**7. Morbidity and mortality**

In general, inner city asthma has a higher index of severity, is associated with increased morbidity, and has a higher mortality rate than asthma outside the inner city milieu [29]. Several criteria may be used to evaluate the level of acuity. These include, among others, emergency room visits, hospitalizations, office visits, time lost from work, and absenteeism from school. Research shows that inner city asthma is associated with increased morbidity in each of these criteria. The national database report of 2006 indicated that around 3.5 million visits to physician offices, half a million visits to hospital outpatient departments, an equivalent number of visits to an emergency department, and over 150,000 hospitalizations were related to asthma in this population [55].

Inner city asthma is associated with increased mortality when adjusted for the level of acuity. As far as mortality is concerned, there were 167 deaths from asthma in 2005 among children and adolescents [29, 55]. Interestingly, African-Americans demonstrate a sevenfold increase in mortality, around threefold increase in emergency department visits, threefold increase in hospitalization, but 20% lower nonemergency ambulatory visits than white children. Data on Hispanic children show emergency department visits to be twice that of whites [55].
