes in reporting an asthma attack in the past year were observed between 2001–2004 and 2006–2010 (Table 3). For many demographic groups (whites, blacks, Puerto Ricans, males, females, children, adults, male children, persons with incomes <450% of FPL, and those living in the Northeast and Midwest), reporting an asthma attack decreased significantly. Between 2001–2004 and 2006–2010, the disparity between the various Hispanic subgroups and that between male children and female children were eliminated, and the disparity between adults and children and that among the FPL groups decreased. However, more women than men now report having had an asthma attack in the past year, and persons in the West and the South now report having had an attack more often than persons in the Midwest and the Northeast.

Discussion

Findings from this report are comparable to those of previous reports (1,3,4,6). Within the U.S. population, the percentage of persons with current asthma reporting an asthma attack in the past year varies by demographic and economic groups. Similar to current asthma prevalence, asthma attacks were more prevalent among females, children, the poor, persons of multiple races, and Puerto Ricans. However, while current asthma prevalence was higher in the Northeast, attacks were reported more frequently in the South and in the West than in other regions.

Demographic and socioeconomic characteristics associated with more frequent reporting of asthma attacks (e.g., females, children, persons living in the South and the West, Puerto Ricans, and the poor) were identified. However, causality cannot be determined from cross-sectional survey data. Surveillance data on asthma attacks cannot be used to determine the reasons for the observed differences among the demographic and economic subgroups examined in this report. The differences might be attributable to differing levels of exposure to environmental irritants and allergens (e.g., environmental irritants such as tobacco smoke or air pollutants and environmental allergens such as house dust mites, cockroach particles, and cat and dog dander) (7,9,13) or they might be attributable to differences in disease self-management or medical treatment. The reasons for the differences in the frequency of reported asthma attacks can be addressed only by research studies designed to determine the effect of a specific exposure or a specific disease management protocol.

Limitations

The results of this analysis are subject to at least three limitations. First, the asthma attack prevalence estimates in this report rely on self-reported data and thus are subject to recall bias. The respondent must recall a physician's diagnosis of asthma correctly, which in turn requires that the physician's diagnosis was correct and conveyed successfully to the person. Because no definitive test exists for asthma, the diagnosis and self-report cannot be validated; however, a 1993 review of asthma questionnaires documented a mean sensitivity of 68% and a mean specificity of 94% when self-reported data on an asthma diagnosis were compared with a clinical diagnosis (1). Second, because NHIS includes only the civilian, noninstitutionalized population of the United States, results might not be representative of other populations. Finally, because NHIS is conducted only in English and Spanish, results might not be representative of households whose residents have other primary languages.

Conclusion

With the exception of a few specific occupational exposures, the exact cause of asthma is unknown. Once diagnosed, asthma requires ongoing comprehensive management on a long-term basis. Appropriate management requires both access to the health system and appropriate use of that system. Financial resources and social support are instrumental in long-term management of all chronic conditions, not just asthma (13–15). Acquiring self-management knowledge and skills and limiting exposure to environmental allergens and irritants are necessary to improve health and quality of life for persons with asthma, and especially for those with uncontrolled asthma (2,13–15).

Although surveillance data can identify disproportionately affected groups, research is needed into the role of self-management factors, environmental exposures, health-care system factors, and financial factors to understand better how their interrelations affect individual asthma management and control. Identifying the population-specific factors that contribute to asthma exacerbations among disproportionately affected demographic and socioeconomic groups can lead to targeted interventions. Strategies for asthma self-management and medical treatment protocols for asthma that are culturally appropriate and take into consideration population-specific characteristics can reduce the occurrence and severity of asthma exacerbations (14). For example, an intervention for children with asthma that included the use of multitrigger, multicomponent environmental factors resulted in improved symptom control and reduced the number of school days missed (16). Similar effective interventions are needed to address other disproportionately affected demographic and economic groups identified in this report.

References

  1. CDC. National surveillance for asthma—United States, 1980–2004. MMWR 2007;56(No. SS-8).
  2. National Institutes of Health. National Heart, Lung, and Blood Institute. Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, National Asthma Education Program; 2007.
  3. Moorman JE, Akinbami LJ, Bailey CM, et al. National surveillance of asthma—United States, 2001–2010. Vital Health Stat 2012;3(35).
  4. CDC. Current asthma prevalence—United States, 2006–2008. In: CDC health disparities and inequalities report—United States, 2011. MMWR 2011;60(Suppl; January 14, 2011).
  5. Evans R 3rd, Mullally DI, Wilson RW, et al. National trends in the morbidity and mortality of asthma in the US. Prevalence, hospitalization and death from asthma over two decades: 1965–1984. Chest 1987;91(Suppl 6):S65–74.
  6. Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd SC. Surveillance for asthma—United States, 1980–1999. MMWR 2002;51(No. SS-1):1–13.
  7. Homa DM, Mannino DM, Lara M. Asthma mortality in U.S. Hispanics of Mexican, Puerto Rican, and Cuban heritage, 1990–1995. Am J Respir Crit Care Med 2000;161:504–9.
  8. Rose D, Mannino DM, Leaderer BP. Asthma prevalence among US adults, 1998–2000: role of Puerto Rican ethnicity and behavioral and geographic factors. Am J Public Health 2006:96:880–8.
  9. CDC. CDC health disparities and inequalities report—United States, 2011. MMWR 2011;60(Suppl; January 14, 2011).
  10. CDC. Introduction: In: CDC health disparities and inequalities report—United States, 2013. MMWR 2013;62(No. Suppl 3).
  11. CDC. National Health Interview Survey (NHIS), 2007 data release. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2010. Available at http://www.cdc.gov/NCHS/nhis/nhis_2007_data_release.htm.
  12. US Census Bureau. How the Census Bureau measures poverty. Available at http://www.census.gov/hhes/www/poverty/about/overview/measure.html.
  13. Institute of Medicine. Clearing the air: asthma and indoor air exposures. Washington, DC: National Academies Press; 2000.
  14. US Department of Health and Human Services. Healthy people 2010: understanding and improving health. 2nd ed. Washington, DC: US Government Printing Office; 2000.
  15. Wade S, Weil C, Holden G, et al. Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study. Pediatr Pulmonol 1997;24:263–76.
  16. US Task Force on Community Prevention Services. Asthma control: home-based multi-trigger, multicomponent environmental interventions. Available at http://www.thecommunityguide.org/asthma/multicomponent.html.

TABLE 1. Percentage of persons with current asthma* who reported an asthma attack in the past year, by selected characteristics — National Health Interview Survey, United States, 2006–2010

Characteristic

Total

FPL§

<100% FPL

100%–249% FPL

250%–449% FPL

≥450% FPL

Weighted %

SE

Sample size

Weighted %

SE

Sample size

Weighted %

SE

Sample size

Weighted %

SE

Sample size

Weighted %

SE

Sample size

Race/Ethnicity

Non-Hispanic

51.1

(0.6)

11,586

54.3

(1.3)

2,533

52.0

(1.2)

3,476

48.8

(1.2)

2,843

50.3

(1.2)

2,734

White**

51.1

(0.7)

7,552

56.3

(1.8)

1,229

52.1

(1.5)

2,157

48.6

(1.4)

1,982

50.0

(1.3)

2,184

Black**

49.4

(1.1)

3,015

52.1

(2.1)

1,066

48.1

(1.9)

1,042

48.4

(2.7)

606

45.9

(3.9)

138

American Indian/Alaska Native**

61.6

(7.8)

92

†† 

(—)

36

(—)

28

(—)

17

( — )

11

Asian**

53.7

(3.1)

474

50.1

(7.9)

72

46.8

(5.9)

94

55.1

(5.3)

138

57.3

(5.1)

170

Other§§

56.3

(3.3)

436

50.2

(5.8)

126

68.7

(4.4)

147

42.4

(6.3)

97

60.6

(8.0)

66

Hispanic¶¶

53.8

(1.5)

2,644

57.0

(2.4)

899

52.1

(2.3)

935

49.3

(3.0)

497

58.1

(3.8)

313

Puerto Rican

55.6

(3.4)

663

61.0

(4.4)

299

54.1

(4.8)

102

47.8

(8.1)

52

53.6

(9.9)

64

Mexican

52.6

(2.1)

1,338

54.0

(3.4)

396

52.3

(3.5)

521

49.6

(4.2)

266

55.8

(5.3)

155

Other***

54.6

(2.6)

643

57.9

(4.2)

204

50.1

(4.3)

214

49.8

(5.7)

131

66.6

(6.8)

94

Sex

Male

48.8

(0.9)

5,699

52.7

(2.0)

1,242

50.0

(1.5)

1,754

46.1

(1.8)

1,388

47.0

(1.8)

1,316

Female

53.5

(0.7)

8,531

56.3

(1.4)

2,190

53.4

(1.3)

2,657

50.9

(1.4)

1,952

53.9

(1.5)

1,731

Age

Child (aged 0–17 yrs)

56.1

(0.9)

4,739

56.3

(1.9)

1,208

56.1

(1.7)

1,544

54.3

(2.1)

1,111

57.8

(2.2)

876

Adult (aged ≥18 yrs)

49.6

(0.7)

9,491

53.9

(1.4)

2,224

50.1

(1.2)

2,867

46.9

(1.4)

2,228

48.9

(1.4)

2,171

Child

 

 

 

 

Male

55.7

(1.4)

2,740

54.4

(2.7)

717

57.1

(2.3)

884

54.3

(2.7)

631

56.7

(3.0)

508

Female

56.7

(1.5)

1,999

59.4

(2.7)

491

54.8

(3.0)

660

54.3

(3.1)

480

59.5

(3.5)

368

Adult

Male

44.1

(1.2)

2,959

50.5

(2.8)

525

44.8

(2.1)

870

41.6

(2.5)

757

42.8

(2.2)

807

Female

52.6

(0.8)

6,532

55.2

(1.5)

1,699

53.0

(1.4)

1,997

50.0

(1.7)

1,472

52.9

(1.1)

1,364

Educational attainment
(aged ≥18 yrs)

Less than high school

51.2

(1.5)

1,889

55.5

(2.2)

889

49.2

(2.3)

712

47.4

(4.6)

215

46.4

(7.5)

73

High school graduate or equivalent

44.6

(1.3)

2,349

50.4

(2.7)

584

44.5

(2.3)

864

40.6

(2.7)

570

44.8

(3.3)

331

Some college

50.3

(1.3)

2,090

53.4

(3.0)

464

53.1

(2.4)

680

46.7

(2.4)

552

48.8

(3.3)

394

College graduate or higher

52.1

(1.2)

3,099

59.1

(3.6)

273

56.7

(2.6)

586

51.0

(2.2)

876

50.2

(1.8)

1,364

Place of birth

U.S. and U.S. territories

51.2

(0.6)

13,277

54.6

(1.2)

3,177

52.0

(1.1)

4,110

48.5

(1.2)

3,148

50.3

(1.2)

2,842

Outside U.S. and U.S. territories†††

55.5

(2.1)

950

58.4

(4.4)

255

51.8

(3.6)

300

54.8

(5.4)

192

58.2

(4.8)

203

Geographic region§§§

Northeast

47.8

(1.3)

2,731

52.9

(3.0)

699

47.1

(2.2)

781

45.4

(2.9)

608

47.1

(2.4)

642

Midwest

49.4

(1.1)

3,263

51.9

(2.2)

810

50.2

(2.4)

986

45.4

(2.4)

774

50.5

(2.7)

693

South

53.1

(1.0)

4,957

56.1

(1.9)

1,255

53.8

(1.7)

1,669

51.5

(2.0)

1,113

50.7

(2.1)

920

West

54.5

(1.3)

3,279

58.3

(2.9)

669

55.1

(2.2)

974

51.3

(2.5)

844

54.9

(2.2)

792

Total

51.5

(0.6)

14,230

54.8

(1.2)

3,432

52.0

(1.0)

4,411

48.8

(1.2)

3,340

50.8

(1.2)

3,047

Abbreviations: FPL = federal poverty level; SE = standard error.

* Persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" or "Has a doctor or other health professional ever told you that (sample child) had asthma?" and "yes" to the question, "Do you (does sample child) still have asthma?"

Persons who answered "yes" to the question, "During the past 12 months, have you (has sample child) had an episode of asthma or an asthma attack?"

§ FPL was based on U.S. Census Bureau poverty thresholds (available at http://www.census.gov/hhes/www/poverty.html). Imputed income values were used when income was not reported.

Unweighted pooled sample size, 2006–2010. Because of item nonresponse, individual characteristic categories might not sum to total.

** Includes persons who indicated only a single race.

†† If the relative SE is >30%, or if the sample size (denominator) is <50, estimates are considered unreliable and are suppressed.

§§ Includes Native Hawaiians and Other Pacific Islanders, persons reporting more than one race, and persons reporting their race as something other than those listed.

¶¶ Persons of Hispanic ethnicity can be of any race or combination of races.

*** Includes persons reporting Cuban, Dominican, Central or South American, Spanish, multiple, and unspecified Hispanic ancestry.

††† Includes U.S. citizens born abroad (one or both of whose parents were U.S. citizens) as well as naturalized citizens and noncitizens.

§§§ Northeast: Connecticut, Maine, Massachusetts, New Jersey, New Hampshire, New York, Pennsylvania, Rhode Island, and Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. 


TABLE 2. Multivariate association between reporting an asthma attack in the past year* and selected characteristics of persons with current asthma — National Health Interview Survey, United States, 2006–2010

Characteristic

Child (aged 0–17 yrs)

Adult (aged ≥18 yrs)

Crude

Adjusted

Crude

Adjusted

PR

(95% CI)

PR

(95% CI)

PR

(95% CI)

PR

(95% CI)

Race/Ethnicity

Non-Hispanic, white§

1.0

Ref.

1.0

Ref.

1.0

Ref.

1.0

Ref.

Non-Hispanic, black§

0.8

(0.7–1.0)

0.8

(0.7–1.0)

0.9

(0.8–1.0)

0.8

(0.7–0.9)

Non-Hispanic, other

1.0

(0.8–1.4)

0.9

(0.7–1.3)

1.2

(1.0–1.5)

1.1

(0.9–1.4)

Hispanic**

0.9

(0.5–1.1)

0.8

(0.7–1.0)

1.1

(1.0–1.3)

1.0

(0.8–1.2)

Puerto Rican

1.3

(0.9–1.8)

1.6

(1.2–2.3)

1.0

(0.7–1.5)

1.2

(0.8–1.7)

Mexican/Other††

1.0

Ref.

1.0

Ref.

1.0

Ref.

1.0

Ref.

Sex

Male

1.0

Ref.

1.0

Ref.

1.0

Ref.

1.0

Ref.

Female

1.0

(0.9–1.3)

1.1

(0.9–1.3)

1.4

(1.3–1.6)

1.4

(1.2–1.5)

Age group (yrs)

0–4

1.9

(1.5–2.4)

1.9

(1.5–2.5)

NA

NA

NA

NA

5–11

1.3

(1.1–1.5)

1.3

(1.1–1.6)

NA

NA

NA

NA

12–17

1.0

Ref.

1.0

Ref.

NA

NA

NA

NA

18–34

NA

NA

NA

NA

1.3

(1.1–1.5)

1.4

(1.2–1.6)

35–44

NA

NA

NA

NA

1.9

(1.6–2.3)

2.0

(1.7–2.4)

45–54

NA

NA

NA

NA

1.8

(1.5–2.2)

1.9

(1.6–2.3)

55–64

NA

NA

NA

NA

1.5

(1.3–1.8)

1.6

(1.4–1.9)

≥65

NA

NA

NA

NA

1.0

Ref.

1.0

Ref.

Educational attainment (aged ≥18 years)

Less than high school education

NA

NA

NA

NA

1.0

(0.8–1.1)

0.9

(0.8–1.1)

High school graduate or equivalent

NA

NA

NA

NA

0.7

(0.7–0.9)

0.7

(0.6–0.9)

Some college

NA

NA

NA

NA

0.9

(0.8–1.1)

0.9

(0.8–1.1)

College graduate or higher

NA

NA

NA

NA

1.0

Ref.

1.0

Ref.

Federal poverty level (FPL)§§

<100% FPL

0.9

(0.8–1.2)

1.0

(0.8–1.2)

1.2

(1.1–1.4)

1.4

(1.2–1.6)

100%–249% FPL

0.9

(0.4–1.2)

0.9

(0.8–1.2)

1.1

(0.9–1.2)

1.2

(1.1–1.4)

250%–449% FPL

0.9

(0.7–1.1)

0.9

(0.7–1.1)

0.9

(0.8–1.1)

1.0

(0.8–1.2)

≥450% FPL

1.0

Ref.

1.0

Ref.

1.0

Ref.

1.0

Ref.

Place of birth

U.S. and U.S. territories

1.0

Ref.

1.0

Ref.

1.0

Ref.

1.0

Ref.

Outside U.S. and U.S. territories¶¶

1.1

(0.7–1.8)

1.3

(0.8–2.0)

1.3

(1.1–1.5)

1.2

(1.0–1.4)

Geographic region***

Northeast

1.0

Ref.

1.0

Ref.

1.0

Ref.

1.0

Ref.

Midwest

1.2

(1.0–1.6)

1.2

(1.0–1.6)

1.0

(0.9–1.2)

1.0

(0.9–1.2)

South

1.3

(1.1–1.7)

1.3

(1.1–1.7)

1.2

(1.0–1.4)

1.2

(1.1–1.4)

West

1.5

(1.1–1.9)

1.5

(1.2–2.0)

1.3

(1.1–1.5)

1.3

(1.1–1.5)

Abbreviations: 95% CI = 95% confidence interval; NA = not applicable; PR = prevalence ratio; Ref. = Referent.

* Persons who answered "yes" to the question, "During the past 12 months, have you (has sample child) had an episode of asthma or an asthma attack?

Persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" or "Has a doctor or other health professional ever told you that (sample child) had asthma?" and "yes" to the question, "Do you (does sample child) still have asthma?"

§ Includes persons who indicated only a single race group.

¶ Includes Asians, American Indians/Alaska Natives, Native Hawaiians and Other Pacific Islanders, persons reporting more than one race, and persons reporting their race as something other than those listed.

** Persons of Hispanic ethnicity can be of any race or combination of races.

†† Includes persons reporting Mexican, Cuban, Dominican, Central or South American, Spanish, multiple, and unspecified Hispanic ancestry.

§§ FPL was based on U.S. Census Bureau poverty thresholds (available at http://www.census.gov/hhes/www/poverty.html). Imputed income values were used when income was not reported.

¶¶ Includes U.S. citizens born abroad (one or both of whose parents were U.S. citizens), naturalized citizens, and noncitizens.

*** Northeast: Connecticut, Maine, Massachusetts, New Jersey, New Hampshire, New York, Pennsylvania, Rhode Island, and Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. 


TABLE 3. Percentage of persons with current asthma* who reported an asthma attack in the past year, by selected characteristics — National Health Interview Survey, United States, 2001–2004 and 2006–2010

Characteristic

2001–2004

2006–2010

%

(SE)

%

(SE)

Race/Ethnicity

Non-Hispanic

55.2

(0.6)

51.1

(0.6)

White§

54.6

(0.7)

51.1

(0.7)

Black§

56.6

(1.2)

49.4

(1.1)

Other

59.2

(2.3)

55.9

(2.2)

Hispanic**

55.7

(1.3)

53.8

(1.5)

Puerto Rican

64.2

(2.3)

55.6

(3.4)

Mexican

50.3

(1.9)

52.6

(2.1)

Sex

Male

54.3

(0.8)

48.8

(0.9)

Female

56.0

(0.7)

53.5

(0.7)

Child (aged 0–17 yrs)

62.6

(1.0)

56.1

(0.9)

Male

63.9

(1.2)

55.7

(1.4)

Female

60.8

(1.6)

56.7

(1.5)

Adult (aged ≥18 yrs)

52.0

(0.6)

49.6

(0.7)

Male

47.2

(1.2)

44.1

(1.2)

Female

54.6

(0.8)

52.6

(0.8)

Federal poverty level (FPL)††

<100% FPL

58.9

(1.3)

54.8

(1.2)

100%–249% FPL

56.4

(1.0)

52.0

(1.0)

250%–449% FPL

57.3

(1.2)

48.8

(1.2)

≥450% FPL

53.2

(1.1)

50.8

(1.2)

Geographic region§§

Northeast

54.3

(1.1)

47.8

(1.3)

Midwest

55.7

(1.1)

49.4

(1.1)

South

55.5

(0.9)

53.1

(1.0)

West

55.3

(1.2)

54.5

(1.3)

Total

55.3

(0.5)

51.5

(0.6)

Abbreviation: SE = standard error.

* Persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" or "Has a doctor or other health professional ever told you that (sample child) had asthma?" and "yes" to the question, "Do you (does sample child) still have asthma?"

Persons who answered "yes" to the question, "During the past 12 months, have you (has sample child) had an episode of asthma or an asthma attack?

§ Includes persons who indicated only a single race.

Includes Asians, American Indians/Alaska Natives, Native Hawaiians and Other Pacific Islanders, persons reporting more than one race, and persons reporting their race as something other than those listed.

** Persons of Hispanic ethnicity can be of any race or combination of races.

†† FPL was based on U.S. Census Bureau poverty thresholds (available at http://www.census.gov/hhes/www/poverty.html). Imputed income values were used when income was not reported.

§§ Northeast: Connecticut, Maine, Massachusetts, New Jersey, New Hampshire, New York, Pennsylvania, Rhode Island, and Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. 


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