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|  Asthma InitiativeAsthma is a common disease among New York City's children and adults. People with asthma have chronic lung inflammation and episodes of airway tightening that cause symptoms such as wheezing, coughing, and shortness of breath. Asthma is a leading cause of missed school among children and is the most common cause of hospitalization for children 14 years and younger. Among adults, asthma causes missed work, emergency department visits, and limitation of activity. In the past two decades, the number of people with asthma has increased, although some improvements, such as fewer hospitalizations, have occurred in recent years. Although we do not yet know how to prevent asthma, we do know that asthma can be controlled both by avoiding exposure to triggers and by taking anti-inflammatory medicines. With good control, almost all people with asthma can lead normal, active lives. Asthma Hospitalizations in New York City Decreased in 2005The number of hospitalizations for asthma among New York City residents decreased by more than 9% from 28212 in 2004 to 25615 in 2005. Hospitalization data summarized in this report are based on DOHMH analyses of data provided by the New York State Department of Health’s SPARCS hospital discharge data system. Included are hospitalizations of New York City residents at hospitals located anywhere in New York State. The data were updated in July 2006 for hospitalizations in 2003, 2004 and 2005. Data updated in April 2005 are used for all prior years. Counts for 2003, 2004, and 2005 differ from those in the last annual update as they are based on a more recent version of SPARCS data, which are revised monthly based on ongoing updates submitted by New York State hospitals. As in prior years, children have the highest asthma hospitalization rates. The rate among those 0-14 years of age declined by an estimated 17% in 2005, to 5.4 per 1000 population (Table 1 ). The hospitalization rate among children is 43% lower than in 1997, when nearly 15,000 children 0-14 were hospitalized for asthma compared with fewer than 9000 in 2005. Despite the decline, this rate is higher than the national rate (3.1 in 2004 ). Hospitalization rates continue to vary widely across neighborhoods; with the highest rates occurring in the United Hospital Fund (UHF) neighborhoods of East Harlem (11.9), Central Harlem (11.2), Highbridge-Morrisania (11.0), Williamsburg-Bushwick (10.5), Crotona-Tremont (10.3), and Hunts Point-Mott Haven (9.5). As a group, low-income neighborhoods like these have had the highest asthma hospitalization rates over time but have also experienced the greatest decline in rates since 1997 (45%) compared with those living in the wealthiest neighborhoods (37%) (Figure 1). Given the large number of neighborhoods being tracked, year to year changes in hospitalization rate in individual neighborhoods should be interpreted cautiously as they may be due to chance. Among boroughs, the Bronx had the highest rate in 2005 (8.9) and Staten Island (2.5) the lowest. Asthma hospitalization rates were lowest (1.1 per 1000) among those 15-34 years of age and fell by 8% from 2004 to 2005 (Table 2). As with children, hospitalization rates vary considerably among neighborhoods with East Harlem (4.0) and Hunts Point (3.9) having rates more than three times the citywide rate. Although the gap in asthma hospitalization rates between persons living in low-income neighborhoods and in the most affluent neighborhoods has narrowed somewhat, more than a three fold difference remains (Figure 2). Asthma hospitalization rates among adults over age 35 were 5% lower in 2005 (3.6 per 1000) compared with 2004 (3.8 per 1000, Table 3 ). Neighborhood variation follows a similar pattern to those seen at younger ages with low-income neighborhoods having the highest rates (Figure 3). Compared with younger age groups, those over age 35 have experienced a much smaller decline in hospitalizations for asthma since 1997 (3%) . Asthma is common among New York City’s children and adults. People with asthma have chronic lung inflammation and episodes of airway tightening that cause symptoms such as wheezing, coughing, chest tightness, and shortness of breath. Asthma can’t be cured, but it can be controlled with proper treatment and management. The New York City Department of Health and Mental Hygiene, continues to work towards reducing asthma morbidity and mortality. The New York City Asthma Initiative’s (NYCAI) strategic focus has shifted away from administering direct services, to activities that support broader system improvements. The Initiative’s primary target continues to be children 0-14 years old in communities with the highest asthma rates, however its program scope includes enhancement of clinical and self-management support for adults with asthma. NYCAI is working to:
The Asthma Initiative continues to coordinate the New York City Asthma Partnership (NYCAP), a citywide coalition of over 300 organizations and individuals initiated in 1999. NYCAP brings together representatives from schools, daycare, health care institutions, pharmacies, community based organizations, government, and others who make recommendations to improve citywide policies and systems that affect people with asthma. NYCAP addressee the following: the environment, asthma education, data and research, health care delivery, and issues affecting children in schools, childcare, and recreation programs. In addition, the Department continues to support the following programs: The Asthma Training Institute offers monthly courses various topics including asthma basics, asthma self-management, skill building for community educators, and other clinical topics for medical providers, educators, social workers, nurses, community health workers, and homeless shelter workers in New York City. The program also provides free educational materials, including Asthma Action Plans, posters, and brochures to medical and community providers for distribution. Managing Asthma in Schools is a comprehensive program designed to improve the coordination of care for children with asthma in public elementary schools. A key component of the program is the use of an automated student health record (ASHR) to track asthma and other medical care. The program also provides enhanced asthma training to school nurses and physicians, works to improve communication between school health clinicians and community providers. Managing Asthma in Daycare supports the enhancement of health tracking and coordination of care for children with asthma in 180 Early Childhood Programs in New York City. The project targets neighborhoods with consistently high rates of asthma hospitalizations among children: East and Central Harlem, North and Central Brooklyn, and the South Bronx. Community Integrated Pest Management Program (IPM): DOHMH works with pest control agencies, and community partners to eliminate cockroaches and mice, common asthma triggers in low-income apartments where people with asthma reside. DOHMH’s East and Central Harlem District Public Health Office (E/CH DPHO) focuses on improving asthma care and management in East and Central Harlem which have historically high rates of asthma and asthma-related hospitalizations. E/CH DPHO is providing comprehensive coverage of neighborhood schools to ensure that children with poorly controlled asthma are identified and supported. The office also gives assistance to medical providers to ensure that children are treated with appropriate medications and have access to medications in school. Beginning Fall 2005, the Department initiated an Asthma Care Coordinator program. The program provides follow-up support to children with asthma who visit the Emergency Department, are hospitalized, or are identified in schools as being poorly controlled. Asthma Care Coordinators are currently in 4 East and Central Harlem Hospitals, with plans for expansion additional hospitals in Central Brooklyn and the South Bronx in 2007. DOHMH continues to educate NYC residents and providers about asthma. We encourage individuals with asthma to understand and manage it: (KICK Asthma):
DOHMH recommends that medical providers:
Call 311 to request asthma brochures and other materials. Key Publications and Programs
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