Analyzing Age and Gender Relationship Stratified by Race, Region and Poverty level in Asthma Population Estimates (2009)

By: Veatasha H. Dorsey

Research Background and Significance According to CDCs National Center for Health Statistics: 8.2% of the U.S. population has asthma, or about 25 million people 3,395 asthma deaths were reported in 2008 Asthma accounted for 10.5 million lost school days and 14.2 million lost work days in 2008 4.2% of the population in 2009 reported at least one asthma attack in the previous year Asthma is a very frequent respiratory disease with roughly 8.2% of children and adolescents having asthma. During childhood, it is more frequent in males. However, during adulthood, it is more frequent in females. The prevalence (people who suffer asthma at the same moment) is on the rise, especially among children.

Given these statistics, I wish to see if there is a statistically significant relationship between the age and gender of asthma sufferers delineated by race, region and economic status. A relationship, and particularly the strength (not analyzed in this study) is important in the field of public health given the increased focus on health disparities commonly associated with these three census markers. Research Question: Stratified by race, region and economic status, is there a statistically significant relationship between gender and age of current asthma sufferers? Method: The method that I used was a Chi Square Test for Independence. This test was most appropriate given my data set included random sampling, a large sample size, categorical variables, and an expected frequency count > 5 in each cell of the contingency table ( > 2x2 contingency table). My null and alternative Hypotheses are as follows. H0: There is not a statistically significant relationship between age and gender (meaning gender and age are independent) and Ha: There is a statistically significant relationship between age and gender (gender and age are not independent or related). I used a dataset from the CDC on the current national asthma population in 2009. I chose the CDC based on its national reputability and rigorous attention to sample size estimation and efficacious statistical analyses. The categories from this particular data set that I used are as follows: Categories Race: White, Black, Hispanic , Mexican (Subset of Hispanic) Region: Northeast, Midwest, South, West Family Income: Poverty Threshold The family income-poverty threshold is the ratio of income to poverty is a family's or person's income divided by their poverty threshold. The Frequency ratios are < 1.00 (below 100 percent of poverty) are below the official poverty definition and > 1.00 or greater (100 percent of poverty or greater) indicate income above the poverty level.

Results-Chi Square Test

Chi Square Test

Asthma Sufferers Race* White Black Hispanic Mexican Region Income:Poverty Threshold * Yates Continuity Correction for X 2
Conclusions At the 0.05 level of significance we reject the null hypothesis and conclude that there is a relationship between age and gender of asthma sufferers in the stratified by race, region and economic status. A graphical depiction of the categories (shown in the Appendix below) is generally representative of the idea that male children have increased asthma rates among children sampled and adult females have increased asthma rates among the sampled adults. However, we see that the gap between black male and female children with asthma sampled is closer than any other race. An interesting finding is that among lower income children the asthma rate is higher, however, among higher income adults the asthma rate is also higher. This can possibly be explained by a childs respiratory system being more susceptible to environmental pollutants (a major contributor to asthma), especially in poorer areas, than adults who develop asthma during adulthood. Limitations This study was largely delimited by time. In addition, the testing method used could have caused a limitation to gathering the most information from this study. While Chi Square shows us statistical significance (as respresented by the table above and the rejection of the null hypothesis) it does not give us much information about the strength of the relationship or substantive significance, much like if the Odds Ratio was calculated once a dependency was found. Region and Economic Status were not stratified by race within the sample. If it was, it could have possibly given more insight spatially (for region) in the analysis.

df 1 1 1 1 2 2

X2 790.4 197.5 141.0 93.3 99.0 602.7

P(X2) P(X2) Round 6.73E-174 0 7.20E-45 0 1.64E-32 0 4.55E-22 0 2.61E-21 0 2.67E-130 0

References World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach [database on the Internet]. http://www.who.int/gard/publications/GARD_Manual/en/index.html Centers for Disease Control and Prevention. 2008 adult asthma data: prevalence tables and maps [database on the Internet]. 2008. http://www.cdc.gov/asthma/brfss/08/lifetime/tableL1.htm American Lung Association. Trends in asthma morbidity and mortality [database on the Internet]. 2010. http://www.lungusa.org/finding-cures/our-research/trend-reports/asthma-trend-report.pdf. Centers for Disease Control and Prevention. Adult self-reported current asthma prevalence rate by sex and state or territory: BRFSS 2008 [database on the Internet]. http://www.cdc.gov/asthma/brfss/08/current/tableC21.htm Barnes PM, Heyman KM, Freeman G, et al. Early release of selected estimates based on data from the 2009 National Health Interview Survey. Hyattsville, MD: National Center for Health Statistics; 2010. http://www.cdc.gov/nchs/nhis.htm. Appendix (Contingency Tables and Graphs)

White Male Female Total

Black Male Female Total

Children (< 18 yrs) Adult (> 18 yrs) 2135 4364 1338 8120 3473 12484
Children (< 18 yrs) Adult (> 18 yrs) 972 739 816 1542 1788 2281

Total 6499 9458 15957

Total 1711 2358 4069

2009 National Health Interview Survey (NHIS) Data

Previous Table | Next Table

Table 3-1 Current Asthma Population Estimates -- in thousands by Age, United States: National Health Interview Survey, 2009
Age (years) 15-34 All ages Total 24,567 10,325 14,241 Children Age <18 7,111 4,268 2,843 Adults Age 18+ 17,456 6,058 11,398 04 514 15 34 6,363 2,553 3,810 15 19 1,839 873 966 20 24 1,758 724 1,035 25 34 2,765 956 1,809 35 64 9,450 3,098 6,352

Characteristic Total: Male Female

65+ 2,906 1,061 1,845

1,332 4,515 856 476 2,758 1,758

White Non-Hispanic: Male Female

15,957 6,499 9,458

3,473 2,135 1,338

12,484 4,364 8,120

505 359 146*

2,149 1,341 808

4,305 1,721 2,584

1,153 529 624

1,199 535 663

1,954 657 1,297

6,668 2,197 4,471

2,331 881 1,449

Black Non-Hispanic: Male Female

4,069 1,710 2,358

1,788 972 816

2,281 739 1,542

413 182 231

1,109 668 441

1,008 368 641

397 199 197

262 58 203

350 110 240

1,313 433 880

226 59 167

Other Non-Hispanic: Male Female

1,544 688 856

574 392 182

969 296 673

105 90* 14*

405 262 143

380 167 213

103 44* 59*

133* ** 85*

144 75* 69

510 134 376

144* ** 109*

Hispanic: Male Female

2,997 1,428 1,569

1,276 769 507

1,721 659 1,062

310 225 85

852 486 366

669 297 372

187 101 86

165 83* 82

318 114* 204

960 334 626

206 86* 120

Puerto Rican:a Male Female

756 291 465

243 158 85

513 132* 381

79* 61* **

135 85 50*

140 34* 105*

47* 18* **

24* ** **

68* ** 59*

356 100* 256

47* ** 35*

Mexican/MexicanAmerican:a Male

1,583 764

757 461

826 302

169 133*

513 289

366 143

126 78*

98 43*

142 **

427 138

107* 61*

Table 3-1 Current Asthma Population Estimates -- in thousands by Age, United States: National Health Interview Survey, 2009
Age (years) 15-34 All ages Total 819 Children Age <18 295 Adults Age 18+ 524 04 36* 514 225 15 34 223 15 19 48* 20 24 55* 25 34 120 35 64 289

Characteristic Female

65+ 46*

Region: Northeast Midwest South West 4,864 6,385 8,027 5,291 1,386 1,934 2,529 1,261 3,477 4,450 5,498 4,030 224 410 522 176 864 1,104 1,659 887 1,300 2,016 1,879 1,168 444 603 505 289 316 485 582 376 540 928 793 503 1,907 2,249 3,018 2,277 569 605 949 783

Ratio of Family Income to Poverty Threshold:b 0-.99 1.00-2.49 2.50-4.49 4.50 and above 5,093 5,039 6,999 7,435 2,097 1,616 1,594 1,805 2,996 3,423 5,405 5,631 593 197 293 249 1,316 1,049 968 1,182 1,307 1,563 1,793 1,700 318 536 475 510 430 473 512 343 559 553 805 848 1,550 1,513 2,881 3,506 326 717 1,065 798