Definition

This report estimates the economic cost of childhood asthma that is attributable to the environment. This estimate is based on total cost of asthma. This includes direct health care costs and indirect costs. Indirect costs include costs associated with missed school days and lost wages for parents. The estimate is also based on an environmental attributable fraction, which estimates the proportion of childhood asthma that can be credited to the environment. The environment is being defined as outdoor and indoor pollutants from sources that could potentially be reduced.

Numerator

This Indicator Report contains the following measures: 1. environmental attributable fraction for childhood asthma among the child population, age 17 years or less 2. childhood asthma environmentally attributable costs

Denominator

N/A

Data Interpretation Issues

Odds ratios were obtained from a literature review for each environmental exposure. When available, proportions were used from Utah specific data. When Utah-specific data was not available, a national or study proportion was used. This could skew the results if Utah has a proportion exposed at a higher or lower rate than the national estimate. Because this is a new topic of discussion, some findings, mainly traffic exposure, had odds ratios that were not considered statistically significant because of the small sample sizes or few surveys asking questions about exposure.

Why Is This Important?

The term "environmental burden" refers to what extent environmental exposures are attributable to the overall incidence and cost of a disease. Each year, modifiable environmental risk factors affect health, causing significant suffering, stress, financial strain to families, and a considerable economic impact. Calculating the environmental burden for children and then computing the proportion of overall cost that is attributable to the environment is important because it is one way to show how the environment impacts human health. Children are more susceptible to environmental factors than adults. A child's nervous, immune, reproductive, and digestive systems are still developing and because they are growing, children tend to breathe more air as well as eat and drink more in proportion to their weight. For these reasons, exposure to environmental factors such as breathing in particulate matter, ozone, or cigarette smoke can have more negative effects on children than adults.

How Are We Doing?

The EPA recognizes secondhand smoke, mold, chemical irritants, and outdoor air pollution as common triggers for asthma. Asthma is one of the most common chronic diseases among children. The American Lung Association and Center for Disease Control and Prevention estimate that about 7.1 million children under the age of 18 are affected by asthma. According to the Environmental Protection Agency (EPA), children who reported currently having asthma has risen from 8.7% in 2001 to 9.4% percent in 2010. The Utah Asthma Program has estimated that the current prevalence of asthma among children ranges from about 2 percent in younger children to almost 10 percent among children ages 15-17.

How Do We Compare With the U.S.?

This was a one-time project collaborating with other states to calculate a state specific environmental burden of disease. The contributions of environmental factors vary by state and because of this, Utah's combined environmental attributable fraction (EAF) differed from others. In Utah, PM2.5 is the largest contributor to the total EAF.

The term "Environmental Attributable Fraction" (EAF) refers to what extent the environment is responsible for cases of childhood asthma.

Data Notes

It is expected that if a child is exposed to one environmental exposure, they will also be exposed to others. For this reason the overall EAF formula accounts for some of the association between the different environmental exposures. That is why the overall EAF is not the same as the sum of the separate environmental exposures.

References and community resources

World Health Organization http://www.who.int/ceh/risks/en/ Environmental Protection Agency http://www.epa.gov/ace/ American Lung Association http://www.lung.org/lung-disease/asthma/resources/facts-and-figures/asthma-children-fact-sheet.html