摘要：Objectives . We developed and evaluated a statewide and community-level asthma surveillance system. Methods . Databases and measures included a community prevalence survey, hospital admissions data, emergency department/outpatient clinic visit records, and a physician survey of diagnosis and treatment practices. We evaluated the system in 5 Maine communities varying in population and income. Results . Asthma hospitalizations were high in the rural/low-socioeconomic-status communities studied, although diagnosed asthma was low. Males were more likely than females to experience asthma symptoms, although they were less likely to have been diagnosed with asthma or to have used hospital-based asthma care. Conclusions . Databases were useful for estimating asthma burden and identifying service needs as well as high-risk groups. They were less useful in estimating severity or in identifying environmental risks. The prevalence of asthma has risen precipitously over the past 2 decades, especially among children. 1– 3 Estimates from the 1998 National Health Interview Survey suggest that 26 million Americans have been diagnosed with asthma at some point in their life, and nearly 11 million suffer an acute asthma attack each year. 4 Annually, asthma is responsible for more than 500 000 hospitalizations, 5000 deaths, and 134 million days of restricted activity. 5 As might be expected, the economic costs are staggering, totaling nearly $11 billion in 1994, a 54% increase since 1984. 6 Although most asthma prevention and management programs are implemented and evaluated at the local level, there is no comprehensive statewide system to monitor the burden of asthma and/or evaluate the impact of asthma-related interventions. 1, 7 The Centers for Disease Control and Prevention has urged state and territorial health departments to combine existing utilization data with survey-based prevalence estimates as part of a comprehensive asthma surveillance effort. 8 Moreover, one of the nation’s Healthy People 2010 health objectives is for at least 25 states to establish a surveillance system for tracking asthma mortality, morbidity, access to care, and management. 5 The purpose of our research was to design, pilot-test (in a sample of 5 communities), and evaluate a prototype system of asthma surveillance for the state of Maine. Our immediate goal was to develop a geographically linked system to monitor prevalence and severity of diagnosed asthma among adults and children, symptoms of undiagnosed disease, asthma risk factors, accessibility and use of asthma-related health care in communities across Maine, and provider practices of diagnosing and treating asthma. Our ultimate goal was to develop a data collection and analysis system that could yield information about the prevention and disease management implications of community-level data on asthma risk, disease burden, and treatment patterns. Such information will be useful to health planners and providers at both state and local levels as they attempt to articulate the scope and dimensions of the problem and as they develop and target prevention and treatment initiatives to address the problem.
