Boston Globe
16 May 2003

Asthma worst in Bay State, study finds
CDC sees high rate throughout N.E.

By Stephen Smith

Adults in Massachusetts report the highest rates of asthma in the United States, according to a new study that identifies New England as the region hardest hit by the respiratory disease.

The health survey, conducted by the Centers for Disease Control and Prevention, discovered that five of the seven states with the highest incidence of adult asthma were in New England: Massachusetts, Maine, Rhode Island, Vermont, and New Hampshire. In the Bay State, 9.5 percent of adults reported that they suffered from asthma, more than 2 percent above the national average.

''We looked at this as a region and we said, `Oh, my God. Five of the top seven states are in New England, and every single state in the region is higher than the national average,''' said Laurie Stillman, executive director of the Asthma Regional Council, a private agency founded by federal authorities in New England to address environmental aspects of asthma. ''That was telling us that there is something going on in New England that we have to start understanding and paying attention to.''

The report arrives as asthma levels have soared to unprecedented levels nationally, with about 20 million adults and children believed to be stricken with a disease that accounts for 2 million emergency room visits each year, and that disproportionately strikes poor children in urban neighborhoods.

Across the six New England, states, 8.9 percent of adults said they had asthma, compared with 7.2 percent nationally. And preliminary data suggest an even more widespread crisis among children, with asthma rates in the region twice those of the adult population.

The findings, part of a federal telephone survey of medical conditions and lifestyle practices, offer no answers to the question of why New England's asthma rates are so high. But they are serving as a call to arms for specialists devoted to the disease.

''It is a big deal, and it's a big problem,'' said Dwight Littlefield, health program manager for the Maine Asthma Prevention and Control Program. ''Asthma is a critical issue, and part of the burden is literally billions of dollars of medical costs in the United States.''

Still, the precise scope of that health-care burden remains uncertain, a fact acknowledged by authors of the ''Asthma in New England'' report being released this month, which contains the findings on asthma levels.

Rates of the disease are based on people identifying themselves as being asthmatic. What remains unclear to researchers is how much of the difference among states reflects true variance in the intensity of asthma and how much reflects regional differences in the quality of health care and public awareness of the disease.

''It's certainly interesting and important for us from a public health perspective to recognize what these rates mean,'' said Suzanne Condon, assistant commissioner for environmental health at the Massachusetts Department of Public Health. ''But what will be much more important is trying to do some additional research to see if we can't get to what's behind those numbers.''

That research has already begun across the region.

In Massachusetts, public health authorities are scouring school medical records to derive a sharper snapshot of the incidence of asthma in children. Until now, such estimates have been based on information gathered from hospitals, which have yielded only a partial picture.

So the Massachusetts Department of Public Health initiated an experiment in the Merrimack Valley that involved comparing school nurse records on asthma with hospital documents. In Lawrence, a review of the school reports suggests that asthma is twice as common as previously believed. In coming years, the record review will expand statewide.

Such initiatives, specialists said yesterday, are vital both to exploring the scope of asthma and unlocking the secrets of a disease whose roots have been traced to everything from hormonal conditions to mold to tiny chunks of tires swirling in the air.

Theories for the higher rates of asthma in New England involve weather patterns that could carry pollution into the region, more pronounced seasonal weather changes, and aging buildings with inferior ventilation systems.

To look for causes of asthma and to correct them, the American Lung Association has sent teams into about 15 Boston schools in recent months, hunting down blocked vents, buses belching exhaust too close to air intake systems, and mold coating walls.

The stakes are substantial: Asthma is the single biggest cause of school absences nationally.

Stephen Smith can be reached at stsmith@globe.com.