The numbers concerning asthma hospitalizations and emergency room visits are disconcerting, to say the least.
"It's been several years now that we've seen rates were high, especially high, in certain ZIP codes within Duluth," said Wendy Brunner, asthma program manager and epidemiologist for the Minnesota Department of Health.
Data the health department released last month shows higher rates of hospitalization and emergency room visits for asthma in Duluth than in the state as a whole (see accompanying chart). But a deeper dive shows greater differences when the numbers are separated according to ZIP code.
State health department data using the years 2010-14 and accounting only for people younger than 18 show a rate of 55.7 asthma emergency department visits per 10,000 for Duluth as a whole. But in the 55806 ZIP code, which includes Lincoln Park and the Central HIllside, it was 82.3; for the 55805 ZIP code, which includes the East Hillside, it was 145.8.
Both districts have below-average household incomes ($35,296 for 55806 and $25,892 for 55805 compared with $65,699 for the state, according to Census Bureau data). They also share, with much of the rest of the city, relatively old housing stock - the majority of houses in the two ZIP codes were built before 1939.
"Older housing stock ... is a big issue in Duluth," said Carrie Gertsema, public health nursing supervisor for St. Louis County Public Health and Human Services. "Along with older housing stock comes mold and mildew."
Other "triggers" of asthma attacks include secondhand smoke and droppings from pests such as mice and roaches, Brunner said.
Although asthma can afflict people in any income group, poverty can contribute to the triggers of asthma attacks, she said.
"We know that poverty rates (are) higher in parts of Duluth, and poverty impacts a lot of things ... like housing quality and limited housing options," Brunner said. "Like maybe, say, there's mold in the home but there's not really a place you can move to."
With encouragement from the state and using a model first used in Dakota County, for the past two years St. Louis County has had a program designed to combat high rates of asthma ED visits and hospitalization.
Suzy Van Norman is the primary public health nurse for the county's asthma home visiting program. Originally targeting children in the 55805 ZIP code, the program now is available to anyone in the county of any age and any income level who has particular difficulties with asthma, Gertsema said.
Those include waking up two or more times in a month with asthma symptoms, an emergency room visit with asthma symptoms, using a rescue inhaler two or more times in a week "or having symptoms that really make it hard for people to exercise, work or go to school," she said.
The program was designed for three home visits, Gertsema said. The first is an assessment. "She'll look for mold or humidity, smoking in the house. They do a lot of educating on smoking cessation. ... They will go over the medications and the asthma plan that they're supposed to be following from the doctor."
Van Norman has found that many patients or their families don't have an asthma plan - a list of instructions from a doctor about what to do if there's an asthma attack.
On the second visit, Van Norman comes bearing gifts. State grant money has made it possible for the county to provide supplies such as a waterproof mattress pad or a vacuum cleaner with an air filter that can improve conditions for a person with asthma, Gertsema said.
The third visit is a follow-up check to assess how things are going for the patient. In reality, though, there may be up to six total visits.
"We found that the families are needing more support than just those three visits," Gertsema said.
As of Dec. 18, 20 people had been enrolled in the program, ranging in age from 2 to 45, according to state Health Department data. Van Norman currently is visiting eight homes in the asthma program, Gertsema said.
Van Norman is the only public health nurse making asthma visits now, Gertsema said, spending about 20 percent of her time for that purpose. But other county public health nurses also have taken the two-day American Lung Association that's a prerequisite for making home asthma visits.
Gertsema said she thinks more people could benefit from the program but may not be aware of it.
With such a small sample size, the evidence about the program's success is more anecdotal than statistical.
"I know that the clients we've been seeing haven't been going back to the emergency room," Gertsema said.
Van Norman also has been able to get some families enrolled in health insurance who previously were uninsured and has been able to connect families to primary care physicians, she said.
To learn more
If you're interested in learning more about the asthma home visiting program, contact Suzy Van Norman, public health nurse, at (218) 725-5291 or email firstname.lastname@example.org.