Asthma and its Effects on those Residing in Boston as Well as the Overall State of Massachusetts

This report covers vital data related to asthma and, its effects on those residing in Boston as well as the overall state of Massachusetts. In this paper, relevant information concerning the condition including epidemiology of the disease, the population at risk/health status (race, age, gender), relevant epidemiology of geographic location (e.g. live, work and/or play), and time variables are incorporated. Material concerning rates, causes, and risk factors are also included. According to study findings, only 1 in 4 Massachusetts adults define their asthma condition as well controlled (Massachusetts Department of Public Health, Massachusetts SENSOR (Sentinel Event Notification System for Occupational Risk) Work-Related Asthma, 2007) and, even more children suffer from the condition in the state. This goes to show that this is an exceptionally critical public health matter to address and, that this condition needs to be further investigated to aid in decreasing the amount of asthma related cases.

Source of the data:

Most of the information encompassed in this paper was found using Mass.gov, google scholar, and the Centers for Disease Control and Prevention (CDC) websites. Since this report is focused on asthma in Massachusetts and in particular, Boston (a large urban area within the state), it was crucial to obtain information directly from these government websites. Some search terms used while researching this condition include asthma risk factors, causes, prevalence, and incidence in Boston or Massachusetts. Ultimately, government websites were used as sources since the government has the most up to date epidemiological data and statistics regarding this area.

Descriptive Epidemiology:

Asthma is considered a chronic inflammatory disease of the airways. It is a progressive condition with exacerbations and remissions from time to time. Asthma causes the airways to become narrowed due to swelling and excessive mucus production. In turn, asthma negatively affects a person who has the condition by making it extremely difficult to breath regularly. (National Center for Biotechnology Information, Asthma: Symptoms and Diagnosis, 2017)

Person:

It is important to note that worldwide, the extent of occurrence of asthma has been expanding since the year of 1980. This includes the prevalence among all age, gender, and racial groups. Among all states across the nation, the prevalence of asthma here in Massachusetts has been one of the most excessive. Children and Seniors 65 years and up have the most asthma related complications in relation to age in Massachusetts. However, children ages 0-4 have the highest overall rates in the state. Asthma inpatient hospitalization rates were highest in children ages 0 to 4 years old in the Boston area than that of the overall state of Massachusetts. Emergency room visits, and Asthma hospital observation stays were much higher for this age group in Boston as well. Compared to the state of Massachusetts, Boston has significantly higher rates overall. (Massachusetts Department of Public Health, Health of Massachusetts, 2010) The ages with the highest ED discharges per 10,000 residents in Massachusetts is among the 0-4 age group as well. (Commonwealth of Massachusetts, Statistics about asthma, 2018)

Figure 3 Age-Specific Rates of Emergency Department (ED) Visits Due to Asthma, Massachusetts Residents, 2009-2013

Data source: CY2011-2013 Massachusetts Emergency Department Discharge Database, Massachusetts Center for Health Information

Throughout the course of 2010, 2013, and 2015 overall, a higher percentage of Black (20%) and Latino (18%) Boston female adult residents had asthma compared to White female adults (14%) and Asian female adults (7%). In 2015, Black residents ages 3-5 had the highest rate of asthma related visits to the emergency department. Statistics displayed that there were 558.8 ED visits per 10,000 residents ages 3-5. Black and Latino residents in every age group had higher rates when compared with White residents of all ages. The age-specific emergency department visit rate heightened by 15% in children aged 3-5 in relation to asthma as well. (Boston Public Health Commision, Health of Boston, 2016) The populations that are most at risk according to race and gender in the Boston area includes the black non-Hispanic race and the female gender. Overall, Boston displays a significantly higher rate of asthma among the female population compared to the entire state of Massachusetts. (Commonwealth of Massachusetts, Statistics about asthma, 2018)

Level of Control among Massachusetts Children with Current Asthma, 2006-2010

Data source: CY2006-2010 MA Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey

This pie chart retrieved from the Mass.gov website displays crucial information about the level of control that kids have over their asthma here in Massachusetts throughout the years of 2006-2010. In this specific chart, it is evident that between the years of 2006-2010, 48.0% of the children who had asthma claimed that it was not well controlled, 33.8% of those interviewed in the call-back survey believed it was well controlled, and 18.2% believed that their asthma was very poorly controlled. This data reveals that a lesser amount or percentage of children from this sample in Massachusetts who had asthma thought that it was well controlled during this time-period. (Commonwealth of Massachusetts, Statistics about asthma, 2018)

Place:

Boston children have higher rates of hospitalizations and emergency room visits due to asthma related complications than children throughout the whole state of Massachusetts. Throughout the 2011-2012 school period, over 15.9 % of children in Boston attending Kindergarten through 8th grade had asthma. This is a significantly larger prevalence than K-8 students statewide which was approximately 11.9 percent. Over 40% of children located in Massachusetts who were 18 and under and had asthma, missed school as well as daycare because of their symptoms from the year of 2006 to 2010. Parents in the area are also affected by asthma in children since typically, if their children miss daycare or school due to exacerbations, parents must miss a day of work to care for them which then disturbs productivity in the community. (The Facts About Pediatric Asthma, 1986) The statewide prevalence of pediatric asthma in the year of 2009 was reported as 10.9 percent (%) and the prevalence of pediatric asthma in Boston was 13.9 percent (%) during that same time-period. By viewing the chart below, it is evident that the prevalence has increased in both areas since 2005. (Massachusetts Department of Public Health,Pediatric Asthma in Massachusetts 20082009, 2012)

According to Mass.gov, work related asthma cases between 1993-2006 was highest among managerial and professional workers. This is since they had accounted for one-third of all cases (n=206, 32.6%). The most frequently reported occupations within this group were nurses and teachers. Operators, repair workers and laborers followed by auditing for 27.1% of cases (n=171) within the same time-period. Technical, sales and administrative workers accounted for 23.0% (n=145) of these work-related asthma cases. Asthma prevalence is known to be higher in urban neighborhoods due to susceptibility to impurities in the air such as pollution and a multitude of other environmental causes. Indoor air pollutants, cleaning products, dusts, chemicals, mold, and solvents are proclaimed to be the main environmental triggers. (Massachusetts Department of Public Health, Massachusetts SENSOR (Sentinel Event Notification System for Occupational Risk) Work-Related Asthma, 2007)

The above maps from the CDC's Behavioral Risk Factor Surveillance System display crude rates for the year of 2016. The crude rate, rather than the age adjusted rate, shows the actual number of cases over this year. The two maps display the crude rate for adults who had been told they currently have asthma. One map displays the results for adults within the 35-54-year-old age group, and the other displays the results for adults ages 65 and over in the same year (2016). It is noticeable that adults ages 65 and over had a higher crude prevalence rate (9.212.2%) as opposed to adults who were 35-54 years-old (9.210.7) within 2016 in Massachusetts. (CDC. BRFSS Prevalence & Trends Data, 2018)

Time:

As previously stated, the extent of the occurrence of asthma has been expanding worldwide since the year of 1980. This chart displays this information in a more meaningful way, showing that the prevalence has increased over the years. (Akinbami, O. J., Moorman, J. E., & Liu, X. (2011). Asthma prevalence, health care use, and mortality: United States, 2005-2009)

Data Source: Akinbami, O. J., Moorman, J. E., & Liu, X. (2011). Asthma prevalence, health care use, and mortality: United States, 2005-2009.

This is a fact specifically in Massachusetts since epidemiological statistics displayed in the chart below show that even costs related to the disease have drastically increased from 2002 to 2013 in the state. (Commonwealth of Massachusetts, Statistics about asthma, 2018)

Figure 2. Total Charges for Hospitalizations Due to Asthma, Massachusetts Residents, 2002-2013

Data source: CY2002-2013 Massachusetts Hospitalization Discharge Database, Massachusetts Center for Health Information and Analysis

Rates:

The most current national and local prevalence and incidence rates available are from 2016. Nationally, children ages 5-14 have the highest prevalence of asthma at 10.1%., women at 10.4%, black non-Hispanic children at 15.7%, and those below 100% of the poverty level at 11.8%. The percent of persons with current asthma who reported having one or more asthma attacks is highest among those who are ages 18 and under at 53.7%. Mortality is highest among women of the black non-Hispanic race over 18 years old. Local data here in Massachusetts displays that 10.2% of adults currently have asthma. (Centers for Disease Control and Prevention, Most Recent Asthma Data, 2018)

Causes and Risk Factors:

While the exact cause or etiology of each individual asthma case may not be known, and no cure exists, asthma can be controlled. Asthma can cause symptoms such as chest tightness, wheezing, shortness of breath, coughing, or even sneezing when allergic asthma is the case. (Asthma: Symptoms and Diagnosis, 2017) Symptoms may exacerbate as well, meaning that they become worse and a person having an attack requires immediate medical attention. Different people have varying or different symptoms and, the severity of the disease varies from person to person. The disease may even be deathly or cause disability if a person suffers from an asthma attack without getting immediate medical treatment. Asthma affects individuals differently resulting in differing severity, presentation of symptoms and, responsiveness to treatment (i.e. albuterol and steroid inhalers, respiratory therapy, and breathing treatments/nebulizers). (National Institutes of Health, Chronic Diseases: Asthma and You, 2011)

Asthma prevalence is known to be higher in urban neighborhoods with lower incomes which makes these two factors risk factors for the disease. As previously mentioned, this is due to considerable and extensive susceptibility to impurities in the air such as pollution and a variety of other indoor and outdoor environmental causes. The typical asthma triggers that are due to environmental factors include indoor allergens such as pet dander, rodents, cockroaches, dust mites, and mold and outdoor allergens such as grass, pollen, weeds, florals, and trees. Other outdoor irritants include tobacco smoke, gas, chemical fumes, and various other strong odors. Exposure to things like air fresheners, cleaning products, pesticides, and perfumes/cologne, the common cold, influenza and other illnesses can trigger asthma as well. Stress, extensive exercise, medications/drugs, and food additives may trigger an asthma attack too. Weather conditions including cold air, or extremely dry, wet or windy weather can also have a largely negative impact on a person's asthma and maintaining its stability. (Gautier, C., & Charpin, D,Environmental triggers and avoidance in the management of asthma, 2017)

Data Source: 2006-2007 Massachusetts Adult Asthma Call-back Survey

Conclusion:

When asthma is well controlled, people who suffer from the chronic disease can sleep well through the night, attend school or work, and live normal, or even active lives. It is important to decrease the publics contact to asthma triggers and know factors that put people at risk to asthma. This will in turn prevent the expansion of the disease and allow better control of asthma symptoms. An asthma attack or exacerbation can be prevented by eliminating certain known environmental triggers. It is also crucial to take medication correctly, following a specific care plan, and taking action when symptoms worsen. (National Institutes of Health, Chronic Diseases: Asthma and You, 2011)

Hypotheses:

My research has brought me to hypothesize that environmental triggers play a crucial role in the prevalence of asthma however, it is unknown whether these triggers actually cause the disease. I consider these environmental triggers to be the most probable cause of asthma. The actual cause of the disease is currently unknown therefore, signifies the need for further research of these environmental triggers to determine which specific one produces the largest burden of disease.

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