Childhood Asthma Rates Level Off, But Racial Disparities Remain

Dec 28, 2015
Originally published on December 28, 2015 2:32 pm

There's finally some good news about childhood asthma in the United States: After rising for decades, the number of children with the breathing disorder has finally stopped increasing and may have started falling, according to a government analysis.

"That was a big surprise," says Lara Akinbami of the National Center for Health Statistics. "We were expecting the increase to kind of continue. But in fact we saw the opposite."

The percentage of U.S. children with asthma doubled in the 1980s and 1990s and had been increasing steadily since then. The reason for the increase has remained mysterious, but there may be many possible factors, including exposure to secondhand smoke, obesity and children's immune systems failing to develop properly.

Akinbami and her colleagues detected the first change in that trend when they analyzed data from the National Health Interview Survey between 2001 and 2013.

Among children ages 17 and younger, the prevalence of asthma peaked at 9.7 percent in 2011 and then plateaued until 2013, when it declined to 8.3 percent, the researchers report Monday in the journal Pediatrics.

But asthma prevalence continues to rise among children in the poorest families and remains far more common among African-American children than white children. More than 14 percent of black children have asthma, compared with about 8 percent of white children. Black children are also much more likely than white children to suffer severe complications.

And it's not clear "whether 2013 represents just one of the fluctuations in that leveling or whether that's going to show us the beginning of a decreasing trend," Akinbami says.

The reason for the shift remains as mysterious as the rise. One possibility is that the proportion of children who are genetically susceptible to asthma may have peaked, Akinbami says.

Regardless of the cause, other experts are welcoming the trend.

"It is good news for kids," says Stephen Teach, chairman of pediatrics at the Children's National Health System in Washington, D.C. In addition to deaths and hospitalizations, asthma attacks cause children to miss school and their parents to miss work.

"It's an economic and health care drag on our system and our potential for children to develop," Teach says.

Teach and others say we still have a long way to go.

"Roughly 1 in 9 children have asthma. That's a pretty profound burden of a health condition in a population that really should be very, very healthy overall," says Elizabeth Matsui, a professor of pediatrics at the Johns Hopkins Children's Center in Baltimore. "So there's still a lot of work to be done."

That includes addressing the persistent racial and economic inequities. "There are stark and dramatic disparities in the prevalence of the disease," Teach says.

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Transcript

RENEE MONTAGNE, HOST:

There is finally some good news about childhood asthma in the U.S. The Centers for Disease Control and Prevention is reporting that asthma has stopped its decades-long rise among kids and may have even begun falling. NPR health correspondent Rob Stein has the details.

ROB STEIN, BYLINE: Asthma can be a terrible disease. Kids gasp for breath, race for their inhalers. Sometimes they end up in the hospital, sometimes even die. Lara Akinbami of the CDC has been watching asthma in kids for decades.

LARA AKINBAMI: Asthma had been dramatically increasing in the 1980s and 1990s, which is usually referred to as the asthma epidemic, where the asthma prevalence doubled among children.

STEIN: And it just kept going up year after year. There are lots of theories why - secondhand smoke, obesity, kids taking too many antibiotics. But no one really knew what was going on. Akinbami and her colleagues finally found a glimmer of hope when they analyzed the latest government data.

AKINBAMI: It appears that asthma has stopped increasing and has either leveled off or it may even be declining. And that decline was a big surprise 'cause we were expecting the increase to kind of continue. But in fact we saw the opposite.

STEIN: Now, the reason for the turnaround remains as mysterious as the rise. It could be kids aren't breathing as much secondhand smoke, aren't getting fatter. It could just be asthma's maxed out among kids. No one knows. But Stephen Teach of the Children's National Health System in Washington says it's good news.

STEPHEN TEACH: The bad things that happen to children with asthma cost our health care system a great deal. But more importantly, they result in a huge number of missed school days, sleepless nights, missed job opportunities for parents. It's an economic and a health care drag on our system and on the potential for children to develop.

STEIN: Teach says the asthma rate is still way too high. Nearly 10 percent of kids have asthma, and it's still going up for poor kids and hitting black kids the hardest.

TEACH: There are stark and dramatic disparities in the prevalence of the disease, but more importantly in the bad outcomes which affect those kids with the disease - emergency department visits rates. Hospitalizations remained much higher among minority urban children than their less-disadvantaged nonminority peers.

STEIN: So doctors are trying to find ways to turn that around, too. Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.