State ofthe Region’s Health—2002 Message from the Medical Officer of Health T he annual State of the Region’s Health reports highlight important health issues and trends affecting the one million residents of the Region of Peel. The latest health indicators summarized here reveal that the Region’s population as a whole continues to enjoy relatively good health by provincial and national standards. Yet within this positive picture many health challenges remain. The 2002 report highlights asthma,a common chronic disease which affects the lives of many Peel residents,both young and old. Recent years have seen increasing awareness of this important illness,and new information about the role of indoor and outdoor air pollution in the development and triggering of asthma symptoms. Municipal governments in the Region have been active in addressing environmental tobacco smoke in public places,and local sources of outdoor air pollution,both of which threaten the health of people with asthma and other respiratory diseases. More remains to be done to reduce the burden of illness of asthma in Peel. The Region ofPeel works with individuals and organizations in the public and private sectors to prevent illness and promote good health. The information in this and other Peel health status reports is intended to help chart a course to better health for everyone in Peel. David McKeown,MDCM,MHSc,FRCPC Medical Officer of Health 2002 health State of the Region’s Focus on Asthma A Peel Health Status Report Acknowledgements This report was authored by:Julie Stratton,Senior Epidemiologist; Dr.David McKeown,Medical Officer of Health;Karen Funnell,Health Analyst;and Kit Ping Wong,Health Analyst. Estimates of the asthma morbidity associated with air pollution in Peel region were provided by Kyle Wivcharuk,Environmental Health Research and Policy Analyst,and Paul Callanan,Manager,Environmental Health, using the Ontario Medical Association’s Illness Costs ofAir Pollution (ICAP) software. This report was designed and formatted by the Region of Peel, Communication Services. Please use the following citation when referencing this document:Region of Peel Health Department.State ofthe Region’s Health 2002—Focus on Asthma.2002. State ofthe Region’s Health—2002 Table of Contents 1 Introduction 2 Overview of Asthma 2 Introduction 2 Asthma in Ontario and Canada 4 Asthma in the Region of Peel 4 Asthma Prevalence 5 Hospitalization due to Asthma 8 Mortality due to Asthma 9 Asthma Risk Factors and Triggers 9 Introduction 9 Risk Factors for Asthma 10 Asthma Triggers 12 Air Pollution and Asthma 12 Introduction 13 The Impact of Air Pollution and Asthma in Peel 14 Summary 15 Peel Health Facts 20 Data Sources,Methods and Limitations 22 References The Regional Municipality ofPeel List of Figures and Tables Figure 1 3 Prevalence of Asthma Among Children Aged 0–14 Years,Canada,1978–1995 Figure 2 5 Hospitalization for Asthma, Ontario and Region of Peel, 1971–2000 Figure 3 6 Hospitalization for Asthma by Age Group, Region of Peel and Ontario,1998 Figure 4 7 Hospitalization for Asthma by Month of Admission, Region of Peel, 2000 Figure 5 8 Asthma Related Deaths by Age Group, Region of Peel and Ontario, 1987–1996 Combined Table 1 11 Prevalence of Asthma Triggers among Those Diagnosed with Active Asthma, by Age Group, Canada, 1996–1997 State ofthe Region’s Health—2002 2002 health State of the Region’s Focus on Asthma Introduction The State of the Region’s Health report is published annually as a summary of the health status of residents of Peel region. It is intended to highlight key health issues and trends for the population of Peel. The State ofthe Region’s Health 2002report focuses on asthma,a common chronic respiratory disease that affects individuals of all ages but is more prevalent in children and adolescents. This report describes the occurrence of asthma in Canada,Ontario and Peel region.It also outlines what is known about the risk factors that can lead to the development of asthma,and the “triggers”that can provoke symptoms in individuals who already have asthma.In addition,the relationship between asthma and air pollution is described. At the end of this report,a section titled Peel Health Facts(see page 15) highlights the most recent health indicator data,including population, leading causes of mortality and premature mortality,leading causes of hospitalization and selected reproductive health statistics,for Peel region. The Regional Municipality ofPeel 1 Overview of Asthma HIGHLIGHTS • In Canada, an estimated 10% of children and 5% of adults have active asthma, making it one of the most common chronic illnesses. • Asthma is responsible for approximately 43,000 hospitalizations and 500 deaths in Canada each year. Introduction Asthma is a condition that results in chronic inflammation of the airways.When the bronchial tubes in the lungs become inflamed and swollen,airflow to the lungs becomes blocked. This blockage causes symptoms such as wheezing,coughing,tightness in the chest,shortness of breath and an increased production of mucus. The severity of asthma symptoms can range from mild to life-threatening. Asthma is not always easy to diagnose because its symptoms can be similar to other respiratory conditions. Asthma in Ontario and Canada Currently,asthma is one of the most prevalent chronic conditions in Canada.In 1997,over 2.2 million Canadians were diagnosed with asthma by a physician.1 In the 1996/97 National Population Health Surveyit was estimated that 10% of Canadian children and 5% of adults had “active” asthma.2 Canadians were defined as having active asthma ifthey had asthma diagnosed by a physician,and were either on medication for asthma or had experienced asthma symptoms or attacks in the past 12 months.Over the past two decades,the percentage of children with self-reported asthma appears to have increased from 2.5% in 1978/79 to 11.2% in 1994/95 (see Figure 1 on the following page).3 Changes in awareness and diagnosis of asthma may have contributed to this increase. Asthma is responsible for approximately 43,000 hospital admissions and approximately 500 deaths in Canada every year.4,5 These morbidity and mortality statistics measure only the most severe impacts of asthma.In order to determine the full burden of illness related to asthma,data would also need to be obtained on family doctor,clinic and emergency department visits,as well as on symptoms that do not lead to the use of health services. Between 1995 and 1996,a national study on childhood asthma was conductedin sentinel health units across Canada. The study reported that 13% of children between the ages of five and 19 years had been diagnosed with “current”asthma.Children were described as having current asthma if they had been diagnosed with asthma by a physician and had one or more 2 State ofthe Region’s Health—2002 Figure 1: Prevalence of Asthma Among Children Aged 0–14 Years, Canada, 1978–1995 12 Cases per 100 1111..22 10 8 6 4 33..11 22..55 Sources: 1978/79 Canada Health Survey; 1983/84 Canadian Health and Disability 2 Survey; 1994/95 National Longitudinal Survey of Children and Youth (for ages 0 to 11); 1994/95 National Population Health Survey (for ages 12 to 14). Adapted from Millar WJ, Hill GB. Childhood asthma. Health Reports 1998, 10(3):9-21. 0 1978/79 1983/84 1994/95 Year of the following characteristics in the past 12 months:wheezing or whistling in the chest,an asthma attack or had taken asthma medication.Two Ontario cities in the study (Kingston and Guelph) had reported asthma rates in children aged five to 19 years of 16% and 11% respectively.6 Of the Canadian children who had current asthma: • 69% had an asthma attack in the past 12 months and 4% had one or more asthma attacks per week, • 90% had taken medication for asthma in the past 12 months, • 64% had sleep disturbances and 7% experienced these disturbances more than once a week on average, • 19% had visited an emergency department in the past 12 months, • 4% had spent the night in hospital,and • 16% had missed more than a week of school. In the 1998/99 National Population Health Survey,10% of Ontario children aged four to 19 and 7% of Ontario adults reported having been diagnosed with asthma by a physician.In the 1996/97 National Population Health Survey,nearly 49,000 Ontarians with asthma reported that their activities at home,school or work were limited by their asthma. In the same survey,18 per cent of asthma sufferers reported they had visited an emergency room in the past year for asthma-related symptoms. In 1996,192 deaths were directly attributed to asthma in Ontario.1 The Regional Municipality ofPeel 3 Asthma in the Region of Peel HIGHLIGHTS • In 2000/2001, 8.3% of Peel residents aged 12 years and older reported that a physician had diagnosed them with asthma. • Hospitalization rates for asthma are declining. In 2000 in Peel, there were 1,200 asthma-related hospitalizations. • Since 1997, hospitalization rates for asthma in Peel region have been slightly higher than provincial rates. • In the ten years from 1987 to 1996, there were 85 deaths in Peel due to asthma. Mortality rates for asthma are highest in the population aged 65 years and older. Asthma Prevalence Preliminary results from the recently released 2000/01 Canadian Community Health Survey indicate that among those aged 12 and older,nearly 72,000 (or 8.3%) of Peel residents had been told they had asthma by a health care professional.Proportions for Ontario and Canada were 8.5% and 8.4%, respectively.Similarly,data from the2001 Peel Community Health Survey indicated 7% of Peel residents aged 18 years and older had been diagnosed with asthma by a health professional. Detailed information from the 1996/97 Ontario Health Surveyshowed over half (55% for Peel and 58% for Ontario) of respondents with self- reported asthma had asthma symptoms or asthma attacks in the previous 12 months. Over three-quarters of respondents reported using asthma medications such as inhalers,nebulizers,pills,liquids or injections in the past year (76% for Peel and 78% for Ontario),and 74% ofthose with asthma in Peel reported asthma medication use in the past month (70% in Ontario). Overall,5% ofthe Peel population currently use asthma medication to control their illness,a proportion similar to that found in Ontario and Canada.7 4 State ofthe Region’s Health—2002