Prevalence of Asthma, Asthma Attacks, and Emergency Department Visits for Asthma Among Working Adults — National Health Interview Survey, 2011–2016

In 2010, an estimated 8.2% of U.S. adults had current asthma, and among these persons, 49.1% had had an asthma attack during the past year (1). Workplace exposures can cause asthma in a previously healthy worker or can trigger asthma exacerbations in workers with current asthma* (2). To assess the industry- and occupation-specific prevalence of current asthma, asthma attacks, and asthma-related emergency department (ED) visits among working adults, CDC analyzed 2011–2016 National Health Interview Survey (NHIS) data for participants aged ≥18 years who, at the time of the survey, were employed at some time during the 12 months preceding the interview. During 2011–2016, 6.8% of adults (11 million) employed at any time in the past 12 months had current asthma; among those, 44.7% experienced an asthma attack, and 9.9% had an asthma-related ED visit in the previous year. Current asthma prevalence was highest among workers in the health care and social assistance industry (8.8%) and in health care support occupations (8.8%). The increased prevalence of current asthma, asthma attacks, and asthma-related ED visits in certain industries and occupations might indicate increased risks for these health outcomes associated with workplace exposures. These findings might assist health care and public health professionals in identifying workers in industries and occupations with a high prevalence of current asthma, asthma attacks, and asthma-related ED visits who should be evaluated for possible work-related asthma. Guidelines intended to promote effective management of work-related asthma are available (2,3).

The NHIS is an annual survey that collects health information from a nationally representative sample of the noninstitutionalized U.S. civilian population through personal interviews.^† Survey participants were considered to be working in the last 12 months if they reported having a job or business at any time during the past 12 months.^§ For analyses, information on respondents’ current industry (21 major groups/79 detailed industries) and occupation (23 major groups/94 detailed occupations) were used.^¶ Participants who had ever been told by a doctor or other health professional that they had asthma and reported that they still have asthma were considered to have current asthma. Persons with at least one asthma attack in the past year, or at least one asthma-related ED visit in the past year were identified by affirmative responses to questions “During the past 12 months, have you had an episode of asthma or an asthma attack?” and “During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?,” respectively.

Data were weighted to produce nationally representative estimates using sample weights, and variance estimates were calculated to account for the clustered survey design. Estimates with a relative standard error (standard error of the estimate divided by the estimate) ≥30% were not reported. The Rao-Scott chi-square test was used to determine statistically significant differences (p<0.05) between groups. Data were analyzed using statistical software.

During 2011–2016, an estimated (annual average) 160.7 million adults were working at any time during the past 12 months (Table 1), 6.8% (11.0 million) of whom had current asthma. Current asthma prevalence was highest among workers aged 18–24 years (8.5%), females (8.9%), non-Hispanic blacks (8.2%), those with higher than a high school education (7.2%), those categorized as “poor”** (8.7%), those having health insurance (7.1%), and those living in the Northeast (7.6%).

Among workers with current asthma, 44.7% (4.9 million) had at least one asthma attack, and 9.9% (1.1 million) had at least one asthma-related ED visit in the past 12 months (Table 1). The proportion of workers with current asthma who had at least one asthma attack was highest among workers aged 45–64 years (47.4%), females (48.4%), non-Hispanic whites (45.4%), those with higher than a high school education (45.2%), those categorized as poor (49.2%), those with no health insurance (47.5%), and those living in the South (46.1%). The proportion of workers with current asthma who had at least one asthma-related ED visit was highest among workers aged 18–24 years (10.5%), females (11.7%), non-Hispanic blacks (17.6%), those with less than high school education (13.3%), those categorized as poor (17.0%), those with no health insurance (14.5%), and those living in the South (11.3%).

By major industry, current asthma prevalence was highest among workers in the major industry groups of health care and social assistance (8.8%) followed by educational services (8.2%) (Table 2); these groups also had the first and second highest numbers of workers with asthma attacks (860,000 and 602,000, respectively) and asthma-related ED visits (212,000 and 102,000, respectively). The highest prevalence of asthma attacks was among workers with asthma in the transportation and warehousing (51.7%) industries, and the highest prevalence of asthma-related ED visits was among workers in retail trade (12.4%).

By detailed industry sector, current asthma prevalence was highest among workers in electronics and appliance stores (11.9%) (Table 2). Among persons with current asthma, the highest asthma attack prevalence was among workers in wood products manufacturing (57.3%), followed by the plastics and rubber products manufacturing (56.7%), and the highest prevalence of asthma-related ED visits was among workers in private households (22.9%). The highest numbers of asthma attacks (307,000) and asthma-related ED visits (75,000) were among persons working in ambulatory health care services.

By major occupation group, current asthma prevalence was highest among workers in health care support (8.8%), followed by personal care and service (8.6%) occupations (Table 3). Among those with current asthma, the highest prevalence of asthma attacks was among workers in the education, training, and library (51.5%) major occupations; the highest prevalence of asthma-related ED visits was among workers in personal care and service (17.4%) occupations. The highest numbers of workers with asthma attacks (711,000) and asthma-related ED visits (137,000) were in the office and administrative support major occupation.

By detailed occupation subgroup, the highest prevalence of current asthma (10.7%) and asthma attack in the past 12 months (64.0%) was among workers in other education, training, and library occupations^†† (Table 3). Prevalence of asthma-related ED visits was highest among personal appearance workers^§§ (25.0%). The highest number of workers with asthma attacks was among those working in other management occupations^¶¶ (302,000), and the highest number of workers with asthma-related ED visits was among retail sales workers (99,000).

Acknowledgments

David N. Weissman, Respiratory Health Division, National Institute for Occupational Safety and Health, CDC.

Corresponding author: Jacek Mazurek, JMazurek1@cdc.gov, 304-285-5983.

¹Respiratory Health Division, National Institute for Occupational Safety and Health, CDC.

References

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Abbreviation: CI = confidence interval.
* Defined as a “yes” response to the questions “Have you ever been told by a doctor or other health professional that you had asthma?” and “Do you still have asthma?”
^† Survey respondents who answered “yes” to the question “Did you have a job or business at any time in the past 12 months?”
^§ Defined as a “yes” response to the question “During the past 12 months, have you had an episode of asthma or an asthma attack?”
^¶ Defined as a “yes” response to the question “During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?”
** Weighted to provide national estimates.
^†† Estimates suppressed because relative standard error for the estimate was ≥30%.
^§§ Poverty index is based on family income and family size using the U.S. Census Bureau’s poverty thresholds for the previous calendar year. Persons who are categorized as “poor” have family incomes <100% of the poverty threshold, “near poor” have family incomes ≥100% to <200% of the poverty threshold, and “not poor” have family incomes ≥200% of the poverty threshold. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2016/srvydesc.pdfpdf icon, https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.htmlexternal icon.

Abbreviation: CI = confidence interval.
* Defined as a “yes” response to the questions “Have you ever been told by a doctor or other health professional that you had asthma?” and “Do you still have asthma?”
^† Survey respondents who answered “yes” to the question “Did you have a job or business at any time in the past 12 months?”
^§ Defined as a “yes” response to the question “During the past 12 months, have you had an episode of asthma or an asthma attack?”
^¶ Defined as a “yes” response to the question “During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?”
** Industry that employed sample adults were working in during the week prior to their interview. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2014/srvydesc.pdfpdf icon.
^†† Weighted to provide national estimates.
^§§ Estimates suppressed because relative standard error for the estimate was ≥30%.

Abbreviation: CI = confidence interval.
* Defined as a “yes” response to the questions “Have you ever been told by a doctor or other health professional that you had asthma?” and “Do you still have asthma?”
^† Survey respondents who answered “yes” to the question “Did you have a job or business at any time in the past 12 months?”
^§ Defined as a “yes” response to the question “During the past 12 months, have you had an episode of asthma or an asthma attack?”
^¶ Defined as a “yes” response to the question “During the past 12 months, have you had to visit an emergency room or urgent care center because of asthma?”
** Occupation that employed sample adults had during the week prior to their interview. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2014/srvydesc.pdfpdf icon.
^†† Weighted to provide national estimates.
^§§ Estimates suppressed because relative standard error for the estimate was ≥30%.