Pediatric Asthma in Massachusetts 2003 - 2004

Pediatric Asthma in Massachusetts 2003 - 2004 Massachusetts Department of Public Health Center for Environmental Health 250 Washington Street Boston, MA 02108 August, 2005 Table of Contents I Introduction II Methods A Target Population B Project Definition of Asthma C Data Collection D Data Management E Data Analysis III Results A Participation B Reported Asthma Prevalence .5 C Other Variables IV Discussion V Future Efforts Aimed at Pediatric Asthma Surveillance .9 VI References 10 Figures .12 Tables 15 Appendix I Advisory Committee .19 Appendix II MDPH Pediatric Asthma Survey, 2003-2004 .20 Appendix III Reported Asthma Prevalence by School 23 i List of Figures and Tables Figures Figure Communities Included in the MDPH Pediatric Asthma Survey 13 Figure Distribution of Reported School Asthma Prevalence 14 Tables Table Variables Collected on the Pediatric Asthma Survey 16 Table Reported Asthma Prevalence by Grade 17 Table Answers to Questions Related to School Nurses Records 18 ii Acknowledgements The MDPH would like to thank school nurses in both private and public school systems who contributed to the success of the second year of its pediatric asthma surveillance effort by completing a pediatric asthma surveillance form We would also like to thank the asthma surveillance advisory committee for its valuable input during both the planning and implementation phases of the project iii Pediatric Asthma In Massachusetts 2003-2004 I Introduction Asthma is a common chronic disease among children that appears to have increased in prevalence over the past decades [1] It affects more than 12% of Americans under the age of 18 [2] , and costs $11.5 billion in direct health care costs annually [3] The magnitude of prevalence and cost of this disease have made asthma a priority concern among public health organizations across the country Historically the information available regarding asthma prevalence in Massachusetts has been limited to prevalence figures for the state as a whole Statewide prevalence figures have been collected through the Behavioral Risk Factor Surveillance System (BRFSS), a random telephone survey implemented by state health departments in conjunction with the U.S Centers for Disease Control and Prevention (CDC) Although BRFSS data are useful for estimating asthma prevalence in the state as a whole, they not provide information regarding asthma at the community level Before this environmental public health tracking effort, community level data have been available only for a small number of communities in which specialized surveillance programs or research studies have been implemented While statewide prevalence figures are a convenient way to summarize the overall health of Commonwealth residents, there remains a need to better quantify the scope of the problem on the state and local level, particularly as it relates to the pediatric population, the population for which the largest increases in asthma prevalence have been detected over time [4] A standardized pediatric asthma surveillance or “tracking” system that collects asthma prevalence data at the community level allows public health officials to identify populations with asthma on the local level, evaluate at risk groups, and evaluate the impact of interventions over time more effectively than state-level data Given the need for a comprehensive, systematic approach to pediatric asthma tracking in the Commonwealth, the Massachusetts Department of Public Health (MDPH), Center for Environmental Health (CEH), developed a proposal to track pediatric asthma through school health records Massachusetts law authorizes the MDPH to access school health records in public health investigations and requires the strict protection of the privacy of the information collected (Massachusetts Student Record Registration Section 23.7 (4) (h) and MGL c111, s 24A) CEH staff sought assistance from school health nurses in the review of records and ascertainment of children diagnosed with pediatric asthma within each school participating This project is being implemented as part of a larger effort aimed at tracking several health outcomes thought to be impacted by environmental exposures The overall tracking project, primarily funded through the U.S Centers for Disease Control and Prevention (CDC) National Environmental Public Health Tracking Program, aims to track the prevalence of pediatric asthma in Massachusetts school children, lupus in the city of Boston, and developmental disabilities in Berkshire County A supplemental award is allowing for tracking childhood cancer, reproductive outcomes, and childhood lead poisoning in relation to potential environmental exposures This report describes the methods used to implement the pediatric asthma tracking effort and summarizes the asthma prevalence data collected during year two, which encompassed all public and private schools in the Commonwealth serving grades K through Year results were released in May 2004, and consisted of data from a smaller number of schools [5] Thus, year two represents the first time pediatric asthma data were collected statewide II Methods A Target Population During the 2003-2004 school year the MDPH requested all public and private schools in Massachusetts with any grade kindergarten through (2,128 schools) to report the number of students with asthma enrolled in the school B Project Definition of Asthma School nurses provided the number of students with asthma in each school by grade and gender on a standardized report form (Appendix II) Specific sources in the health record for the nurses’ knowledge of a child’s asthma status included emergency cards, parent resource centers, parent communications, student communications, health care provider documentation, or direct observation of an asthma attack The percentage of cases with a documented provider diagnosis or medication orders was requested in the survey C Data Collection During March 2004, public school nurse leaders and private school health contacts were asked to distribute to nurses in their district a one-page reporting form asking for aggregate numbers of children with asthma by grade, gender, and school building (Appendix II) The form also contained questions regarding the source of the data reported The reporting forms were sent to the nurse leader or school health contact via email, whenever possible, to facilitate electronic data submission If electronic mail was not available, then forms were sent via the U.S Postal Service Follow-up telephone calls were placed to nurses who did not respond by April 2004 School enrollment data were collected from the Massachusetts Department of Education (DOE) or from a school’s administrative staff Schools that did not return a complete survey or for which 2003 -2004 enrollment data could not be obtained by September 2004 were considered nonresponders D Data Management MDPH staff reviewed surveys for completeness and accuracy, and attempted to resolve missing data or inconsistencies Massachusetts DOE school identifier codes were assigned to each school’s survey In the case of a school that was not listed in the DOE database, or was listed as part of a larger school, the MDPH assigned its own unique identifier code, following the DOE code structure Complete survey data were manually inputted to the tracking project database upon satisfactory review Incomplete surveys were not input to the project database E Data Analysis Data analysis was performed with SAS version and Microsoft Access The percent participation of the target population was calculated, along with the breakdown of submitted surveys by type of school The prevalence of asthma with 95% confidence intervals was calculated for each participating school, and for the entire state Additionally, statewide prevalence was calculated by gender and by grade level III Results A Participation MDPH received asthma data from a total of 1,664 public, private, and charter schools, approximately 78% of the schools serving any of grades K-8 in the Commonwealth during the school year Of the 1,664 completed report forms, 1,305 were received from public schools (85%), 30 from charter schools (73%), and 329 from private schools (58%) Figures 1a and 1b show the geographic distribution of schools that participated and those that did not participate Some asthma report forms were incomplete and so could not be included in all prevalence analyses The data reported from 20 schools could not be used to estimate prevalence by grade and 19 schools could not be included in gender-specific prevalence estimates However, the data from all but two reporting schools were used in the estimate of statewide prevalence B Reported Asthma Prevalence The reported prevalence of asthma among the 638,421 students enrolled in the 1,664 schools participating was 9.5% (95% CI1 9.4% - 9.6%) Reported prevalence by school ranged from – 39.1% Prevalence figures for the 1,664 participating schools are listed in Appendix III, and their frequency distribution is presented in Figure By school type, reported asthma prevalence was 10.0 % in charter schools, 9.6% in public schools, and 8.2% in private schools Reported statewide asthma prevalence by grade ranged from 8.2% (kindergarten) to 10.3 % (5th grade) (Table 2) Asthma prevalence for males was 10.9% and for females was 8.0% C Other Variables Responses to survey questions relating to the nurses’ health records are summarized in Table The percent of students with documentation in the health record of a provider diagnosis of asthma ranged from - 100%, and averaged 68.6% When asked which other components of the health record nurses used to determine asthma status, emergency cards and parent communications were reported most frequently (Table 3.) 95% Confidence Interval (CI) of a the prevalence is a statistical range used to indicate the stability of a prevalence estimate IV Discussion School-Specific Prevalence While there was notable variation in reported asthma prevalence between schools (range of - 39.1%), caution should be used when comparing school prevalence estimates It is likely that differences in school health record keeping and reporting account for some of the differences observed between schools In order to better understand this issue, the MDPH hopes to verify school nurse reported asthma data against the reports of other nurses and physician’s medical records A funding request to CDC for this activity is pending It is also important to note that a higher prevalence of asthma at one school compared with another does not necessarily indicate the presence of environmental problems within that school Pediatric respiratory symptoms have been associated with a number of factors including exposures in the outdoor environment [6-8], exposures in the home environment [9-11], genetic factors [12, 13], and lifestyle factors [14, 15] The MDPH pediatric asthma tracking project is a surveillance effort, not a research study Therefore the data cannot be used to draw conclusions regarding the causes of reported asthma prevalence in any school A MDPH companion effort however is tracking indoor environmental data in a number of schools statewide with the ultimate goal of linking the datasets Similar environmental linkage efforts are underway for each of the health outcomes tracking efforts funded under the CDC award District Prevalence Year one pediatric asthma surveillance data were reported by school district In this report, year two asthma prevalence data are reported by individual school A town might be part of both a regional and local school district at the same time, putting some of the schools located within a town boundary in one school district, and other schools located within the town boundary in another school district Additionally, private and charter J Turner Hood 298 HAVERHILL ST NORTH READING 13.3 10.3 School Address Community Prevalence (%) 95% Confidence Interval - 16.2 Comparison with Statewide Prevalence L D Batchelder 11 PEABODY STREET NORTH READING 7.6 5.2 - 10.1 not statistically significantly different North Reading Middle 19 SHERMAN RD NORTH READING 3.4 2.0 - 4.8 statistically significantly lower Bridge Street PARSONS STREET NORTHAMPTON 15.6 11.6 - 19.6 statistically significantly higher Clarke School for the Deaf ROUND HILL ROAD NORTHAMPTON 9.5 2.3 - 16.8 not statistically significantly different Jackson Street 120 JACKSON ST NORTHAMPTON 11.5 8.0 - 15.0 not statistically significantly different John F Kennedy Middle 100 BRIDGE RD NORTHAMPTON 14.5 11.9 - 17.0 statistically significantly higher Leeds 20 FLORENCE ST NORTHAMPTON 5.2 2.9 - 7.6 statistically significantly lower Northampton Developmental 737 BRIDGE RD NORTHAMPTON R K Finn Ryan Road 498 RYAN ROAD NORTHAMPTON 9.7 6.3 - 13.1 not statistically significantly different Smith College Campus GILL HALL NORTHAMPTON 11.4 7.6 - 15.2 not statistically significantly different Lincoln Street 76 LINCOLN STREET NORTHBOROUGH 5.8 3.4 - 8.3 statistically significantly lower Marguerite E Peaslee 31 MAPLE ST NORTHBOROUGH 6.8 3.8 - 9.7 not statistically significantly different Marion E Zeh 33 HOWARD ST NORTHBOROUGH 10.8 7.3 - 14.2 not statistically significantly different Robert E Melican Middle 145 LINCOLN ST NORTHBOROUGH 11.0 8.7 - 13.4 not statistically significantly different St Bernardette's 266 MAIN STREET NORTHBOROUGH 5.3 3.1 - 7.5 statistically significantly lower YMCA Center for Child Care 23 MAIN ST NORTHBOROUGH Northbridge Middle 171 LINWOOD AVE, NORTHBRIDGE 12.5 10.2 - 14.8 statistically significantly higher Northbridge Primary 30 CROSS ST NORTHBRIDGE 5.1 3.0 - 7.2 statistically significantly lower W Edward Balmer 21 CRESCENT ST NORTHBRIDGE 9.0 6.6 - 11.3 not statistically significantly different Whitinsville Christian 279 LINWOOD AVE NORTHBRIDGE 11.0 7.9 - 14.0 not statistically significantly different Linden Hill 154 S MTN RD NORTHFIELD 9.1 -7.9 - 26.1 not statistically significantly different Northfield Elementary 104 MAIN ST NORTHFIELD 9.0 5.4 - 12.6 not statistically significantly different Pioneer Valley Regional 97 F SUMNER TURNER RD NORTHFIELD 11.2 7.0 - 15.4 not statistically significantly different Henri A Yelle 64 WEST MAIN ST NORTON 2.5 1.2 - 3.8 statistically significantly lower J C Solmonese 315 W MAIN STREET NORTON 6.7 4.8 - 8.5 statistically significantly lower L G Nourse Elementary 38 PLAIN ST NORTON 5.3 2.9 - 7.7 statistically significantly lower New Testament NEW TAUNTON AVE NORTON 4.0 0.6 - 7.4 statistically significantly lower Norton Middle 215 WEST MAIN ST NORTON 8.7 6.8 - 10.7 not statistically significantly different Charles J Prescott 66 RICHLAND RD NORWELL 10.0 6.5 - 13.5 not statistically significantly different F A Cleveland 33 GEORGE WILLETT PARKWAY NORWELL 6.6 4.2 - 9.1 statistically significantly lower Grace Farrar Cole 81 HIGH STREET NORWELL 7.9 5.5 - 10.3 not statistically significantly different Norwell Middle School 328 MAIN ST NORWELL 14.1 11.1 - 17.1 statistically significantly higher William G Vinal 103 OLD OAKEN BUCKET ROAD NORWELL 7.9 5.4 - 10.4 not statistically significantly different Balch 1170 WASHINGTON ST NORWOOD 3.1 1.2 - 5.0 statistically significantly lower Cornelius M Callahan 116 GARFIELD AVE NORWOOD 9.9 6.2 - 13.7 not statistically significantly different John P Oldham 165 PROSPECT STREET NORWOOD 9.3 6.1 - 12.5 not statistically significantly different St Catherine Of Siena 249 NAHATAN STREET NORWOOD 10.4 8.0 - 12.9 not statistically significantly different Oakham Center DEACON ALLEN DRIVE OAKHAM 11.1 6.9 - 15.2 not statistically significantly different Butterfield 94 SOUTH MAIN STREET ORANGE 16.7 11.6 - 21.8 statistically significantly higher Dexter Park DEXTER STREET ORANGE 9.7 4.7 - 14.7 not statistically significantly different Fisher Hill 50 DEXTER STREET ORANGE 9.2 6.3 - 12.1 not statistically significantly different Cape Cod Lighthouse Chart 225 RT 6A ORLEANS 7.2 3.4 - 11.0 not statistically significantly different Osterville Bay Elementary 99 WEST BAY ROAD OSTERVILLE 6.5 2.9 - 10.0 not statistically significantly different Osterville Elementary 350 BUMPS RIVER RD OSTERVILLE 2.5 0.7 - 4.4 statistically significantly lower School Address Community Prevalence (%) 95% Confidence Interval - DATA NOT SHOWN* - *K-8 enrollment