Asthma Among American Indians in Minnesota
The Minnesota Department of Health (MDH) Asthma Program tracks different aspects of asthma
(e.g., the percentage of Minnesota residents with asthma, rates of asthma-related hospitalizations
and emergency department visits) to better understand the burden of asthma in Minnesota.
This report covers information on asthma in Minnesota’s American Indian population from a
number of data sources, including Indian Health Service, the Minnesota Student Survey, the
Minnesota Youth Tobacco and Asthma Survey and the Minnesota Department of Human
Services.
What We Know:
Indian Health Service (IHS)
Data from IHS show that among children under age 5, boys are almost twice as likely as girls to
have asthma. (See Figure 1.) Among young to middle age adults, men are more likely to have
asthma. In the older age groups, women are more likely to have asthma. Asthma rates are highest
among the elderly, however the high rates may also be due to chronic obstructive pulmonary
disease (COPD), a chronic lung disease that becomes more common with age and is difficult to
distinguish from asthma.
Figure 1. Active Users of Tribal Health Care in Minnesota Who Have Asthma
Data Source: IHS General Data Mart, 2008-2009
Among active users of tribal health care in Minnesota:
 7% of preschool aged children have asthma: 1 in 14 preschool children
 5% of school aged children have asthma: 1-2 students in a classroom of 30
 4% of young to middle aged adults have asthma
 9% of adults and 16% of the elderly have asthma
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Individuals were identified as having asthma based on office visits, ED visits, hospitalizations or
medications for asthma. It is important to note that asthma data from IHS may not be comparable
with asthma data from other sources based on surveys (such as the Minnesota Student Survey
and the MN Youth Tobacco and Asthma Survey) since surveys tend to show higher rates of
asthma than reports based on administrative data.
Minnesota Student Survey
Data from the 2010 Minnesota Student Survey show that American Indian students in grade 12
had the highest prevalence of asthma compared with other groups, and the second highest
prevalence among 6th and 9th graders.
Figure 2. Percentage (%) of students reporting “Yes” to “Has a doctor or nurse ever told you
that you have asthma?” by grade and race/ethnicity
% ever diagnosed with asthma
Grade 6
American Indian
22.0
Asian American/Pacific Islander
13.0
Black, African or African-American
26.0
Hispanic
15.8
White
14.5
Don't know
14.2
Source: Minnesota Student Survey, 2010
Grade 9
23.7
13.6
24.3
17.6
17.7
20.7
Grade 12
28.0
12.3
22.7
18.4
18.9
20.5
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Minnesota Youth Tobacco and Asthma Survey
Results from the Minnesota Youth Tobacco and Asthma Survey show that 26% of American
Indian students in grades 6-12 have a history of asthma and 22% currently have asthma. There
are notable differences in the prevalence of asthma by race/ethnicity among Minnesota youth;
however, these none of these differences is statistically significant (i.e., all within the margin of
error).
Table 1. Percentage of youth reporting ever diagnosed and current asthma by race/ethnicity
Ever diagnosed*
Still has asthma#
American Indian
25.8%
22.4%
Asian American/Pacific Islander
18.6%
11.5%
Black, African or African-American
20.1%
12.8%
Hispanic
12.7%
6.6%¶
White
16.8%
12.2%
Source: Minnesota Youth Tobacco and Asthma Survey, 2011
*Yes to: Has a doctor or nurse ever told you or your parents that you have asthma?
#
Yes to: During the past 12 months, have you had wheezing, tightness in your chest or other
symptoms of asthma? and Has a doctor or nurse ever told you or your parents that you have
asthma?
¶
Relative standard error is greater than 30%; thus results may be unreliable.
Minnesota Health Care Programs
Among enrollees in Minnesota’s Medical Assistance program, 5.7% of American Indians had
“persistent” asthma compared with 3.0% of Asians, 7.7% of Blacks, 5.0% of Hispanics and 5.2%
of Whites. Among enrollees in MinnesotaCare, the prevalence of “persistent” asthma was
highest in American Indians at 9.6% compared with Asians (2.7%), Blacks (6.0%), Hispanics
(4.6%) and Whites (5.5%). (See Figure 3.) Note that this data source includes only those
American Indians enrolled in Medical Assistance or MinnesotaCare and does not completely
overlap with IHS data. (Note: See MDH Asthma Program report, “Asthma in Minnesota: 2012
Epidemiology Report” for definition of persistent asthma.)
Figure 3. Percentage of enrollees with persistent asthma by program and race/ethnicity
Source: Minnesota Department of Human Services Data Warehouse, 2010
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Figure 4. shows rates of asthma-related emergency department (ED) visits and hospitalizations
by race/ethnicity among individuals enrolled in Medical Assistance. Rates for American Indian
enrollees are higher than the total rate for all enrollees. In 2010, the rate of asthma-related ED
visits among American Indian enrollees was 200 per 10,000 enrollees and the rate of asthmarelated hospitalizations was 118 per 10,000 enrollees, compared with 160 per 10,000 and 70 per
10,000, respectively, for all enrollees. Rates for American Indian enrollees in MinnesotaCare are
not reported here due to the relatively small number of hospitalizations/ED visits leading to
unstable rates.
Figure 4. Rate of asthma-related hospitalizations, emergency department visits and
office visits by race/ethnicity among enrollees in Medical Assistance, 2010
ED Visits
Hospitalizations
American Indian
200.0
75.4
Asian/Pacific Islander
48.7*
28.7*
Black
339.4
126.1
Hispanic
162.9
40.6
Other
118.1
56.0
White
102.8
57.4
Total
160.1
69.6
Rate per 10,000 enrollees
*Relative standard error is greater than 30%; rate may be unstable
Source: Minnesota Department of Human Services, 2010
Asthma-related office visits include both visits for preventative care and visits for worsening
asthma symptoms. In 2010, the rate of office visits for asthma among American Indian enrollees
in Medical Assistance was 557 per 10,000 compared with 615 per 10,000 for all enrollees. The
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rate was 588 per 10,000 for American Indian enrollees in Minnesota Care compared with 462 per
10,000 for all enrollees.
Summary
There are continuing indications that the burden of asthma is high in the American Indian
population in Minnesota, with the highest asthma prevalence rates among students in grade 12,
and higher than average rates of hospitalizations and ED visits for asthma among American
Indians enrolled in Medical Assistance. These indicators consistently show an increased burden
of asthma when compared with other groups; however, the picture is incomplete. There are still
gaps in our knowledge, such as an overall comparison of the prevalence of asthma in Minnesota
American Indians compared with other groups, with Minnesota as a whole and with the national
average.
The causes of asthma are largely unknown, however we do know a lot about substances that can
trigger an asthma attack or exacerbation, such as air pollution, respiratory infections, wood
smoke, tobacco smoke, dust mites, pollen and mold. The MDH Asthma Program is currently
working with tribal partners in several communities to reduce environmental triggers in the
homes of children and adults living with asthma.
The Minnesota Department of Health Asthma Program worked with the Bemidji Area Office of
the Indian Health Service (IHS) to develop a “Tribal Asthma Data Profile” that describes the
burden of asthma among American Indians living in Minnesota (who are active users of tribal
health care systems). Data from the profile have been included in this report.
Available at: http://www.health.state.mn.us/asthma/documents/tribalasthmadatareportmn.pdf
Tribes may request asthma data profiles for their communities by contacting Jason Douglas,
Bemidji Area Office statistical officer, 218-444-0550, [email protected].
For more information on Minnesota asthma data, please contact Wendy Brunner, MDH Asthma
Program epidemiologist, 651-201-5895, [email protected].
January 2013
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