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Asthma hospitalization rate

This is a pilot of a new, interactive way to publish Results Minneapolis reports. Expand each section of the report by clicking the headings (marked with a “+” symbol). Hover your cursor over the data points to explore the data and draw your own insights. Use the scroll bars to see all the data and use the check boxes to change the data that you see. We recommend using Google Chrome to view this page.

Introduction

What is this report?

    City Goal Results Minneapolis roundtables are focused on answering the question "Are we there yet?" by reporting progress on our community indicators. These reports are analytical in nature and focused on making connections with cross-sector data. Creating these reports requires input from multiple departments and, in many cases, external participants. The goal of this initiative is to reflect the realities being experienced in our communities. The objectives of the report and roundtable are to 1) have a new and different understanding of the indicator and 2) think differently about solutions.

    This report was created with participation from the Minneapolis Health Department.

Why the asthma hospitalization rate?


  • The City is concerned about asthma hospitalization rates because it represents a measure of serious health impact to Minneapolis residents. Asthma hospitalization rates are one of many examples of health disparities among Minneapolis residents.
  • Asthma hospitalizations is not a measure of the total prevalence of asthma. It captures the most extreme asthma cases.

Framework

Expand to view framework

    Asthma is a disease with indoor air quality, outdoor air quality, and social, cultural and disease management causes. There is some interaction between these factors, but the degree and nature of this interaction is not well understood.

    a. Contributors to asthma risk

    City Goal Results Minneapolis - Asthma framework 1




    b. Asthma is everyone’s problem, but some people are affected more than others.

    There are two types of asthma triggers: 

    • Irritant triggers damage airway surface tissues, similar to a burn. Irritants can affect anyone.
    • Inflammatory triggers cause an allergic reaction for people who are sensitive to those triggers

    A person with an inflamed system is more likely to be affected by irritants as well. Inflammation can be caused by inflammatory triggers and by many social determinants of health.

    City Goal Results Minneapolis - Asthma framework 2

Report

1. Disparities in asthma hospitalization rates exist within Minneapolis and within Minnesota. This health equity issue reflects social, cultural and racial inequities. Targeted solutions are needed in order to address these disparities.


  • There are vast regional geographic disparities in asthma hospitalizations. While male children living in greater Minnesota have the lowest rates, the rate for adult males in Minneapolis is more than five times higher.
  • Disparities also exist by sex. Although female children have higher asthma hospitalization rates than male children in all regions, these disparities are flipped and magnified once they become adults.
  • Asthma hospitalization rates are highest and have the most fluctuation for children in Minneapolis.
  • Data is not available by race and ethnicity for asthma hospitalization rates. While we can't completely understand race disparities unless we have that information, disparities in underlying social determinants of health, including poverty and unemployment, also contribute to asthma. Areas with the highest poverty rates overlap with the areas with the highest asthma hospitalization rates.

    How to read this chart: The chart below shows the age-adjusted rate of asthma hospitalizations per 10,000 people by region (Minneapolis, metro area, greater Minnesota, and Minnesota), by age group (children, adults, and all ages combined) and by sex for the years 2009-2013. Data source: Minnesota Hospital Discharge Data, maintained by the Minnesota Hospital Association

    Notes:
    • Age-adjusted rates are calculated by multiplying rates for each age group by their respective weights from the 2000 U.S. Census.
    • Minneapolis estimates include the zip codes 55401, 55402, 55403, 55404, 55405, 55406, 55407, 55408, 55409, 55410, 55411, 55412, 55413, 55414, 55415, 55417, 55418, 55419, 55454, and 55455. 
    • The metro area includes Anoka, Carver, Dakota, Hennepin, Scott, Ramsey, and Washington Counties. All other counties are included in Greater Minnesota.
    • Children are defined as those under the age of 18. Adults are defined as those 18 years and older.
    • This data represents the place where the person lives, not where they had the asthma attack or where they were hospitalized.
    • The rate of asthma hospitalizations is not a measure of the total prevalence of asthma. It captures the most extreme asthma cases.

    If the image does not load on your device, please click here to view it in a new window.


  •  How to read this graph: The graph below shows seasonal overall (non-age-adjusted) asthma hospitalizations rates per 100,000 people by region and age group for the year 2013. Data source: Minnesota Hospital Discharge Data, maintained by the Minnesota Hospital Association

    Notes:
    • Minneapolis estimates include the zip codes 55401, 55402, 55403, 55404, 55405, 55406, 55407, 55408, 55409, 55410, 55411, 55412, 55413, 55414, 55415, 55417, 55418, 55419, 55454, and 55455. 
    • The metro area includes Anoka, Carver, Dakota, Hennepin, Scott, Ramsey, and Washington Counties. All other counties are included in Greater Minnesota.
    • Children are defined as those under the age of 18. Adults are defined as those 18 years and older.
    • This data represents the place where the person lives, not where they had the asthma attack or where they were hospitalized.
    • The rate of asthma hospitalizations is not a measure of the total prevalence of asthma. It captures the most extreme asthma cases.

    If the image does not load on your device, please click here to view it in a new window.



      How to read this map: The map below shows the age-adjusted rate of asthma hospitalizations per 10,000 people by zip code for the years 2009-2013. In some zip codes, asthma hospitalization rate data is either suppressed or unstable due to insufficient data. Data source: Minnesota Hospital Discharge Data, maintained by the Minnesota Hospital Association

    Notes:
    • Age-adjusted rates are calculated by multiplying rates for each age group by their respective weights from the 2000 U.S. Census.
    • This data represents the place where the person lives, not where they had the asthma attack or where they were hospitalized.
    • The rate of asthma hospitalizations is not a measure of the total prevalence of asthma. It captures the most extreme asthma cases.

    If the image does not load on your device, please click here to view it in a new window.

    1c. Asthma hospitalization rate by zip code (2009-2013)





       How to read this map: The map below shows the age-adjusted rate of chronic obstructive pulmonary disorder (COPD) hospitalizations per 10,000 people by zip code for the years 2009-2013. In some zip codes, COPD hospitalization data is unstable due to insufficient data. Data source: Minnesota Hospital Discharge Data, maintained by the Minnesota Hospital Association

    Notes:
    • Age-adjusted rates are calculated by multiplying rates for each age group by their respective weights from the 2000 U.S. Census.
    • This data represents the place where the person lives, not where they had the COPD attack or where they were hospitalized.
    • The rate of COPD hospitalizations is not a measure of the total prevalence of COPD. It captures the most extreme COPD cases.

    If the image does not load on your device, please click here to view it in a new window.

    1d. Chronic Obstructive Pulmonary Disorder (COPD) hospitalization rate by zip code (2009-2013)

2. We have a relatively good understanding of the major triggers of asthma symptoms. Environmental triggers inside the home are a major cause of asthma symptoms. If triggers can be removed or avoided, asthma symptoms can be reversed or prevented. Some fixes are easy and some are more difficult.


  • The presence of environmental triggers in the home usually represents a rental housing violation code. The number of housing orders for indoor air quality violations mirrors the areas with highest asthma hospitalization rates.
  • Pest problems can trigger asthma symptoms. In Minnesota, mice are a bigger problem than cockroaches or dust mites.
    • Pest problems can be easier to see and sometimes to manage. However, renters of single family homes are responsible for managing pests even if the problem is due to improper maintenance of the home.
  • Mold has many different causes, which vary by each individual house. To address mold issues we have to work on a house-by-house basis. While the City can play a role in addressing some causes of mold, homeowners and renters can address others.
    • Some aspects of the City’s housing code could be more proactive to prevent indoor mold growth. This could be accomplished by installation of modern ventilation equipment and practices found in new homes.
    • Some landlords contribute to moisture in their properties by not caring properly for their unit or building. For example, painting over mold between tenants hides the true extent of mold buildup, and can make it difficult for renters to find or prove mold issues that might be causing asthma symptoms.
    • Homeowners and renters’ lifestyle choices can also contribute to moisture in their homes. For example, placement of furniture (like beds or couches) along an outside wall can trap moisture and create an environment where mold can grow.

    How to read this map: The map below shows the number of indoor health violations in Minneapolis from 2013 to 2015 by block group. This data includes violations that indicate the presence of indoor asthma triggers. The data represents a variety of housing inspections (such as routine inspections and complaint-driven inspections), and represents primarily rental housing. Data source: Minneapolis Regulatory Services Department

    If the image does not load on your device, please click here to view it in a new window.

  • 2a. Indoor health violations by block group (2013-2015)


3. We also have a good understanding of the interventions that we know are successful. The issue is having the resources we need to pay for these interventions.


  • The City of Minneapolis implemented the Environmental Action for Children’s Health (EACH) program between 2004-2009. Children with asthma symptoms were referred to this program, and upon referral a City inspector went into their homes to provide recommendations about improvements to their home environment and how to manage their symptoms. This intervention resulted in a number of statistically significant outcomes, reducing asthma disruptions for children.
  • Another intervention that is often successful is to get products that we know prevent or reduce asthma hospitalizations into the homes of families. Examples of these products include mattress covers, vacuums and HEPA air cleaners. A paradigm shift to consider this type of indoor air quality equipment as medical devices is needed in order to continue to provide community-based public health interventions and partnerships. A bill was in the legislature during the 2016 legislative session to consider indoor air quality equipment as medical devices.
  • There is currently a successful model for lead control that we believe can and should be replicated for asthma. Implementing a similar model would mean that kids who are hospitalized for asthma problems would trigger a housing inspection. The City has done this kind of work periodically in the past, but with inconsistent funding, it can be difficult to build those relationships with care providers and families.

    How to read this graph: The graph below illustrates changes in asthma burden after the City of Minneapolis implemented the Environmental Action for Children's Health (EACH) program to remediate allergens, lead, mold, and other home-based health hazards. The estimates for each time period are color coded to reflect whether they are statistically significant or not. Note: Higher asthma symptom burden scores indicate less symptom burden. Data source: Minneapolis Health Department

    If the image does not load on your device, please click here to view it in a new window.

Discussion questions

Expand to view questions


  1. The gap between regulatory standards and health standards is hard to bridge and sustain. How can we build on existing levers or invent new ones in order to do this work?
  2. The City often takes a "bottom up" approach to air quality protection, meaning we work with individuals, small groups or businesses to address air quality issues. This is different from the "top down" regulatory approach agencies often take. How do we find ways to support and mobilize around this "bottom up" work?

 

Last updated Oct 31, 2016

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