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Children who live in inner-city areas may have higher rates of asthma than indicated by national survey data. Researchers surveyed 662 households with 1285 children younger than 18 years in Bronx County, NY. Results were compared to the 1988 National Health Interview Survey data. Slightly more than 14% of Bronx County children had asthma sometime during their lives. Almost 9% of the children had asthma within the last year compared to 4% of all U.S. children. Higher rates of asthma were found in Bronx children of all age groups and both genders than in their U.S. counterparts. White and Hispanic children and those from low-income families in the Bronx had higher asthma rates than white, Hispanic, or low-income children in other parts of the U.S. Slightly more than 4% of Bronx children who never had asthma experienced wheezing. Younger children, whites, and blacks were most likely to report this condition., Objective. To estimate the prevalence of asthma and wheezing unassociated with a diagnosis of asthma among inner-city children. Design. Cross-sectional survey of a sample of Bronx households. Methods. Random digit dialing telephone survey using parental report. Setting. Bronx County, NY. Participants. 662 self-designated heads-of-household who reported for all children 0 through 17 years of age living in their households. Measurements. Questions from the Child Health Supplement to the 1988 National Health Interview Survey and the International Union Against Tuberculosis and Lung Disease Bronchial Symptoms Questionnaire were used to estimate the prevalence of asthma and wheezing-related illness. Results. Information was gathered on 1285 children. Of this sample, 184 (14.3%) were reported to have ever had asthma (cumulative prevalence) and 111 (8.6%) were reported to have asthma in the last 12 months (period prevalence). The asthma period prevalence rate among Bronx children was twice the United States rate (4.3%) Among children 0 through 11 years of age, the prevalence rate was similar for boys and girls, although among children 12 through 17 years of age, asthma was significantly more prevalent among boys. Fifty-four children (4.2%) were reported to have had wheezing in the past 12 months unassociated with a diagnosis of asthma (wheeze only). The cumulative, but not the period, prevalence rate of asthma differed significantly by income and race/ethnicity. The cumulative prevalence was significantly higher among Hispanics and children from the lowest income families. The prevalence of wheeze only (no reported history of asthma) was higher among whites (6.4%) and blacks (5.8%) than Hispanics (2.9%) (P < .1) The reported number of wheezing attacks and the average number of nights per week that sleep was disturbed by wheezing during the past year were similar for those with asthma and those with wheeze only, although severe attacks (wheezing severe enough to limit speech) were significantly more likely among those reported to have asthma (P < .001). The total asthma prevalence (period prevalence of asthma plus wheeze only) was 12.8% and was quite consistent across subgroups. Conclusions. These data suggest that the prevalence of asthma among inner-city children may be substantially higher than the rates for this group estimated from national survey data. Some proportion of the wheeze only group may represent undiagnosed, and thereby undertreated, asthma. Public health efforts directed at reducing asthma morbidity and mortality need to address the possibility that asthma prevalence is higher within inner cities and that a large number of children with asthma may be inadequately diagnosed and treated. Pediatrics 1994;94:356-362; asthma, wheezing.

Hospitalization is the largest component of health care costs for asthma and the cost of hospitalization could be reduced by educating asthma patients about their disease, giving them regular check-ups and treating them in clinics. A projection was made of the amount of money spent on care and treatment of asthma patients in 1990 based on the estimated amount spent in 1985. The cost of treatment for asthma patients in 1990 was estimated at $6.2 billion. The largest estimated direct cost was inpatient hospital care at approximately $1.6 billion. The largest indirect cost was days missed from school at approximately $900 million. Hospitalization, emergency room use and death made up 43% of costs associated with care and treatment of asthma patients. Asthma patients who receive regular medical care are rarely hospitalized. But those who cannot afford regular care may be hospitalized more frequently, and are more likely to die from asthma complications. More effective drugs for asthma patients may increase the immediate cost of medical care, but decrease expenses associated with hospitalization and death.

The National Hospital Discharge Survey has revealed a disturbing increase in the number of children hospitalized for asthma. During the period from 1979 to 1987, asthma-related hospitalizations for children under 17 years of age rose an average of 4.5 percent per year. The hospitalization rate was highest for younger children; an annual increase of 5.0 percent was observed for children 4 years and under, in contrast with the 2.9 percent annual rise for those from 5 to 17 years. Blacks suffered an increase 1.8 times that of whites. The reason for the increase in asthma-related hospitalizations is not known. It seems that it is not due to a greater likelihood to diagnosing asthma, rather than bronchitis. If this were the case, the rise in asthma hospitalizations should be accompanied by a reduction in the hospitalizations for bronchitis. This was not the case; hospitalizations due to bronchitis have not declined. Some of the increased hospitalization rate may be due, however, to an increased recognition among physicians of the value of treating younger children with asthma. It is also possible that environmental pollutants may play a role. Although the total suspended particulates in the air has decreased over the last decade, there are no data specifically on particulates less than 10 microns in diameter, which are most significant for lower respiratory tract disease. It is not known whether similar increases in asthma are occurring in other nations, nor is it known what further health problems will ensue as this group of children grow older. (Consumer Summary produced by Reliance Medical Information, Inc.)

Correct analysis of trends in diseases and mortality requires careful work. Sometimes, the apparent increase in a disease might reflect improvements in its recognition and diagnosis, rather than a real increase in incidence. However, this does not appear to be the case for the increase in deaths due to asthma, which occurred during the 1980s. Almost 10 million Americans are affected by asthma; children, blacks, and the poor are disproportionately affected. (The rate of asthma among blacks is twice that of whites.) An analysis of the US Vital Records from 1968 through 1987 revealed a 7.8 percent annual decline in asthma-related mortality in children and young adults during the 1970s. This decline was more rapid among women and nonwhites. However, the 1980s witnessed a reversal of this trend when asthma deaths increased at a rate of 6.2 percent per year. Children seemed to suffer the most; the mortality rate for those under 15 years of age rose more rapidly than for patients between 15 and 34. The increased mortality rates seem to be similar for whites and nonwhites. However, the distribution of the increase in mortality is not geographically uniform. Much of the nation's asthma mortality can be accounted for by increases in New York City and Cook County, Illinois (the Chicago area). The mortality rate for asthma in New York City was 10.1 per million population between 1982 and 1985, almost three times that of the nation as a whole. Only mortality data was included in this study; it is not known if other health problems related to asthma have shown a similar increase over the past decade. (Consumer Summary produced by Reliance Medical Information, Inc.)

Illness, hospitalization, and death from asthma occur with a seasonal periodicity, but no large-scale study of these seasonal effects has been described. To gain insight into these aspects of asthma, two large databases, the US Vital Records and the National Hospital Discharge Survey, were examined for the period between January 1, 1982, and December 31, 1986. Results showed a principal discharge diagnosis of asthma for approximately 458,000 hospitalizations, with the highest hospitalization rates for children under five years and adults older than 65. Nonwhites were hospitalized almost three times as often as whites. The annual average mortality was 1.52 per 100,000 population, with an overall increase of 25 percent during the period analyzed. Mortality for nonwhites was almost twice that for whites. Monthly mortality evaluation showed striking seasonal trends. Periods throughout the year differed by as much as 25 percent, with the peak mortality occurring during January and the lowest point in September. The youngest group (age 5 through 34) had its lowest death rate in February and its highest in July. The oldest age group (65 or above) had its highest mortality between January and March and its lowest between July and September, a pattern similar to that for the whole group. The middle-aged group showed no particular seasonal pattern. Hospitalizations, too, showed patterns: the number decreased from June through September, then increased beginning in September. Among older patients, there was a close seasonal match between rates of death and hospitalization, while for younger people, hospitalizations peaked in the fall, mortality in summer. More people in this group died in a hospital in the autumn, while during the summer, out-of-hospital deaths or deaths upon arrival were more common. These results must be interpreted with due regard for several other factors besides asthma-related ones that could have influenced the data, but, on the whole, they indicate that the seasonal variations in hospitalization and death rate due to this condition could have implications for its etiology and treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)