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  • Title: Trends in asthma prevalence, hospitalization risk, and inhaled corticosteroid use among alaska native and nonnative medicaid recipients younger than 20 years.
    Author: Gessner BD, Neeno T.
    Journal: Ann Allergy Asthma Immunol; 2005 Mar; 94(3):372-9. PubMed ID: 15801249.
    Abstract:
    BACKGROUND: Few trend data on asthma prevalence exist for U.S. indigenous populations, and none exist for Alaska Natives. OBJECTIVE: To document the epidemiologic features of asthma in Alaska Natives and nonnatives stratified by urban (Anchorage) and rural (non-Anchorage) residence. METHODS: We conducted a retrospective review of Alaskans younger than 20 years enrolled in Medicaid during 1999 to 2002. Asthma was defined as a claim for International Classification of Diseases, Ninth Revision, codes 493.0x to 493.9x plus asthma-associated medication during the same calendar year. RESULTS: Among 117,080 Medicaid enrollees, the 4-year asthma prevalence was 3.1% and was 40% to 90% greater for urban residents regardless of race. Yearly prevalence increased from 1.0% to 2.2% (P < .001), with increases in all subgroups. Of 4 predominantly Alaska Native census areas, the area with resident pediatricians and previous participation in asthma research had a 4-year asthma prevalence 5- to 11-fold higher than the other areas. Among persons with asthma, yearly hospitalization risk decreased (from 9.3% to 6.8%; P = .02) concurrent with an increase in the yearly use of inhaled corticosteroids (from 50% to 64%; P < .001). Urban Alaska Natives had the greatest decrease in hospitalization risk and the greatest increase in inhaled corticosteroid use. CONCLUSIONS: Relatively dramatic demographic differences and temporal trends in asthma prevalence occurred in the absence of known differences or changes in risk factor prevalences. This suggests a role for differences in the use of asthma as a diagnosis for respiratory illness. Failure to diagnose and thus treat asthma may affect outcomes because decreases in hospitalization risk were temporally associated with increases in inhaled corticosteroid use.
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