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Epidemiology

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Variations in asthma prevalence rates depend at least in part on diagnostic practices among different population groups

Childhood asthma has become more prevalent and severe in the past two decades, with the greatest disease burden affecting low-income groups. However, it is unclear to what extent observed variations in asthma prevalence between population groups are due to differences in actual prevalence or differences in the likelihood of being diagnosed with asthma. A new study shows different rates of asthma diagnosis among American Indian and Alaska Native children from different Northwest regions despite similar rates of asthma symptoms and respiratory-related medical visits.

This finding suggests that future efforts to describe asthma prevalence should consider the potential influence of diagnostic practices, concludes Peter J. Gergen, M.D., M.P.H., of the Center for Primary Care Research, Agency for Healthcare Research and Quality. Researchers from the University of Washington and Children's Hospital in Seattle and Yukon-Kuskokwim Delta Regional Hospital in Bethel, AK, administered an asthma screening survey to 147 middle school American Indian and Alaska Native students in metropolitan Washington and to 365 similar students in nonmetropolitan Alaska. They compared the children's self-reported rates of asthma symptoms, asthma diagnoses, and health care use.

Both groups reported similar rates of asthma symptoms (for example, wheezing, coughing, or shortness of breath) and medical visits for asthma-like symptoms in the previous year. However, more than twice as many Washington students reported that a doctor had diagnosed their asthma as students in Alaska. Among children who had made one or more visits to the doctor for respiratory problems in the past year, those in metropolitan Washington were nearly five times as likely as those in nonmetropolitan Alaska to report ever having had a diagnosis of asthma. The researchers conclude that factors such as locale, ethnicity, and socioeconomic status may have a stronger effect on physician diagnosis of asthma than prevalence of asthma symptoms.

See "Differences in asthma prevalence between samples of American Indian and Alaska Native children," by James W. Stout, M.D., M.P.H., Lisa C. White, M.P.H., Gregory J. Redding, M.D., and others, in Public Health Reports 116, pp. 51-57, 2001.

Reprints (AHRQ Publication No. 02-R005) are available from the AHRQ Publications Clearinghouse.

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