Asthma hospitalization and emergency department visit rates: Rhode Island's progress in meeting Healthy People 2010 goals.

Building off decades-long work, Healthy People 2010 (HP2010) is the national agenda-setting framework for the United States’ public health authorities at all levels of government for the first decade of the third millennium. HP2010 has two primary goals: 1. to improve quality and years of healthy life; and 2. to eliminate health disparities. Within these broad goals are 28 disease/condition-specific objectives based on bestavailable, evidence-based knowledge and surveillance. For respiratory diseases, HP2010 specifies eight asthma-specific objectives. Specifically, Objective 24-2 sets the following target rates for asthma hospitalization: (1) an age-specific rate of 25 per 10,000 children ages 0-4 years (2) an age-standardized* rate of 7.7 per 10,000 children and adults ages 5-64 years, and (3) an age-standardized rate of 11 per 10,000 adults ages 65+. Similarly, there are well-defined targets for the reduction of hospital emergency department (ED) visits for asthma: from an age-specific rate of 150.0 per 10,000 in 1998 to 80 per 10,000 among children aged 0-4 in 2010; from an age-standardized rate of 71.1 per 10,000 in 1998 to 50 per 10,000 for children and adults 5-64 in 2010; and from an age-standardized rate of 29.5 per 10,000 in 1998 to 15 per 10,000 among adults ages 65+ in 2010. Health departments charged with monitoring the burden of asthma in their state must track asthma-related hospitalization and ED visits. Hospitalization rates are an important population-level marker of asthma severity. Indeed, hospitalizations account for the single largest portion of the direct health care costs for asthma, estimated at nearly $18 billion a year. Large variations in the asthma-specific hospital discharge and ED visit rates across age groups may indicate differences in co-morbidities and/or the efficacy of asthma management in younger versus older age groups. This brief assesses Rhode Island’s progress in meeting HP2010 goals for decreasing inpatient hospitalizations and ED visits for asthma. The information will help guide Rhode Island’s Asthma Control Program as it continues to develop infrastructure and interventions to improve the health of people with asthma. A more indepth analysis of these hospitalization and ED visit rates for asthma by measures of disparity can be found elsewhere in this issue. METHODS Data on asthma-related hospital discharges and ED visits were obtained from Rhode Island’s public-use Hospital Discharge Data and ED databases. These data contain de-identified health record level details on patient demographics, diagnoses, procedures, discharge status, residence location by census tract, and charges for every ED visit and hospitalization in Rhode Island to a non-federal hospital facility. This report covers hospital discharges beginning January 1, 2000 through December 31, 2008 and ED visits from January 1, 2005 through December 31, 2008. The data are based on the number of ED visits and hospital discharges or “events” and not the number of unique individuals who visited the ED or who were hospitalized. Thus, some of these events may include individuals with repeat admissions. Asthma hospitalizations and ED visits were defined as a principal diagnosis using ICD-9-CM diagnosis code 493. Since some Rhode Island residents are hospitalized in neighboring states, only data on hospital discharges and ED visits for Rhode Island residents receiving treatment in one of Rhode Island’s 11 acute care hospitals were included in the analyses. Also excluded were out-of-state patients hospitalized for asthma in a Rhode Island hospital. We followed the HP2010 convention of calculating age-specific rates for children aged 0-4 and ageadjusted rates for those ages 5–64 and 65+ in order to compare Rhode Island data with HP2010 targets. Age adjustment was accomplished by first multiplying the age-specific rates of hospitalizations and ED visits by age-specific weights.