Fast Facts on Childrens Environmental Health Asthma

Asthma is a common chronic disease among children in the United States1 In 2006, 9.9 million children under 18 years of age were reported to have ever been diagnosed with asthma; 6.8 million children had an asthmatic episode in the last 12 months2 The hospitalization rate for asthma remained at 27 per 10,000 children from 2002-2004.3 Asthma is the third ranking cause of non-injury related hospitalization among children less than 15 years of age.4 Although asthma deaths among children are rare, 195 children under 18 years of age died from asthma in 2003.3

Disparities of Asthma

Asthma disproportionately affects children from lower-income families and children from various racial and ethnic groups. 5 African-American children have a 500% higher mortality rate from asthma as compared with Caucasian children.6 In 2005, 13% of African-American children were reported to have asthma as compared with 9% of Hispanic children and 8% of non-Hispanic white children.

Wang LY, Zhong Y, Wheeler L. Direct and indirect costs of asthma in school-age children. Prev Chronic Dis [serial online] 2005 Jan [date cited]. Available from: URL: http://www.cdc.gov/pcd/issues/2005/ jan/04_0053.htm
2

Bloom B, Cohen RA. Summary Health Statistics for U.S. Children: National Health Interview Survey, 2006. National Center for Health Statistics. Vital Health Stat 10(234). 2007.
3

CDC Asthma Prevalence, Health Care Use and Mortality, 2005. See http://www.cdc.gov/nchs/products/pubs/pubd/hestats/ashtma03-05/asthma03-05.htm 4 Kozak LJ, DeFrances CJ, Hall MJ. National Hospital Discharge Survey: 2004 annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Stat 13(162). 2006
3 5

EPA (2003). Americas Children and the Environment, Second Edition, 2003, p. 71. See http://yosemite.epa.gov/ochp/ochpweb.nsf/content/homepage..htm
6

Akinbami, LJ. The State of childhood asthma., United States, 1980-2005. Advance data from vital an health statistics; no 381, Hyattsville, MD; National Center for Health Statistics. 2006.

Larger disparities exist within the Hispanic population such that 20% of Puerto Rican children were reported to have asthma as compared with 7% of Mexican children.7

While national level surveys suggest Asian and Pacific Islander children do not have high rates of asthma, small scale surveys however show a high prevalence of asthma among subgroups of Asian and Pacific Islander children.8 o Filipino children have an asthma prevalence of 23.8%9 o Pacific Islander children have an asthma prevalence of 21%10

Economic Impact of Asthma

In 2002, children 5-17 years old missed 14.7 million school days due to asthma11 The direct and indirect costs of asthma to the U.S. economy were $19.7 billion in 2007. 12 o Approximately $14.7 billion dollars are directly associated with the medical care costs of asthma13 o Approximately $5 billion are associated with lost productivity. 14 Asthmatic patients and their families pay a higher portion of their medical care costs than patients with other diseases due to heavy reliance on prescription medication combined with lower insurance coverage for prescription drugs.15

Federal Interagency Forum on Child and Family Statistics. Americas Children: Key National Indicators of Well-Being, 2007. Federal Interagency Forum on Child and Family Statistics, Washington, DC: U.S. Government Printing Office 8 Davis A, Kreutzer, R et al.(2006). Asthma prevalence in Hispanic and Asian American ethnic subgroups: results from the California kids survey. Pediatrics 118 (2): e363-e370 9 Ibid 10 Ibid 11 CDC, Asthma Prevalence, Health Care Use and Mortality, 2002. See ttp://www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm 12 National Heart, Lung and Blood Institute Chartbook on cardiovascular, lung and blood diseases, U.S. Department of Health and Human Services, National Institute of Health 2007 13 Ibid, p.17 14 Ibid. 15 EPA, National Costs of Asthma for 1997, pp. 21-22

Lead Exposure

A blood lead level of 10 g/dL or greater is considered elevated. However, there is no safe level of lead in blood of children16 Today, elevated blood lead levels in children are due mostly to ingestion of contaminated dust, paint and soil. 17 About 250,000American children ages 1-5 years old had an elevated blood lead level of 10ug/dl in 2001-2002 and 2003-2004 respectively. The number of children affected by lead poisoning has decreased significantly from 4.7 million in 1978. 18 The decline in blood lead levels is due to the phasing out of lead in gasoline between 1973 and 199519 and the reduction in the number of homes with lead-based paint from 64 million in 1990 to 38 million in 2000.20 About 24 million homes still have significant lead-based paint hazards. 21 Childhood lead poisoning reduces IQ, which can never be regained. Recent studies suggest that children with blood lead levels well below the federal standard (10 ug/dl), can suffer from diminished IQ and affects on behavior.22 Other studies suggest that children exposed to lead may be at risk of developing Attention Deficit Hyperactivity Disorder (ADHD). 23 Recently, it has been reported that children have been exposed to lead through toys and other products imported from China. In 2007, The Consumer Product Safety Commission recalled 61 toys involving more than 25 million product units. The products were recalled because they contained dangerous levels of lead. 24

Disparities in Lead Exposure

16

Blood lead levels are higher for children ages 1-5 from lower-income families and for certain racial and ethnic groups.25

CDC, Third National Report on Human Exposure to Environmental Chemicals: Spotlight on Lead, July 2005. See http://www.cdc.gov/exposurereport/pdf/factsheet_lead.pdf 17 CDC, Screening Young Children for Lead Poisoning Guidance for State and Local Public Health Officials, 1997. See http://www.cdc.gov/nceh/lead/guide/guide97.htm. 18 EPA, Americas Children and the Environment. Blood Lead Concentration Data 19 EPA, National Air Quality and Emissions Trends Report, 1998 (2000), p. 78. See http://www.epa.gov/oar/aqtrnd98/toc.html 20 D. Jacobs, R. Clickner, J. Zhou, S. Viet, D. Marker, J. Rogers, D. Zeldin, P. Broene, and W. Friedman, 2002. The Prevalence of Lead-Based Paint Hazards in U.S. Housing, Environmental Health Perspectives 110 (10): 599-606. 21 U.S. Department of Housing and Urban Development. http://www.hud.gov
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23

IBID

Braun, J et. al. (2006). Exposures to Environmental Toxicants and Attention Deficit Hyperactivity Disorder in U.S. children. Environmental Health Perspectives, 114(12):1904-1909 24 The United Consumer Product Safety Commission. CPSC Delivers the ABCs of Toy Safety, Nov. 20, 2007. http://www.cpsc.gov/cpscpub/prerel/prhtml08/08086.html 25 EPA, Americas Children and the Environment. Blood Lead Concentration Data., pg. 54.

6.4 % of children ages 1-5 in the United States have a blood lead level above 5 micrograms per deciliter26 Immigrant children may be at increased risk of lead poisoning27 Foreign born children were five times more likely to have elevated blood lead levels than US born children28

Economic Impact of Lead Exposure

The cost of reduced cognitive ability is measured by IQ scores and valued in terms of forgone earnings and is estimated to be about $9, 600 per IQ point lost.29 The cost of not eliminating lead exposure to children between 2000-2010 is expected to be about $22 billion in forgone earnings. 30

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Federal Interagency Forum on Child and Family Statistics. Americas Children: Key Indicators of WellBeing, 2007. Federal Interagency Forum on Child and Family Statistics, Washington, DC: US Government Printing Office. 27 Tehranifar, P, Leighton, J et al. (2008). Immigration and risk of childhood Lead poisoning: findings from a case-control study of New York City children. American Journal of Public Health, 98 (1). 28 IBID 29 Presidents Task Force on Environmental Health Risks and Safety Risks to Children, Eliminating Childhood Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards, February 2000, pA-26. See http://yosemite.epa.gov/ochp/ochpweb.nsf/content/leadhaz.htm/$file/leadhaz.pdf
30

IBID, p. A-28

Childhood Cancer

In 2007, an estimated 10, 400 new cancer cases were expected to occur among children aged 0-14 years old. An estimated 1,545 deaths from cancer were expected to occur among children in 2007.31 Leukemia is the most common cancer in children under 15, accounting for 30 percent of all childhood cancers, followed by brain and other nervous system cancers.32 Cancer is the second leading cause of death among children ages 1 to 14 years of age, with unintentional injuries being the leading cause.33 The causes of childhood cancer are poorly understood, though different forms of cancer have different causes.34 Parental and childhood exposure to pesticides and radiation may cause certain cancers in children.35

Disparities in Childhood Cancer

Hispanic children were reported to have a higher incidence of acute lymphocytic Leukemia (ALL) than non-Hispanic white children.35 Although national studies indicate that Asian Pacific Islander American (APIA) children overall do not have higher rates of Cancer compared to non- Hispanic whites, a smaller scale study conducted in California showed APIA children are at increased risk of developing acute non lymphocytic Leukemia (ANLL) compared with non-Hispanic white infants 36

Economic Impact of Childhood Cancer

The total cost per case of childhood cancer was estimated to be about $623,00037

31 32

American Cancer Society, Cancer Facts and Figures 2007. Atlanta: American Cancer Society, 2007. Jemal, A, Siegel, R, Ward, E, Murray, T, Xu, J, Thun, M (2007). Cancer Statistics, A Cancer Journal for Clinicians, 57(1): 43-66 33 IBID 34 EPA, Americas Children and the Environment, Second Edition, 2003, p76. See http://yosemite.epa.gov/ochp/ochpweb.nsf/content/publications.htm. 35 Reis, L.A.G., Smith, M.A., et al. (1999). Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975-1995. Bethesda, MD: National Cancer Institute, SEER Program. NIH Pub. No.99-4649. http://www.seer.ims.nci.nih.gov/publications/pedmono.
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Reynold, P., Von Behren, J., & Elkin, E (2002). Birth characteristics and Leukemia in Young children. American Journal of Epidemiology, 155 (7): 603-613 37 Landrigan, Phillip et al. (2002). Environmental Pollutants and Disease in American Children: Estimates of Morbidity, Mortality, and Costs for Lead Poisioning, Asthma, Cancer, and Developmental Disabilities. Environmental Health Perspectives, 110 (7): 771-778

Developmental Disabilities

In 2001-2004, about 7 children out of every 1,000 children were reported to be diagnosed with mental retardation.38 Between 3-8 percent of the babies born each year will be affected by developmental disorders such as attention-deficit/hyperactivity disorder or mental retardation. 39 In 2003--2004, an estimated 300,000 U.S. children aged 4--17 years were reported to have Autism40

Disparities in Developmental Disabilities

Mental retardation is more common for children from lower income families and for certain racial and ethnic groups.41

Economic Impact of Developmental Disabilities

During the 2001-2002 school year, an estimated 6.5 million children were enrolled in special education programs. This is almost 75% increase from 1976-1977. 42 The economic costs associated with autism are approximately $35 billion dollars per year43
Expenditures can range from 1.6 times (for students with specific learning disabilities) to 3.1 times (for students with multiple disabilities) higher than expenditures for a regular education student. 44

38

CDC, NCHS, NHIS. Children reported to have mental retardation, by race/ethnicity and family income, 2001-2004. See www.cdc.gov/nchs/nhis.htm
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B. Weiss and P. J. Landrigan. 2000. The developing brain and the environment: an introduction. Environmental Health Perspectives 108 Suppl. 3:373-4 40 CDC, (2006) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5517a3.htm 41 EPA, Americas Children in the Environment. Developmental Disorders 42 U.S. General Accounting Office (2003). Numbers of Formal Disputes Are Generally Low and States Are Using Mediation and Other Strategies to Resolve Conflicts. 43 Ganz, ML (2007). The Lifetime Distribution of the Incremental Societal Costs of Autism. Archives of Pediatrics and Adolescent Medicine, 161:343-349 44 Chambers, JG, Shkolink, J, Perez, M. Total expenditures for students with disabilities, 1999-2000: spending variation by disability. Washington, DC: American Institutes for Research, 2003. See http://wwww.csefair.org/publications/seep/national/Final_SEEP_Report_5.pdf