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Table 1.  

Characteristic All ages Current asthma
All ages Children Adults
Weighted no. % (SE) (95% CI) Weighted no. Prevalence% (SE) (95% CI) Weighted no. Prevalence% (SE) (95% CI) Weighted no. Prevalence% (SE) (95% CI)
Total 320,600,934 25,486,467 8.0 (0.12) 7.7–8.2 5,947,939 8.1 (0.55) 7.7–8.6 19,538,528 7.9 (0.13) 7.7–8.2
U.S. Census region p = 0.003§ p = 0.01§ p = 0.001§
Northeast 56,983,341 17.8 (0.73) (16.4–19.3) 5,050,436 8.9 (0.31) (8.3–9.5) 1,142,095 9.1 (0.76) (7.8–10.7) 3,908,341 8.8 (0.33) (8.2–9.5)
Midwest 69,891,347 21.8 (0.63) (20.6–23.1) 5,669,742 8.1 (0.22) (7.7–8.6) 1,243,798 8.0 (0.41) (7.2–8.8) 4,425,944 8.2 (0.23) (7.7–8.6)
South 117,084,584 36.5 (1.01) (34.6–38.5) 8,902,468 7.6 (0.19) (7.2–8.0) 2,324,759 8.5 (0.37) (7.8–9.2) 6,577,709 7.4 (0.21) (7.0–7.8)
West 76,641,661 23.9 (0.94) (22.1–25.8) 5,863,821 7.7 (0.28) (7.1–8.2) 1,237,288 6.9 (0.38) (6.2–7.7) 4,626,534 7.9 (0.31) (7.3–8.5)
MSA category p = 0.009§ p = 0.10 p = 0.04§
Large MSA 182,494,015 56.9 (0.74) (55.5–58.4) 13,981,756 7.7 (0.15) (7.4–8.0) 3,242,332 7.7 (0.28) (7.2–8.3) 10,739,424 7.7 (0.16) (7.4–8.0)
Small MSA 96,095,562 30.0 (1.25) (27.6–32.5) 8,082,693 8.4 (0.20) (8.0–8.8) 1,948,888 8.7 (0.39) (8.0–9.5) 6,133,805 8.3 (0.22) (7.9–8.8)
Non-MSA 42,011,357 13.1 (1.10) (11.1–15.4) 3,422,018 8.2 (0.31) (7.6–8.8) 756,719 8.3 (0.59) (7.2–9.5) 2,665,299 8.1 (0.32) (7.5–8.8)
Urban-rural classification** p = 0.002§ p = 0.25 p = 0.005§
Large central metropolitan 100,582,672 31.4 (0.49) (30.4–32.3) 7,327,448 7.3 (0.19) (6.9–7.7) 1,700,141 7.6 (0.38) (6.9–8.3) 5,627,307 7.2 (0.21) (6.8–7.6)
Large fringe metropolitan 82,685,805 25.8 (0.60) (24.6–27.0) 6,705,839 8.1 (0.23) (7.7–8.6) 1,546,829 7.9 (0.42) (7.1–8.7) 5,159,010 8.2 (0.26) (7.7–8.7)
Medium metropolitan 65,861,315 20.5 (1.17) (18.3–22.9) 5,558,467 8.5 (0.25) (8.0–9.0) 1,381,782 9.0 (0.46) (8.2–10.0) 4,176,685 8.3 (0.28) (7.7–8.8)
Small metropolitan 29,459,786 9.2 (1.10) (7.2–11.6) 2,472,695 8.4 (0.33) (7.8–9.1) 562,468 8.3 (0.75) (6.9–9.9) 1,910,227 8.4 (0.35) (7.8–9.1)
Micropolitan 26,461,517 8.3 (0.97) (6.5–10.4) 2,128,466 8.1 (0.39) (7.3–8.9) 470,805 8.2 (0.77) (6.8–9.8) 1,657,661 8.0 (0.41) (7.3–8.9)
Noncore 15,549,840 4.9 (0.67) (3.7–6.3) 1,293,551 8.3 (0.47) (7.4–9.3) 285,914 8.4 (1.00) (6.6–10.6) 1,007,638 8.3 (0.50) (7.4–9.3)

Table 1. Characteristics of persons of all ages and prevalence of those with current asthma* among all ages, children aged 0–17 years, and adults aged ≥18 years, by geographic area — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Includes persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" and "Do you still have asthma?"
National Health Interview Survey sample weights were used to adjust for nonresponse, poststratification, and probability of selection to provide estimates for the intended U.S. populations.
§Statistically significant by chi-square test, p<0.05.
Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
**Large central metropolitan areas are counties in MSAs of ≥1 million population containing the principal city; large fringe metropolitan areas are counties in MSAs of ≥1 million population not containing the principal city; medium metropolitan areas are counties in MSAs of 250,000–999,999 population; small metropolitan areas are counties in MSAs of <250,000 population; micropolitan areas have an urban cluster population of 10,000–49,999; and noncore areas include nonmetropolitan areas that did not qualify as micropolitan, including those without an urban cluster population of at least 10,000.

Table 2.  

U.S. Census region Current asthma
Large MSA Small MSA Non-MSA
Weighted no.§ Prevalence% (SE) (95% CI) Weighted no.§ Prevalence% (SE) (95% CI) Weighted no.§ Prevalence% (SE) (95% CI)
All ages p = 0.03 p = 0.01 p = 0.34
Northeast 3,143,580 8.3 (0.34) (7.6–9.0) 1,496,626 10.2 (0.62) (9.0–11.4) 410,230 9.8 (1.06) (7.9–12.1)
Midwest 2,819,643 8.1 (0.30) (7.5–8.7) 1,638,536 8.2 (0.39) (7.5–9.0) 1,211,563 8.1 (0.53) (7.1–9.2)
South 4,710,141 7.5 (0.25) (7.0–8.0) 2,853,692 7.8 (0.29) (7.2–8.4) 1,338,634 7.8 (0.47) (6.9–8.8)
West 3,308,392 7.1 (0.30) (6.6–7.8) 2,093,839 8.5 (0.41) (7.7–9.3) 461,591 8.4 (0.70) (7.1–9.8)
Children p = 0.07 p = 0.03 p = 0.84
Northeast 722,244 8.6 (0.78) (7.2–10.2) 352,346 10.9 (1.26) (8.7–13.7) 67,505 7.5 (1.54) (4.9–11.1)
Midwest 609,728 7.8 (0.57) (6.8–9.0) 346,177 7.7 (0.60) (6.6–9.0) 287,892 8.9 (1.03) (7.1–11.1)
South 1,212,476 8.0 (0.48) (7.1–9.0) 802,969 9.4 (0.64) (8.2–10.7) 309,314 8.2 (0.87) (6.6–10.1)
West 697,884 6.6 (0.48) (5.7–7.6) 447,396 7.4 (0.68) (6.2–8.9) 92,007 7.4 (1.90) (4.4–12.1)
Adults p = 0.06 p = 0.001 p = 0.19
Northeast 2,421,336 8.2 (0.39) (7.5–9.0) 1,144,280 9.9 (0.66) (8.7–11.3) 342,725 10.4 (1.32) (8.1–13.3)
Midwest 2,209,915 8.2 (0.34) (7.5–8.9) 1,292,359 8.4 (0.46) (7.5–9.3) 923,670 7.8 (0.50) (6.9–8.9)
South 3,497,666 7.3 (0.26) (6.8–7.8) 2,050,723 7.3 (0.34) (6.7–8.0) 1,029,320 7.7 (0.50) (6.7–8.7)
West 2,610,508 7.3 (0.33) (6.7–8.0) 1,646,443 8.8 (0.41) (8.1–9.7) 369,583 8.6 (0.71) (7.4–10.1)

Table 2. Prevalence of current asthma* among all ages, children aged 0–17 years, and adults aged ≥18 years, by U.S. Census region and metropolitan statistical area category — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Includes persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" and "Do you still have asthma?"
Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
§National Health Interview Survey sample weights were used to adjust for nonresponse, poststratification, and probability of selection to provide estimates for the intended U.S. populations.
Statistically significant by chi-square test, p<0.05.

Table 3.  

State/Area Current asthma
Total Large MSA Small MSA Non-MSA p value
Prevalence% (SE) (95% CI) Prevalence % (SE) (95% CI) Prevalence % (SE) (95% CI) Prevalence % (SE) (95% CI)
Alabama 8.5 (0.85) (7.0–10.3) 11.2 (2.07) (7.7–15.9) 8.3 (0.81) (6.8–10.0) 6.3 (1.45) (4.0–9.8) 0.24
Alaska 8.4 (0.78) (7.0–10.0) § § 8.8 (0.95) (7.1–10.8) 7.5 (0.00) (7.5–7.5) 0.29
Arizona 8.6 (0.77) (7.2–10.2) 8.5 (1.02) (6.7–10.7) 8.8 (0.67) (7.6–10.2) § § 0.78
Arkansas 8.4 (0.94) (6.7–10.4) § § 9.3 (1.19) (7.2–11.9) 6.2 (1.62) (3.7–10.3) 0.13
California 7.0 (0.32) (6.4–7.7) 6.4 (0.38) (5.7–7.2) 8.9 (0.72) (7.6–10.4) 11.2 (0.00) (11.2–11.2) 0.001
Colorado 9.1 (0.96) (7.4–11.2) 8.0 (1.59) (5.4–11.8) 10.9 (0.61) (9.8–12.2) 6.6 (0.00) (6.6–6.6) 0.03
Connecticut 11.2 (0.92) (9.5–13.2) 11.9 (2.17) (8.3–16.9) 10.7 (0.91) (9.0–12.6) 13.1 (1.60) (10.3–16.6) 0.37
Delaware 10.3 (1.42) (7.9–13.5) 8.3 (1.74) (5.4–12.4) 12.9 (1.99) (9.5–17.3) § § 0.10
District of Columbia 12.0 (1.43) (9.5–15.1) 12.0 (1.43) (9.5–15.1) § § § § §
Florida 7.1 (0.47) (6.3–8.1) 7.5 (0.58) (6.5–8.8) 6.1 (0.79) (4.7–7.8) 10.1 (0.00) (10.1–10.1) 0.17
Georgia 7.9 (0.57) (6.9–9.1) 7.3 (0.82) (5.9–9.1) 9.3 (0.45) (8.4–10.2) 8.4 (1.49) (5.9–11.9) 0.16
Hawaii 5.8 (0.66) (4.6–7.2) § § 5.8 (0.80) (4.4–7.6) 5.8 (0.11) (5.6–6.0) 0.97
Idaho 7.4 (0.59) (6.3–8.7) § § 7.9 (0.72) (6.6–9.4) 6.5 (0.44) (5.7–7.4) 0.20
Illinois 7.4 (0.44) (6.6–8.3) 6.8 (0.53) (5.9–7.9) 9.4 (0.77) (7.9–11.0) 8.4 (1.94) (5.3–13.1) 0.06
Indiana 8.6 (0.59) (7.5–9.8) 9.3 (0.87) (7.7–11.1) 8.0 (0.91) (6.3–9.9) 7.7 (0.61) (6.6–9.0) 0.34
Iowa 8.1 (0.98) (6.4–10.3) § § 7.3 (1.04) (5.5–9.6) 9.7 (1.65) (6.9–13.5) 0.20
Kansas 8.4 (0.53) (7.5–9.5) 8.5 (1.04) (6.7–10.8) 9.1 (1.13) (7.2–11.6) 7.8 (0.41) (7.0–8.7) 0.31
Kentucky 8.0 (0.80) (6.5–9.7) 8.2 (0.66) (7.0–9.6) 7.3 (1.10) (5.4–9.8) 7.9 (1.70) (5.1–11.9) 0.84
Louisiana 8.2 (0.83) (6.7–10.0) 6.3 (1.68) (3.7–10.6) 8.1 (0.95) (6.4–10.2) 11.7 (1.10) (9.7–14.0) 0.14
Maine 12.3 (1.73) (9.3–16.2) § § 14.7 (2.77) (10.0–21.0) 10.3 (1.32) (8.0–13.2) 0.23
Maryland 8.9 (1.15) (6.9–11.4) 8.9 (1.15) (6.9–11.4) § § § § §
Massachusetts 10.4 (1.03) (8.6–12.6) 9.8 (1.07) (7.9–12.1) 12.1 (2.46) (8.0–17.8) 10.2 (1.87) (7.1–14.5) 0.70
Michigan 8.9 (0.52) (7.9–10.0) 10.2 (0.79) (8.8–11.9) 7.3 (0.90) (5.7–9.2) 8.7 (0.43) (7.9–9.6) 0.06
Minnesota 7.2 (0.65) (6.0–8.6) 7.2 (0.93) (5.6–9.3) 7.6 (0.00) (7.6–7.6) 6.9 (1.09) (5.0–9.3) 0.77
Mississippi 7.5 (0.97) (5.8–9.6) 3.2 (0.00) (3.2–3.2) 9.3 (0.56) (8.3–10.5) 5.0 (0.79) (3.7–6.8) 0.001
Missouri 8.8 (0.86) (7.3–10.7) 8.6 (1.10) (6.6–11.0) 9.5 (0.88) (7.9–11.4) 9.0 (2.27) (5.5–14.6) 0.82
Montana 8.3 (0.69) (7.1–9.8) § § 7.0 (0.01) (7.0–7.0) 8.9 (0.76) (7.5–10.5) 0.17
Nebraska 5.0 (0.57) (4.0–6.2) § § 5.0 (0.67) (3.8–6.5) 4.9 (1.00) (3.3–7.3) 0.93
Nevada 8.7 (0.86) (7.1–10.5) 8.9 (1.14) (6.9–11.5) 8.1 (0.09) (7.9–8.3) 6.7 (0.00) (6.7–6.7) 0.56
New Hampshire 10.9 (1.00) (9.1–13.1) 10.4 (0.91) (8.7–12.3) 9.9 (1.94) (6.7–14.4) 12.1 (1.54) (9.4–15.5) 0.72
New Jersey 7.4 (0.65) (6.2–8.8) 7.1 (0.74) (5.8–8.7) 8.8 (0.96) (7.1–10.9) § § 0.18
New Mexico 9.4 (1.23) (7.2–12.1) § § 9.8 (1.91) (6.6–14.2) 8.5 (0.57) (7.5–9.7) 0.59
New York 8.5 (0.49) (7.6–9.5) 8.1 (0.55) (7.1–9.2) 10.0 (1.38) (7.6–13.1) 10.8 (1.98) (7.5–15.3) 0.17
North Carolina 7.5 (0.59) (6.4–8.7) 6.6 (0.62) (5.5–8.0) 8.4 (1.04) (6.6–10.7) 6.5 (0.80) (5.1–8.3) 0.28
North Dakota 6.3 (0.97) (4.6–8.5) § § 6.6 (0.00) (6.6–6.6) 6.1 (1.52) (3.7–9.9) 0.76
Ohio 9.0 (0.69) (7.7–10.4) 8.3 (0.77) (6.9–9.9) 10.2 (1.40) (7.7–13.3) 9.2 (2.24) (5.6–14.6) 0.47
Oklahoma 9.1 (1.13) (7.2–11.6) 10.6 (1.20) (8.5–13.2) 5.3 (1.26) (3.3–8.4) 10.5 (2.79) (6.2–17.4) 0.009
Oregon 8.8 (1.13) (6.8–11.3) 7.8 (1.62) (5.1–11.6) 8.6 (1.18) (6.6–11.2) 13.9 (0.00) (13.9–13.9) 0.51
Pennsylvania 8.3 (0.66) (7.1–9.7) 8.0 (0.73) (6.6–9.5) 9.3 (1.19) (7.2–11.9) 5.6 (0.76) (4.3–7.3) 0.20
Rhode Island 9.6 (0.78) (8.7–11.2) 9.6 (0.78) (8.1–11.2) § § § § §
South Carolina 7.8 (0.89) (6.2–9.7) § § 7.4 (0.93) (5.8–9.5) 9.9 (2.34) (6.1–15.5) 0.37
South Dakota 6.0 (1.17) (4.1–8.8) § § 5.7 (1.58) (3.3–9.7) 6.7 (0.00) (6.7–6.7) 0.58
Tennessee 6.5 (0.49) (5.6–7.5) 4.5 (0.67) (3.4–6.0) 8.7 (1.32) (6.4–11.6) 8.3 (0.43) (7.5–9.2) <0.001
Texas 6.8 (0.37) (6.1–7.6) 6.8 (0.44) (6.0–7.8) 7.2 (0.89) (5.6–9.1) 6.0 (0.61) (4.9–7.3) 0.48
Utah 7.3 (1.46) (4.9–10.8) 8.0 (1.51) (5.5–11.5) 6.9 (2.26)** (3.6–12.9) †† †† ††
Vermont 11.0 (1.67) (8.1–14.7) § § 9.5 (0.98) (7.7–11.6) 14.5 (0.00) (14.5–14.5) 0.09
Virginia 8.0 (0.63) (6.8–9.3) 8.0 (0.57) (7.0–9.2) 5.6 (0.76) (4.2–7.3) 9.5 (2.25) (5.9–14.9) 0.24
Washington 7.7 (0.52) (6.8–8.8) 8.7 (0.64) (7.5–10.0) 6.6 (1.04) (4.8–9.0) 7.0 (0.64) (5.8–8.3) 0.11
West Virginia 9.1 (0.81) (7.6–10.8) § § 9.6 (0.40) (8.9–10.5) 7.8 (1.64) (5.1–11.7) 0.44
Wisconsin 7.7 (0.63) (6.5–9.0) 7.5 (0.78) (6.1–9.1) 9.3 (0.48) (8.4–10.3) 7.2 (1.33) (5.0–10.3) 0.19
Wyoming 8.2 (1.50) (5.7–11.7) § § 8.7 (0.00) (8.7–8.7) 8.0 (2.07) (4.8–13.1) 0.75

Table 3. Prevalence of current asthma,* by state/area and metropolitan statistical area category — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Includes persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" and "Do you still have asthma?"
Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
§State/area does not have the corresponding MSA category.
Statistically significant by chi-square test, p<0.05.
**Relative SE = 30%–50%; estimate is unreliable.
††Suppressed because relative SE ≥50%.

Table 4.  

Characteristic Asthma attack
All ages Children Adults
Weighted no.§ Prevalence% (SE) (95% CI) Weighted no.§ Prevalence% (SE) (95% CI) Weighted no.§ Prevalence% (SE) (95% CI)
Total 11,703,647 46.0 (0.69) (44.6–47.4) 3,146,587 53.0 (1.33) (50.4–55.6) 8,557,060 43.9 (0.77) (42.4–45.4)
U.S. Census region p = 0.28 p = 0.16 p = 0.20
Northeast 2,214,856 43.9 (1.47) (41.0–46.8) 619,571 54.2 (2.90) (48.5–59.9) 1,595,285 40.8 (1.61) (37.7–44.0)
Midwest 2,557,512 45.2 (1.41) (42.4–48.0) 624,634 50.5 (2.92) (44.8–56.2) 1,932,878 43.7 (1.56) (40.7–46.8)
South 4,156,819 46.8 (1.27) (44.3–49.3) 1,183,284 50.9 (2.17) (46.7–55.2) 2,973,535 45.3 (1.45) (42.5–48.2)
West 2,774,459 47.4 (1.38) (44.7–50.1) 719,097 58.3 (2.91) (52.5–63.9) 2,055,362 44.5 (1.43) (41.7–47.3)
MSA category p = 0.53 p = 0.09 p = 0.05
Large MSA 6,321,586 45.3 (1.00) (43.3–47.3) 1,797,752 55.7 (1.90) (51.9–59.3) 4,523,834 42.2 (1.10) (40.0–44.3)
Small MSA 3,771,354 46.7 (1.20) (44.4–49.1) 968,333 49.7 (2.06) (45.7–53.7) 2,803,022 45.8 (1.37) (43.1–48.5)
Non-MSA 1,610,707 47.1 (1.69) (43.8–50.4) 380,502 50.3 (3.43) (43.6–57.0) 1,230,205 46.2 (1.86) (42.6–49.8)
Urban–rural classification** p = 0.80 p = 0.28 p = 0.17
Large central metropolitan 3,308,972 45.2 (1.32) (42.6–47.8) 928,878 54.8 (2.64) (49.6–59.9) 2,380,094 42.3 (1.44) (39.5–45.2)
Large fringe metropolitan 3,051,464 45.6 (1.46) (42.8–48.5) 873,512 56.7 (2.77) (51.2–62.0) 2,177,951 42.3 (1.58) (39.2–45.4)
Medium metropolitan 2,538,772 45.8 (1.49) (42.9–48.7) 687,147 49.7 (2.49) (44.9–54.6) 1,851,625 44.5 (1.74) (41.1–47.9)
Small metropolitan 1,193,733 48.3 (1.97) (44.4–52.2) 276,547 49.2 (3.81) (41.8–56.6) 917,186 48.0 (2.13) (43.9–52.2)
Micropolitan 1,014,584 47.7 (1.98) (43.8–51.6) 225,660 47.9 (4.06) (40.1–55.9) 788,924 47.6 (2.33) (43.1–52.2)
Noncore 596,123 46.1 (2.76) (40.8–51.5) 154,843 54.2 (6.28) (41.9–66.1) 441,280 43.8 (2.93) (38.1–49.6)

Table 4. Asthma attack* prevalence in the past 12 months among all ages, children aged 0–17 years, and adults aged ≥18 years with current asthma, by geographic area — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Having had one or more episodes of asthma or an asthma attack in the past 12 months.
Includes persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" and "Do you still have asthma?"
§National Health Interview Survey sample weights were used to adjust for nonresponse, poststratification, and probability of selection to provide estimates for the intended U.S. populations.
Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
**Large central metropolitan areas are counties in MSAs of ≥1 million population containing the principal city; large fringe metropolitan areas are counties in MSAs of ≥1 million population not containing the principal city; medium metropolitan areas are counties in MSAs of 250,000–999,999 population; small metropolitan areas are counties in MSAs of <250,000 population; micropolitan areas have an urban cluster population of 10,000–49,999; and noncore areas include nonmetropolitan areas that did not qualify as micropolitan, including those without an urban cluster population of at least 10,000.

Table 5.  

U.S. Census region Asthma attack
Large MSA Small MSA Non-MSA
Weighted no. Prevalence% (SE) (95% CI) Weighted no. Prevalence% (SE) (95% CI) Weighted no. Prevalence% (SE) (95% CI)
All ages p = 0.07 p = 0.08 p = 0.11
Northeast 1,412,467 44.9 (2.09) (40.9–49.1) 600,646 40.1 (3.02) (34.4–46.2) 201,743 49.2 (2.70) (43.9–54.5)
Midwest 1,144,694 40.7 (1.98) (36.9–44.6) 816,369 49.9 (3.13) (43.8–56.0) 596,449 49.3 (2.35) (44.7–53.9)
South 2,219,116 47.2 (1.75) (43.8–50.7) 1,377,224 48.4 (2.01) (44.4–52.3) 560,479 41.9 (3.17) (35.8–48.2)
West 1,545,308 46.8 (2.18) (42.5–51.1) 977,114 46.8 (1.78) (43.3–50.3) 252,037 54.6 (3.99) (46.7–62.2)
Children p = 0.12 p = 0.35 p = 0.12
Northeast 427,907 59.2 (4.25) (50.7–67.2) 148,248 42.1 (4.93) (32.8–51.9) 43,416 64.3 (6.32) (51.2–75.6)
Midwest 289,469 48.0 (4.40) (39.5–56.6) 179,598 51.9 (4.71) (42.7–61.0) 155,568 54.1 (5.84) (42.7–65.2)
South 654,941 54.1 (2.97) (48.2–59.8) 399,287 49.7 (3.23) (43.4–56.0) 129,057 41.7 (5.14) (32.1–52.0)
West 425,436 61.3 (4.03) (53.2–68.9) 241,200 53.9 (3.89) (46.2–61.4) 52,462 57.0 (6.69) (43.7–69.4)
Adults p = 0.17 p = 0.16 p = 0.27
Northeast 984,561 40.7 (2.38) (36.1–45.4) 452,398 39.5 (3.67) (32.6–46.9) 158,327 46.2 (3.33) (39.8–52.8)
Midwest 855,226 38.7 (2.09) (34.7–42.9) 636,771 49.4 (3.37) (42.8–55.9) 440,881 47.8 (2.46) (43.0–52.6)
South 1,564,175 44.9 (2.00) (41.0–48.8) 977,938 47.8 (2.34) (43.3–52.4) 431,422 41.9 (3.62) (35.0–49.2)
West 1,119,873 42.9 (2.29) (38.5–47.4) 735,915 44.8 (2.01) (40.9–48.8) 199,575 54.0 (4.77) (44.6–63.1)

Table 5. Asthma attack* prevalence in the past 12 months among all ages, children aged 0–17 years, and adults aged ≥18 years with current asthma, by U.S. Census region and metropolitan statistical area category§ — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Having had one or more episodes of asthma or an asthma attack in the past 12 months.
Includes persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" and "Do you still have asthma?"
§Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
National Health Interview Survey sample weights were used to adjust for nonresponse, poststratification, and probability of selection to provide estimates for the intended U.S. populations.

Table 6.  

State/Area Asthma attack
Total Large MSA Small MSA Non-MSA p value
Prevalence % (SE) (95% CI) Prevalence % (SE) (95% CI) Prevalence % (SE) (95% CI) Prevalence % (SE) (95% CI)
Alabama 46.8 (3.62) (39.8–53.9) 44.6 (7.65) (30.5–59.7) 49.1 (4.95) (39.5–58.7) 45.8 (2.96) (40.0–51.6) 0.83
Alaska 60.3 (8.00) (44.0–74.5) 63.5 (9.42) (44.0–79.5) 51.6 (0.00) (51.6–51.6) 0.32
Arizona 44.2 (4.65) (35.4–53.4) 45.6 (6.07) (34.1–57.5) 40.5 (5.80) (29.8–52.2) 0.53
Arkansas 55.8 (7.32) (41.3–69.3) 60.6 (7.71) (44.9–74.3) 38.5 (3.20) (32.4–44.9) 0.07
California 46.2 (2.50) (41.4–51.1) 45.3 (3.28) (39.0–51.8) 47.3 (3.56) (40.4–54.3) 59.7 (0.00) (59.7–59.7) 0.57
Colorado 44.6 (3.13) (38.5–50.7) 48.8 (6.53) (36.3–61.4) 42.6 (3.31) (36.3–49.2) 34.1 (0.00) (34.1–34.1) 0.43
Connecticut 33.8 (5.36) (24.2–45.0) 43.3 (9.54) (26.3–62.1) 28.4 (6.05) (18.1–41.5) 32.0 (14.01)** (11.8–62.5) 0.49
Delaware 48.6 (4.32) (40.2–57.0) 53.0 (5.95) (41.4–64.3) 45.1 (5.68) (34.3–56.3) 0.36
District of Columbia 50.0 (6.25) (38.0–62.0) 50.0 (6.25) (38.0–62.0)
Florida 49.0 (3.03) (43.1–54.9) 50.7 (3.86) (43.1–58.2) 47.2 (4.78) (38.0–56.5) †† †† 0.50
Georgia 51.3 (4.70) (42.1–60.4) 49.5 (6.23) (37.5–61.5) 44.2 (7.96) (29.7–59.9) 67.0 (6.77) (52.7–78.8) 0.15
Hawaii 47.9 (5.86) (36.7–59.3) 47.3 (7.04) (34.0–61.0) 50.7 (2.59) (45.6–55.7) 0.68
Idaho 52.7 (7.38) (38.4–66.6) 43.0 (7.43) (29.4–57.8) 76.3 (7.33) (59.2–87.7) 0.12
Illinois 41.3 (4.22) (33.3–49.7) 37.8 (5.30) (28.1–48.6) 50.9 (8.36) (35.0–66.6) 42.6 (5.44) (32.4–53.5) 0.44
Indiana 46.1 (2.93) (40.5–51.9) 40.3 (5.34) (30.4–51.1) 55.4 (2.56) (50.4–60.4) 48.7 (3.11) (42.7–54.8) 0.11
Iowa 37.0 (4.68) (28.4–46.6) 33.7 (7.09) (21.4–48.6) 41.7 (2.55) (36.8–46.8) 0.32
Kansas 60.2 (4.28) (51.6–68.2) 59.9 (13.46) (33.2–81.8) 62.2 (2.96) (56.2–67.8) 58.6 (3.54) (51.5–65.3) 0.77
Kentucky 39.0 (3.81) (31.9–46.7) 38.4 (4.29) (30.4–47.1) 49.4 (10.05) (30.7–68.2) 35.9 (6.86) (23.8–50.2) 0.51
Louisiana 40.6 (6.61) (28.6–54.0) 36.5 (8.88) (21.3–54.9) 41.8 (9.89) (24.4–61.5) 41.7 (12.98)** (20.1–67.1) 0.90
Maine 40.3 (5.25) (30.6–50.9) 41.4 (8.00) (27.0–57.5) 38.9 (6.36) (27.4–51.9) 0.81
Maryland 42.5 (5.00) (33.1–52.4) 42.5 (5.00) (33.1–52.4)
Massachusetts 40.4 (5.55) (30.1–51.6) 39.5 (5.58) (29.2–50.8) 41.0 (12.89)** (19.6–66.4) 52.7 (10.40) (32.9–71.6) 0.60
Michigan 48.6 (4.49) (39.9–57.3) 40.4 (5.33) (30.5–51.1) 59.5 (10.97) (37.6–78.2) 55.0 (6.55) (42.1–67.2) 0.11
Minnesota 49.6 (5.03) (39.9–59.4) 48.3 (6.70) (35.6–61.3) 50.8 (0.00) (50.8–50.8) 52.3 (10.60) (32.3–71.6) 0.92
Mississippi 50.2 (4.07) (42.3–58.1) †† †† †† †† 42.0 (6.34) (30.3–54.7) 0.21
Missouri 51.1 (3.90) (43.5–58.7) 51.1 (4.24) (42.9–59.4) 58.8 (15.08) (29.6–82.9) 45.2 (2.65) (40.1–50.4) 0.36
Montana 55.7 (4.48) (46.8–64.2) 64.1 (3.68) (56.6–71.0) 53.1 (5.14) (43.0–62.9) 0.15
Nebraska 34.3 (7.08) (22.0–49.2) 38.9 (8.16) (24.5–55.5) †† †† 0.26
Nevada 37.2 (4.03) (29.7–45.4) 38.8 (5.12) (29.4–49.2) †† †† †† †† 0.44
New Hampshire 48.2 (4.15) (40.2–56.3) 44.2 (5.16) (34.4–54.4) †† †† †† †† 0.26
New Jersey 37.8 (4.31) (29.8–46.5) 38.8 (4.86) (29.8–48.6) 33.5 (9.43) (18.0–53.6) 0.62
New Mexico 43.3 (5.78) (32.5–54.8) 44.8 (7.68) (30.6–59.9) 39.9 (4.84) (30.9–49.7) 0.63
New York 44.8 (3.10) (38.8–51.0) 46.2 (3.52) (39.4–53.2) 29.9 (4.35) (22.1–39.0) 58.7 (1.05) (56.6–60.7) <0.001§§
North Carolina 53.3 (3.77) (45.9–60.5) 42.9 (7.03) (30.0–56.9) 57.0 (5.32) (46.4–67.0) 62.5 (7.35) (47.4–75.5) 0.14
North Dakota 39.1 (6.16) (27.8–51.6) 49.0 (0.00) (49.0–49.0) 32.4 (3.37) (26.2–39.3) 0.02§§
Ohio 42.1 (3.44) (35.5–48.9) 33.7 (3.34) (27.5–40.5) 49.2 (7.59) (34.8–63.7) 51.8 (7.02) (38.2–65.1) 0.04§§
Oklahoma 34.2 (7.42) (21.4–49.8) 37.8 (8.58) (22.9–55.4) 52.6 (14.00) (26.9–76.9) 23.0 (11.27)** (7.9–51.0) 0.35
Oregon 59.2 (3.91) (51.3–66.6) 59.3 (7.48) (44.3–72.8) 56.7 (4.62) (47.5–65.5) 63.3 (0.00) (63.3–63.3) 0.53
Pennsylvania 50.9 (2.59) (45.9–56.0) 51.5 (4.64) (42.5–60.5) 50.4 (2.57) (45.3–55.4) 50.1 (2.18) (45.8–54.4) 0.97
Rhode Island 49.8 (7.25) (35.9–63.6) 49.8 (7.25) (35.9–63.6)
South Carolina 38.8 (4.19) (31.0–47.3) 36.1 (4.28) (28.2–44.8) 50.4 (12.04) (28.3–72.3) 0.40
South Dakota 41.0 (0.30) (40.4–41.6) 41.1 (0.45) (40.2–41.9) 41.0 (0.00) (41.0–41.0) 0.86
Tennessee 47.1 (4.07) (39.3–55.1) 66.5 (7.44) (50.7–70.2) 33.8 (4.55) (25.5–43.2) 40.4 (6.81) (28.0–54.1) 0.008§§
Texas 43.9 (3.30) (37.5–50.4) 44.1 (4.13) (36.3–52.3) 49.1 (6.06) (37.5–60.8) 28.4 (5.06) (19.6–39.2) 0.08
Utah 47.7 (3.98) (40.0–55.5) 44.1 (5.24) (34.2–54.4) †† †† †† †† 0.53
Vermont 47.2 (7.62) (32.9–62.0) 52.0 (9.39) (34.1–69.4) 39.8 (0.00) (39.8–39.8) 0.28
Virginia 51.5 (3.73) (44.2–58.8) 56.0 (3.62) (48.8–62.9) 40.3 (4.76) (31.4–49.8) 39.9 (10.06) (22.6–60.2) 0.11
Washington 52.4 (3.53) (45.5–59.3) 54.5 (4.55) (45.6–63.2) 46.1 (4.71) (37.0–55.3) 59.9 (17.06) (27.1–85.8) 0.33
West Virginia 55.3 (11.98) (32.3–76.2) 59.4 (15.08) (30.1–83.3) 44.1 (6.94) (31.3–57.9) 0.40
Wisconsin 42.7 (4.27) (34.6–51.2) 38.6 (5.43) (28.6–49.6) 33.6 (3.58) (27.0–41.0) 53.5 (9.63) (35.0–71.1) 0.18
Wyoming 60.9 (5.53) (49.7–71.1) 68.1 (0.00) (68.1–68.1) 57.9 (5.84) (46.3–68.8) 0.27

Table 6. Asthma attack* prevalence in the past 12 months among persons with current asthma, by state/area and metropolitan statistical area category§ — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Having had one or more episodes of asthma or an asthma attack in the past 12 months.
Includes persons who answered "yes" to the questions, "Have you EVER been told by a doctor or other health professional that you had asthma?" and "Do you still have asthma?"
§Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
State/area does not have the corresponding MSA category.
**Relative SE = 30%–50%; estimate is unreliable.
††Suppressed because relative SE ≥50%.
§§Statistically significant by chi-square test, p<0.05.

Table 7.  

Characteristic Emergency department and urgent care center visits
All ages Children Adults
Weighted no.§ Prevalence% (SE) (95% CI) Weighted no.§ Prevalence% (SE) (95% CI) Weighted no.§ Prevalence% (SE) (95% CI)
Total 3,029,309 11.9 (0.42) (11.1–12.7) 1,063,589 17.9 (1.02) (16.0–20.0) 1,965,720 10.1 (0.46) (9.2–11.0)
U.S. Census region p<0.001 p = 0.73 p = 0.001
Northeast 546,245 10.8 (0.80) (9.3–12.5) 204,250 17.9 (2.05) (14.2–22.3) 341,995 8.8 (0.86) (7.2–10.6)
Midwest 547,697 9.7 (0.76) (8.3–11.3) 195,903 15.8 (2.15) (12.0–20.5) 351,793 7.9 (0.75) (6.6–9.6)
South 1,263,983 14.2 (0.79) (12.7–15.8) 437,283 18.9 (1.79) (15.6–22.6) 826,700 12.6 (0.92) (10.9–14.5)
West 671,384 11.5 (0.94) (9.7–13.4) 226,153 18.3 (2.17) (14.4–22.9) 445,231 9.6 (1.00) (7.8–11.8)
MSA category** p = 0.001 p = 0.02 p = 0.03
Large MSA 1,831,355 13.1 (0.69) (11.8–14.5) 651,142 20.1 (1.51) (17.3–23.3) 1,180,213 11.0 (0.74) (9.6–12.5)
Small MSA 900,517 11.1 (0.69) (9.9–12.6) 320,476 16.4 (1.74) (13.3–20.1) 580,040 9.5 (0.75) (8.1–11.0)
Non-MSA 297,437 8.7 (0.93) (7.0–10.7) 91,970 12.2 (2.15) (8.5–17.0) 205,467 7.7 (0.93) (6.1–9.7)
Urban–rural classification†† p = 0.003 p = 0.02 p = 0.06
Large central metropolitan 1,021,621 14.0 (0.87) (12.3–15.7) 390,746 23.0 (2.13) (19.1–27.4) 630,875 11.2 (0.92) (9.5–13.2)
Large fringe metropolitan 817,672 12.2 (1.08) (10.2–14.5) 262,450 17.0 (2.21) (13.1–21.8) 555,222 10.8 (1.16) (8.7–13.3)
Medium metropolitan 601,975 10.8 (0.79) (9.4–12.5) 232,263 16.8 (2.12) (13.0–21.4) 369,712 8.9 (0.83) (7.4–10.6)
Small metropolitan 290,603 11.8 (1.37) (9.3–14.7) 86,159 15.3 (3.07) (10.2–22.3) 204,444 10.7 (1.52) (8.1–14.1)
Micropolitan 200,120 9.4 (1.14) (7.4–11.9) 62,933 13.4 (2.68) (8.9–19.6) 137,187 8.3 (1.26) (6.1–11.1)
Noncore 97,317 7.5 (1.25) (5.4–10.4) 29,037 10.2 (2.86) (5.8–17.3) 68,280 6.8 (1.30) (4.6–9.8)

Table 7. Prevalence of emergency department and urgent care center visits* because of asthma in the past 12 months among all ages, children aged 0–17 years, and adults aged ≥18 years with current asthma, by geographic area — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Having had one or more emergency room or urgent care center visits because of asthma in the past 12 months among persons with current asthma.
Includes persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" and "Do you still have asthma?"
§National Health Interview Survey sample weights were used to adjust for nonresponse, poststratification, and probability of selection to provide estimates for the intended U.S. populations.
Statistically significant by chi-square test, p<0.05.
**Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
††Large central metropolitan areas are counties in MSAs of ≥1 million population containing the principal city; large fringe metropolitan areas are counties in MSAs of ≥1 million population not containing the principal city; medium metropolitan areas are counties in MSAs of 250,000–999,999 population; small metropolitan areas are counties in MSAs of <250,000 population; micropolitan areas have an urban cluster population of 10,000–49,999; and noncore areas include nonmetropolitan areas that did not qualify as micropolitan, including those without an urban cluster population of at least 10,000.

Table 8.  

U.S. Census region Emergency department and urgent care center visits
Large MSA Small MSA Non-MSA
Weighted no. Prevalence% (SE) (95% CI) Weighted no. Prevalence% (SE) (95% CI) Weighted no. Prevalence % (SE) (95% CI)
All ages p = 0.47 p = 0.01** p = 0.92
Northeast 392,354 12.5 (1.26) (10.2–15.2) 118,629 7.9 (1.37) (5.6–11.1) 35,263 8.6 (1.64) (5.9–12.4)
Midwest 301,506 10.7 (1.27) (8.4–13.5) 151,962 9.3 (1.16) (7.2–11.8) 94,229 7.8 (1.90) (4.8–12.4)
South 729,548 15.5 (1.20) (13.3–18.0) 409,095 14.3 (1.46) (11.7–17.5) 125,340 9.4 (1.40) (7.0–12.5)
West 407,947 12.4 (1.74) (9.3–16.2) 220,831 10.5 (1.03) (8.7–12.7) 42,605 9.2 (2.08) (5.9–14.2)
Children p = 0.99 p = 0.33 p = 0.67
Northeast 142,983 19.8 (3.47) (13.8–27.5) 49,583 14.1 (3.28) (8.8–21.8) 11,684 17.3 (6.40)†† (8.0–33.5)
Midwest 119,438 19.6 (3.44) (13.7–27.2) 40,356 11.7 (3.04) (6.9–19.1) 36,109 12.5 (3.83)†† (6.7–22.1)
South 250,223 20.7 (2.38) (16.5–25.8) 156,857 19.5 (3.13) (14.1–26.4) 30,203 9.8 (3.21)†† (5.0–18.1)
West 138,498 19.9 (3.23) (14.3–27.0) 73,681 16.5 (3.57) (10.6–24.7) 13,974 15.2 (5.31)†† (7.4–28.7)
Adults p = 0.04** p = 0.04** p = 0.58
Northeast 249,371 10.3 (1.33) (8.0–13.2) 69,046 6.0 (1.17) (4.1–8.8) 23,579 6.9 (1.56) (4.4–10.7)
Midwest 182,067 8.2 (1.27) (6.1–11.1) 111,606 8.6 (1.19) (6.6–11.3) 58,120 6.3 (1.74) (3.6–10.7)
South 479,325 13.7 (1.41) (11.2–16.7) 252,238 12.3 (1.72) (9.3–16.1) 95,137 9.2 (1.48) (6.7–12.6)
West 269,449 10.3 (1.75) (7.4–14.3) 147,150 8.9 (1.19) (6.9–11.6) 28,631 7.7 (2.35)†† (4.2–13.8)

Table 8. Prevalence of emergency department and urgent care center visits* because of asthma in the past 12 months among all ages, children aged 0–17 years, and adults aged ≥18 years with current asthma, by U.S. Census region and metropolitan statistical area category§ — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Health Interview Survey. https://www.cdc.gov/nchs/nhis/index.htm
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Having had one or more emergency room or urgent care center visits because of asthma in the past 12 months among persons with current asthma.
Includes persons who answered "yes" to the questions, "Have you ever been told by a doctor or other health professional that you had asthma?" and "Do you still have asthma?"
§Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
National Health Interview Survey sample weights were used to adjust for nonresponse, poststratification, and probability of selection to provide estimates for the intended U.S. populations.
**Statistically significant by chi-square test, p<0.05.
††Relative SE = 30%–50%; estimate is unreliable.

Table 9.  

Characteristic Asthma mortality rate
All ages Children Adults
No. Rate per million (SE) (95% CI) No. Rate per million (SE) (95% CI) No. Rate per million (SE) (95% CI)
Total 10,523 10.8 (0.11) (10.6–11.0) 586 2.7 (0.11) (2.4–2.9) 9,936 13.2 (0.13) (12.9–13.4)
U.S. Census region
Northeast 1,978 11.7 (0.26) (11.2–12.2) 100 2.8 (0.28) (2.3–3.4) 1,877 14.0 (0.32) (13.4–14.7)
Midwest 2,315 11.3 (0.24) (10.9–11.8) 157 3.4 (0.27) (2.8–3.9) 2,158 13.7 (0.29) (13.1–14.2)
South 3,649 9.8 (0.16) (9.5–10.2) 250 2.9 (0.19) (2.6–3.3) 3,399 11.9 (0.20) (11.5–12.3)
West 2,581 11.1 (0.22) (10.7–11.6) 79 1.5 (0.17) (1.2–1.8) 2,502 14.0 (0.28) (13.5–14.6)
MSA category
Large MSA 5,597 10.3 (0.14) (10.0–10.5) 348 2.8 (0.15) (2.5–3.1) 5,248 12.5 (0.17) (12.1–12.8)
Small MSA 3,212 11.0 (0.19) (10.6–11.3) 164 2.5 (0.19) (2.1–2.9) 3,048 13.4 (0.24) (13.0–13.9)
Non-MSA 1,714 12.4 (0.30) (11.8–13.0) 74 2.4 (0.28) (1.9–3.1) 1,640 15.2 (0.38) (14.5–15.9)
Urban-rural classification§
Large central metropolitan 3,454 11.5 (0.20) (11.1–11.9) 229 3.4 (0.22) (2.9–3.8) 3,225 13.8 (0.24) (13.4–14.3)
Large fringe metropolitan 2,143 8.8 (0.19) (8.4–9.2) 119 2.1 (0.19) (1.7–2.5) 2,023 10.8 (0.24) (10.3–11.2)
Medium metropolitan 2,223 10.9 (0.23) (10.4–11.3) 116 2.5 (0.23) (2.0–2.9) 2,107 13.4 (0.29) (12.8–14.0)
Small metropolitan 989 11.1 (0.35) (10.4–11.8) 48 2.5 (0.35) (1.8–3.2) 941 13.6 (0.44) (12.7–14.4)
Micropolitan 957 11.7 (0.38) (11.0–12.4) 46 2.5 (0.37) (1.9–3.4) 911 14.3 (0.47) (13.4–15.2)
Noncore 757 13.4 (0.49) (12.4–14.4) 28 2.3 (0.43) (1.5–3.3) 729 16.5 (0.61) (15.3–17.7)

Table 9. Asthma mortality rate* among all ages, children aged 0–17 years, and adults aged ≥18 years, by geographic area — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Vital Statistics System, CDC WONDER. https://wonder.cdc.gov/
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Underlying cause of death is asthma; includes International Classification of Diseases, Tenth Revision codes J45–J46.
Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
§Large central metropolitan areas are counties in MSAs of ≥1 million population containing the principal city; large fringe metropolitan areas are counties in MSAs of ≥1 million population not containing the principal city; medium metropolitan areas are counties in MSAs of 250,000–999,999 population; small metropolitan areas are counties in MSAs of <250,000 population; micropolitan areas have an urban cluster population of 10,000–49,999; and noncore areas include nonmetropolitan areas that did not qualify as micropolitan, including those without an urban cluster population of at least 10,000.

Table 10.  

U.S. Census region Asthma mortality rate
Large MSA Small MSA Non-MSA
No. Rate per million (SE) (95% CI) No. Rate per million (SE) (95% CI) No. Rate per million (SE) (95% CI)
All ages
Northeast 1,362 12.0 (0.33) (11.4–12.7) 468 11.2 (0.52) (10.2–12.2) 148 10.8 (0.89) (9.1–12.5)
Midwest 1,153 11.6 (0.34) (10.9–12.3) 607 10.2 (0.41) (9.3–11.0) 555 12.3 (0.52) (11.3–13.3)
South 1,688 8.9 (0.22) (8.5–9.4) 1,248 10.2 (0.29) (9.6–10.8) 713 12.1 (0.45) (11.2–12.9)
West 1,394 9.8 (0.26) (9.2–10.3) 889 12.9 (0.43) (12.0–13.7) 298 14.7 (0.85) (13.0–16.4)
Children
Northeast 80 3.3 (0.37) (2.7–4.2) 17 § § § § §
Midwest 97 4.2 (0.43) (3.4–5.1) 38 2.8 (0.46) (2.0–3.9) 22 2.2 (0.47) (1.4–3.3)
South 120 2.7 (0.25) (2.2–3.2) 87 3.2 (0.34) (2.5–3.9) 43 3.3 (0.50) (2.4–4.4)
West 51 1.6 (0.22) (1.2–2.1) 22 1.3 (0.28) (0.8–2.0) § § §
Adults
Northeast 1,281 14.3 (0.40) (13.5–15.1) 451 13.6 (0.64) (12.4–14.9) 145 13.1 (1.09) (11.0–15.2)
Midwest 1,056 13.8 (0.42) (13.0–14.6) 569 12.3 (0.52) (11.3–13.3) 533 15.2 (0.66) (13.9–16.5)
South 1,568 10.9 (0.27) (10.3–11.4) 1,161 12.2 (0.36) (11.5–12.9) 670 14.6 (0.56) (13.5–15.7)
West 1,343 12.2 (0.33) (11.5–12.8) 867 16.6 (0.56) (15.5–17.7) 292 18.6 (1.09) (16.5–20.7)

Table 10. Asthma mortality rate* among all ages, children aged 0–17 years, and adults aged ≥18 years, by U.S. Census region and metropolitan statistical area category — United States, 2016–2018

Source: CDC, National Center for Health Statistics, National Vital Statistics System, CDC WONDER. https://wonder.cdc.gov/
Abbreviations: CI = confidence interval; MSA = metropolitan statistical area; SE = standard error.
*Underlying cause of death is asthma; includes International Classification of Diseases, Tenth Revision codes J45–J46.
Large MSAs have a population of ≥1 million; small MSAs have a population of <1 million. Non-MSAs consist of persons not living in an MSA.
§Suppressed because N ≤19 persons.

CME / ABIM MOC / CE

Asthma Surveillance — United States, 2006–2018

  • Authors: Cynthia A. Pate, MPH; Hatice S. Zahran, MD; Xiaoting Qin, PhD; Carol Johnson, MPH; Erik Hummelman, MPH; Josephine Malilay, PhD
  • CME / ABIM MOC / CE Released: 12/6/2021
  • Valid for credit through: 12/6/2022
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Target Audience and Goal Statement

This activity is intended for public health officials, internists, pediatricians, pulmonologists, allergists/immunologists, and other clinicians caring for patients with asthma.

The goal of this activity is to describe estimates of current US asthma prevalence, asthma attacks, emergency department (ED) and urgent care center (UCC) visits, and mortality rates by demographic characteristics, poverty level, and geographic area for 2016 to 2018, according to surveillance data from the National Health Interview Survey (NHIS), an annual cross-sectional household health survey.

Upon completion of this activity, participants will:

  • Describe estimates of current U.S. current asthma prevalence by demographic characteristics, poverty level, and geographic area for 2016–2018, according to National Health Interview Survey (NHIS) surveillance data
  • Determine prevalence estimates of current asthma attacks and emergency department/urgent care center (ED/UCC) visits by demographic characteristics, poverty level, and geographic area for 2016–2018, according to NHIS surveillance data
  • Identify estimates of current asthma mortality rates by demographic characteristics and geographic area for 2016–2018, according to National Vital Statistics System (NVSS) mortality data


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Faculty

  • Cynthia A. Pate, MPH

    Division of Environmental Health Science and Practice
    National Center for Environmental Health
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Cynthia A. Pate, MPH, has disclosed no relevant financial relationships.

  • Hatice S. Zahran, MD

    Division of Environmental Health Science and Practice
    National Center for Environmental Health
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Hatice S. Zahran, MD, has disclosed no relevant financial relationships.

  • Xiaoting Qin, PhD

    Division of Environmental Health Science and Practice
    National Center for Environmental Health
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Xiaoting Qin, PhD, has disclosed no relevant financial relationships.

  • Carol Johnson, MPH

    Division of Environmental Health Science and Practice
    National Center for Environmental Health
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Carol Johnson, MPH, has disclosed no relevant financial relationships.

  • Erik Hummelman, MPH

    Division of Environmental Health Science and Practice
    National Center for Environmental Health
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Erik Hummelman, MPH, has disclosed no relevant financial relationships.

  • Josephine Malilay, PhD

    Division of Environmental Health Science and Practice
    National Center for Environmental Health
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Josephine Malilay, PhD, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

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    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

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    Disclosure: Amanda Jett, PharmD, BCACP, has disclosed no relevant financial relationships.

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.


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CME / ABIM MOC / CE

Asthma Surveillance — United States, 2006–2018

Authors: Cynthia A. Pate, MPH; Hatice S. Zahran, MD; Xiaoting Qin, PhD; Carol Johnson, MPH; Erik Hummelman, MPH; Josephine Malilay, PhDFaculty and Disclosures

CME / ABIM MOC / CE Released: 12/6/2021

Valid for credit through: 12/6/2022

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Abstract and Introduction

Abstract

Problem: Asthma is a chronic disease of the airways that requires ongoing medical management. Socioeconomic and demographic factors as well as health care use might influence health patterns in urban and rural areas. Persons living in rural areas tend to have less access to health care and health resources and worse health outcomes. Characterizing asthma indicators (i.e., prevalence of current asthma, asthma attacks, emergency department and urgent care center [ED/UCC] visits, and asthma-associated deaths) and determining how asthma exacerbations and health care use vary across the United States by geographic area, including differences between urban and rural areas, and by sociodemographic factors can help identify subpopulations at risk for asthma-related complications.

Reporting Period: 2006–2018.

Description of System: The National Health Interview Survey (NHIS) is an annual cross-sectional household health survey among the civilian noninstitutionalized population in the United States. NHIS data were used to produce estimates for current asthma and among them, asthma attacks and ED/UCC visits. National Vital Statistics System (NVSS) data were used to estimate asthma deaths. Estimates of current asthma, asthma attacks, ED/UCC visits, and asthma mortality rates are described by demographic characteristics, poverty level (except for deaths), and geographic area for 2016–2018. Trends in asthma indicators by metropolitan statistical area (MSA) category for 2006–2018 were determined. Current asthma and asthma attack prevalence are provided by MSA category and state for 2016–2018. Detailed urban-rural classifications (six levels) were determined by merging 2013 National Center for Health Statistics (NCHS) urban-rural classification data with 2016–2018 NHIS data by county and state variables. All subregional estimates were accessed through the NCHS Research Data Center.

Results: Current asthma was higher among boys aged <18 years, women aged ≥18 years, non-Hispanic Black (Black) persons, non-Hispanic multiple-race (multiple-race) persons, and Puerto Rican persons. Asthma attacks were more prevalent among children, females, and multiple-race persons. ED/UCC visits were more prevalent among children, women aged ≥18 years, and all racial and ethnic groups (i.e., Black, non-Hispanic Asian, multiple race, and Hispanic, including Puerto Rican, Mexican, and other Hispanic) except American Indian and Alaska Native persons compared with non-Hispanic White (White) persons. Asthma deaths were higher among adults, females, and Black persons. All pertinent asthma outcomes were also more prevalent among persons with low family incomes. Current asthma prevalence was higher in the Northeast than in the South and the West, particularly in small MSA areas. The prevalence was also higher in small and medium metropolitan areas than in large central metropolitan areas. The prevalence of asthma attacks differed by MSA category in four states. The prevalence of ED/UCC visits was higher in the South than the Northeast and the Midwest and was also higher in large central metropolitan areas than in micropolitan and noncore areas. The asthma mortality rate was highest in non-MSAs, specifically noncore areas. The asthma mortality rate was also higher in the Northeast, Midwest, and West than in the South. Within large MSAs, asthma deaths were higher in the Northeast and Midwest than the South and West.

Interpretation: Despite some improvements in asthma outcomes over time, the findings from this report indicate that disparities in asthma indicators persist by demographic characteristics, poverty level, and geographic location.

Public Health Action: Disparities in asthma outcomes and health care use in rural and urban populations identified from NHIS and NVSS can aid public health programs in directing resources and interventions to improve asthma outcomes. These data also can be used to develop strategic goals and achieve CDC's Controlling Childhood Asthma and Reducing Emergencies (CCARE) initiative to reduce childhood asthma hospitalizations and ED visits and prevent 500,000 asthma-related hospitalizations and ED visits by 2024.

Introduction

Asthma is a chronic respiratory disease requiring ongoing medical management. In 2017, asthma resulted in an estimated 1.6 million emergency department (ED) visits and 183,000 hospitalizations in the United States.[1] Asthma has had a considerable economic impact[2] and resulted in a substantial number of missed school days.[3,4] In the United States, nearly 24.8 million persons (7.7% of the population) had current asthma in 2018.[1] Among children (persons aged <18 years), asthma was more prevalent among those in families with low incomes and among non-Hispanic Black (Black) children and those of Puerto Rican descent compared with non-Hispanic White (White) children.[5] Approximately, one half of persons with current asthma reported having had an asthma attack within the past 12 months.[1] Asthma has been associated with substantial morbidity and remains a focus of the U.S. Department of Health and Human Services (HHS) Healthy People 2030 initiative.[6,7]

Geographic disparities (e.g., regional, urban, and rural) in health outcomes have been documented,[8–10] with higher numbers of excess deaths from chronic lower respiratory disease in rural areas than in urban areas.[11] Socioeconomic and demographic factors (e.g., poverty, education status, age, race/ethnicity, sex, and insurance status) and health care use might contribute to health outcome patterns observed in urban and rural areas.[9,12–14] Persons living in rural areas typically have worse health outcomes and less access to health care than those in urban areas.[8,9,12,15] Recent studies have focused attention on rural health and related issues.[16,17] Rural residents are more likely to live in areas with hospital closures,[18] travel long distances to receive specialty or emergency care, and live in areas with shortages in the health care workforce, subspecialty care, and preventative services; they are also less likely to have health insurance.[8,9] Barriers to health care access can result in unmet health care needs and preventable hospitalizations.[19] Among inner-city residents, risk factors for developing asthma and experiencing asthma exacerbations include mold or mildew in homes,[20] air pollution, lack of access to health care, and exposure to secondhand smoke.[21] In contrast, suburban residents have been shown to have the best health outcomes.[8]

Social determinants of health play a substantial role in health outcomes.[10] Reducing racial and ethnic disparities in asthma risks and health care is of national strategic importance.[19,22,23] Asthma prevalence disparities among various racial/ethnic groups increased during 1999–2011.[24] Children, Black persons, Hispanic persons, persons insured by Medicaid or the Children's Health Insurance Program, and persons living in the Northeast are more likely to visit an ED for asthma,[25] which is a key indicator of poorly controlled asthma.[26] Racial/ethnic health disparities among rural adults aged ≥18 years also have been reported.[12] Limited health care access and unmet health care needs can result in serious life-threatening respiratory episodes and hinder timely access to ED care and survival.[15]

CDC analyzed 2006–2018 data from the National Health Interview Survey (NHIS) to determine the prevalence of current asthma, asthma attacks, asthma-related ED and urgent care center (UCC) visits, and deaths for which asthma was the underlying cause by certain demographic characteristics, poverty level, and geographic location in the United States. This report is fifth in a series of asthma surveillance summaries[27–30] with a focus on geographic areas, including states, metropolitan statistical area (MSA) category, and six-level urban-rural classification.

The findings from this report can be used by National Asthma Control Program (NACP) funding recipients, public health services, asthma programs, and health care providers to direct interventions, strategic activities, and resource allocations toward specific sociodemographic groups and geographic locations to reduce asthma-related adverse health outcomes and premature deaths. These measures can be implemented with the aid of evidence-based strategies in the Exhale Technical Package[31] to support the Controlling Childhood Asthma and Reducing Emergencies (CCARE) goal of preventing 500,000 asthma-related hospitalizations and ED visits by 2024.[32]