Conundrums in childhood asthma severity, control, and health care use: Puerto Rico versus Rhode Island

Background The lifetime prevalence of self-reported asthma among Puerto Ricans is very high, with increased asthma hospitalizations, emergency department visits, and mortality rates. Differences in asthma severity between the mainland and island, however, remain largely unknown. Objective We sought...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology 2009-08, Vol.124 (2), p.238-244.e5
Main Authors: Esteban, Cynthia A., MSN, MPH, Klein, Robert B., MD, McQuaid, Elizabeth L., PhD, Fritz, Gregory K., MD, Seifer, Ronald, PhD, Kopel, Sheryl J., MSc, Santana, Jose Rodriguez, MD, Colon, Angel, MD, Alvarez, Maria, MD, Koinis-Mitchell, Daphne, PhD, Ortega, Alexander N., PhD, Martinez-Nieves, Brenda, PhD, Canino, Glorisa, PhD
Format: Article
Language:English
Subjects:
Adolescent
Allergy and Immunology
Anti-Asthmatic Agents - therapeutic use
Asthma
Asthma - drug therapy
Asthma - epidemiology
Asthma - physiopathology
Biological and medical sciences
Child
Chronic obstructive pulmonary disease, asthma
clinical guidelines
Clinics
control
Dominican
Ethnicity
Families & family life
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Global Initiative for Asthma
Health care
health care use
Hospitalization - statistics & numerical data
Humans
Immunopathology
Latino
Male
Medical sciences
Methods
Mortality
Pediatrics
Pneumology
Population Groups - ethnology
Population Groups - statistics & numerical data
Puerto Rican
Puerto Rico - epidemiology
Questionnaires
Rhode Island
Rhode Island - epidemiology
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
severity
Severity of Illness Index
Socioeconomic Factors
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Description
Summary:Background The lifetime prevalence of self-reported asthma among Puerto Ricans is very high, with increased asthma hospitalizations, emergency department visits, and mortality rates. Differences in asthma severity between the mainland and island, however, remain largely unknown. Objective We sought to characterize differences in asthma severity and control among 4 groups: (1) Island Puerto Ricans, (2) Rhode Island (RI) Puerto Ricans, (3) RI Dominicans, and (4) RI whites. Methods Eight hundred five children aged 7 to 15 years completed a diagnostic clinic session, including a formal interview, physical examination, spirometry, and allergy testing. Using a visual grid adapted from the Global Initiative for Asthma, asthma specialists practicing in each site determined an asthma severity rating. A corresponding level of asthma control was determined by using a computer algorithm. Results Island Puerto Ricans had significantly milder asthma severity compared with RI Puerto Ricans, Dominicans, and whites ( P < .001). Island Puerto Ricans were not significantly different from RI whites in asthma control. RI Puerto Ricans showed a trend toward less control compared with island Puerto Ricans ( P = .061). RI Dominicans had the lowest rate of controlled asthma. Paradoxically, island Puerto Ricans had more emergency department visits in the past 12 months ( P < .001) compared with the 3 RI groups. Conclusions Potential explanations for the paradoxic finding of milder asthma in island Puerto Ricans in the face of high health care use are discussed. Difficulties in determining guideline-based composite ratings for severity versus control are explored in the context of disparate groups.
ISSN:0091-6749
1097-6825
DOI:10.1016/j.jaci.2009.05.014