States Lack Adequate Records on Asthma, Report Finds

More than half of the states do not have tracking systems in place to monitor asthma--the most common chronic disease afflicting children--although California gets credit for trying, according to a new report released today.

“Today we are essentially blindfolded when it comes to combating asthma because most states don’t have access to one of the least expensive and most effective tools for preventing the spread of the disease--information,” said Jim O’Hara, executive director of Health-Track, a nonprofit organization that conducted the study.

“We don’t know where asthma and many other chronic diseases strike, and in what numbers,” O’Hara said. Public health officials and researchers need such statistics to “identify environmental factors that may cause or exacerbate asthma, and for families and communities to prevent it,” added O’Hara, a former deputy assistant secretary for health in the Clinton administration.

Health-Track, established by Georgetown University with a grant from the Pew Charitable Trusts, studied data that the federal Centers for Disease Control and Prevention collected through a series of questions to state health officials.

The group concluded that only 23 states had procedures for following asthma cases over time and that 30 states had no current status report on asthma. Moreover, even in the 23 states in which asthma tracking occurs, the CDC “does not know how adequate those efforts are.”

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In California, according to the report, health officials have used Geographic Information Systems mapping techniques--computer-assisted collection and display of data by location--to try to understand geographic patterns of asthma within the state.

Quoting state health department officials, who participated in a CDC-sponsored workshop on asthma in February, the report said California is trying to develop its statewide tracking and monitoring capacity, but the “most complete data are available only for hospitalizations and deaths. Additional data, especially on the prevalence in children, are needed.”

The causes for most cases of asthma are not known, but several environmental factors, including air pollution and bad indoor air, are known to increase the severity of the disease.

An estimated 17 million Americans suffer from asthma, including nearly 5 million children. Rates have been rising for the last 20 years, although health officials do not understand why. Asthma rates rose 75% between 1980 and 1994, according to the CDC, which conducted national surveys. Among children younger than 4, the rates climbed 160%, the agency said.

While some areas do try to monitor asthma at both the state and local levels, it is difficult to determine trends across state and city lines, and few jurisdictions try to link cases with environmental triggers, which is essential to prevention, the study said.

The report said that efforts to design asthma prevention programs are impeded because researchers do not have a good understanding of the relationship between existing data on environmental hazards, such as exposure to tobacco smoke or ozone levels, and asthma attacks.

States often lack the funding and staff to do this, according to the study.

In testimony before a House Appropriations subcommittee earlier this month, Dick Jackson, a CDC environmental health official, said that an estimated $25 million in federal funds--or $500,000 per state--could establish a base for state-level tracking of asthma.

Currently, the CDC receives $10 million for asthma tracking, treatment and management support for all 50 states.

“The additional dollars America needs to invest . . . pale in comparison to the billions of dollars we’ll continue to spend . . . if we don’t act,” O’Hara said.

Asthma will cost the U.S. economy $14.5 billion this year, according to the report. The illness restricts adults and kids more than 100 million days annually, the study said.

The report said many states did not have ready access to asthma hospitalization statistics (19 states) or data on the cost of the disease to their jurisdictions (32 states). And 47 states said they did not have ready access “to data that would inform their jurisdictions about the quality of disease management for asthma sufferers in their communities.”

Among those--in addition to California--cited for innovative attempts to deal with this knowledge gap were Maine, Massachusetts, Michigan, the cities of New York and Chicago, and the University of Iowa School of Public Health.