Healthy Development Measurement Toolkit

Health Outcome HO.1 Asthma hospitalization rate per 10,000

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Data Source

Hospitalization data by individual zip code for 2007-2009 were provided by the administrators of the Health Matters in San Francisco website: http://www.healthmattersinsf.org/index.php. Health Matters in SF compiled the data from California Office of Statewide Health Planning and Development (OSHPD). For more information on these preventable hospitalizations, visit: http://www.oshpd.ca.gov/hid/products/preventable_hospitalizations/pdfs/PH_REPORT_WEB.pdf

Explanation and Limitations

This indicator shows San Francisco's hospitalization rate for asthma for youth and adults combined. Data are age-adjusted per 10,000 population. Rates were calculated using population figures from the 2000 U.S. Census. Age standardization allows comparisons across counties or by zip codes that differ in size or age composition.

From California Breathing's Burden of Asthma in California report (2007), "Asthma is a chronic inflammatory lung condition characterized by recurrent flares or exacerbations of breathlessness, wheezing, coughing, and chest tightness. The severity of symptoms can range from mild to life-threatening. Since the early 1980s, the prevalence of asthma has been increasing. In 2004, there were approximately 21 million adults and nine million children with asthma in the United States. There were 13.6 million physician office visits, one million hospital outpatient visits, 1.8 million emergency department visits, and 3,780 deaths due to asthma nationwide in 2004. Asthma also causes millions of school and work absences every year."  Known asthma triggers are strongly impacted by the environment, and include: air pollution, cockroaches, cold air, dust mites, exercise, mold, pet dander, pollen, strong emotions/stress, strong odors, tobacco smoke, and viral infections.

Asthma is considered an "Ambulatory Care Sensitive Condition" (ACSC). "ACSCs are ‘diagnoses for which timely and effective outpatient care can help to reduce the risks of hospitalization by either preventing the onset of an illness or condition, controlling an acute episodic illness or condition, or managing a chronic disease or condition. (J. Billings, et al., "Impact of Socioeconomic Status on Hospital Use in New York City," Health Affairs, 1993, 12(1): 162-173.)'"

The data shown here do not identify what barriers are responsible for the different hospitalization rates, nor do they identify whether the barriers are in the health care system or in the preferences and practices of individuals or communities.

Geographic differences in ACSC hospitalizations are just one indicator of inadequate access to health care in San Francisco. Other factors such as health insurance coverage, transportation to and from the health facility, cultural competency or cultural humility of health care providers, hours of operation, length of reimbursement period, cultural and linguistic competency of administrative and intake staff, availability of child care, availability of prevention programs, and employer requirements are among many factors impeding reliable, continuous access to affordable, quality health care.

Why is this a Community Health Indicator?

Ambulatory care sensitive (ACS) conditions (such as asthma, diabetes, chronic obstructive pulmonary disease and congestive heart failure) are conditions for which hospitalization can usually be prevented when they have been effectively managed in outpatient settings. High hospitalization rates for ACS conditions indicate poor access to outpatient health care.