Asthma and lower airway disease
The burden of adult asthma in the United States: Evidence from the Medical Expenditure Panel Survey

https://doi.org/10.1016/j.jaci.2010.10.042Get rights and content

Background

It is important to have an accurate picture of the sources and extent of medical expenditures and productivity loss to understand the nature and scope of the burden of asthma in the United States (US).

Objective

The current study aims to provide recent nationally representative estimates of direct and productivity-related costs attributable to asthma in adults in the US.

Methods

The 2003 and 2005 Medical Expenditure Panel Surveys were used to estimate the effect of asthma on medical expenditures, use, productivity, and chronic comorbidity among adults (≥18 years). Productivity-related outcome variables included employment, annual wages, missed work days, days spent sick in bed, and activity limitations. Multivariate regression was conducted, controlling for sociodemographics and comorbidity.

Results

Of 47,033 adults, 2,003 reported asthma. Compared with those without, subjects with asthma were significantly less likely to be employed (odds ratio, 0.78), spent 1.4 more days sick in bed annually, and were significantly more likely to have activity limitations or to be unable to work. Adults with asthma incurred an additional $1,907 (2008 US dollars) annually and experienced higher health care use and comorbidity. The total national medical expenditure attributable to adult asthma was $18 billion. Adults with asthma were more likely to be covered by Medicaid (30%) than the general adult population (10%). The largest contributors to medical expenditures for adults with asthma were prescription drugs, followed by inpatient hospitalizations and home health care.

Conclusions

In recent national data adult asthma is associated with a significant deleterious effect on direct and indirect costs in the US.

Section snippets

Data source

The Medical Expenditure Panel Survey (MEPS) is a nationally representative Department of Pharmacy Practice, survey of the US civilian, noninstitutionalized population.7 It is an overlapping panel design in which each cohort is followed for 2 years. Respondents complete the battery of questions in each round (there are 3 rounds per year). The MEPS Household Component contains detailed self-reported information on demographic and socioeconomic characteristics, health conditions, insurance status,

Unadjusted descriptive statistics

Of the 47,033 adults in MEPS, 2,003 subjects reported an encounter for asthma. Details of the study sample and national asthma prevalence by characteristic are provided in Table I.

All unadjusted measures of productivity were worse for subjects with asthma (Table II). Subjects with asthma were less likely to be employed, missed more work days, experienced more days sick in bed, had lower wages, and were more likely to have activity limitations and inability. Likewise, all unadjusted measures of

Discussion

This study provides estimates of the direct cost and indirect burden of adult asthma in recent nationally representative data in the US. The results suggest that asthma continues to be a significant public health concern and represents a substantial economic burden. Subjects with asthma incurred costs of $1,907 per person annually that can be attributed directly to asthma, resulting in $18 billion in medical expenditures annually that can be attributed to asthma in the US. To provide context,

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Supported by a research grant from Amgen, Inc.

Disclosure of potential conflict of interest: P. W. Sullivan and V. H. Ghushchyan have received research support from Amgen, Inc. V. Belozeroff, S. Lin, and D. R. Globe are employed by Amgen, Inc. The rest of the authors have declared that they have no conflict of interest.

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