EDUCATION: URBANMAAP

Research Projects: Asthma

1. Regional Variations in Asthma Prevalence

The spatial distribution of asthma can provide important clues on the factors that are responsible for the dramatic increase in asthma prevalence. Existing studies present a complex and often contradictory picture of asthma depending on the type of data that have been analyzed. Hospitalization and mortality data suggest that asthma is an urban problem. However, these data are generally not reliable for suburban and rural areas where the smaller populations prevent the statistics from being significant. The 2000 Behavioral Risk Factor Surveillance System (BRFSS) survey was the first state-specific prevalence data set available for all 50 states. The median rate of current asthma was 7.3% (ranging from 5.0% in Louisiana to 8.9% in Maine).

We have already seen that the prevalence of asthma varies in the New York metropolitan area and that there are differences between the prevalence of asthma determined directly from the UrbanMAAP surveys and that inferred based on hospitalization and mortality data. This year, we have expanded the range of UrbanMAAP to include schools in other parts of the country. In particular, we have included schools in southern California, southern New Jersey and Washington, DC. As shown below, based on mortality data, we would expect the schools in the Washington DC area to have a higher prevalence of asthma than the schools in Southern New Jersey but a lower prevalence of asthma than that found in the NY metropolitan region.

In a paper presented at the 2001 annual meeting of the ACAAI, Barbara Yawn, MD, Rochester, Minn., et al. presented a talk titled "The Increasing Prevalence and Incidence of Asthma in White Middle Class America: Its Not Just an Inner City Issue." They find asthma rates are comparable in white middle class community to rates reported in inner city and African American populations. The highest rates of new diagnoses are in young boys and adolescent girls with a significant increase in asthma diagnosis since 1990.

Research Question:
Use the UrbanMAAP survey data to determine which area has the highest prevalence of asthma and which has the lowest prevalence of asthma -- what does this suggest about asthma?

Guiding Research Questions: (pick one).

1. Are there regional differences in asthma burden -- where burden is defined to be the average number of asthma attacks reported -- how could this information be used to target asthma management campaigns?
2. 2) Do the regional differences in asthma appear to be related to differences in air quality -- use EPA information for particulates, carbon monoxide (CO), ozone (O₃) and nitrogen oxides.

Additional things to think about:

• How do your results compare with other data?
• Does asthma appear to be an urban problem?
• Are there other factors that may influence asthma that may be biasing your results?

References:

• Asthma in the Nationa's Capital
• Asthma among School-Age Children in Connecticut

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