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Comparative Study
. 2009 Aug;124(2):238-44, 244.e1-5.
doi: 10.1016/j.jaci.2009.05.014. Epub 2009 Jul 16.

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

Cynthia A Esteban  1 , Robert B Klein, Elizabeth L McQuaid, Gregory K Fritz, Ronald Seifer, Sheryl J Kopel, Jose Rodriguez Santana, Angel Colon, Maria Alvarez, Daphne Koinis-Mitchell, Alexander N Ortega, Brenda Martinez-Nieves, Glorisa Canino
Affiliations
Comparative Study

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

Cynthia A Esteban et al. J Allergy Clin Immunol. 2009 Aug.

Abstract

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.

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Figures

FIG 1
FIG 1
Asthma severity distribution by study group. Puerto Ricans (PR) had significantly milder asthma compared with RI Puerto Ricans (RI-PR; P < .001), RI Dominicans (RI-DR; P < .001), and RI whites (P < .001). There were no significant differences among the 3 groups in RI.
FIG 2
FIG 2
ED visits and hospitalizations in the past 12 months by study group. Puerto Ricans (PR) had significantly more ED visits (P < .001) compared with the 3 groups in RI. Island Puerto Ricans had more hospitalizations compared with RI whites and RI Dominicans (RI-DR; P < .001). RI Puerto Ricans (RI-PR) were not significantly different from island Puerto Ricans in hospitalizations.
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References

    1. Loyo-Berrios N, Orengo J, Serrano-Rodriguez R. Childhood asthma prevalence in northern Puerto Rico, the Rio Grande, and Loíza experience. J Asthma. 2006;43:619–24. - PubMed
    1. Lara M, Akinbami L, Flores G, Morgenstern H. Heterogeneity of childhood asthma among Hispanic children: Puerto Rican children bear a disproportionate burden. Pediatrics. 2006;117:43–53. - PubMed
    1. Cohen RT, Canino GJ, Bird HR, Shen S, Rosner BA, Celedon JC. Area of residence, birthplace, and asthma in Puerto Rican children. Chest. 2007;131:1331–8. - PubMed
    1. Cohen RT. Celedón JC. Asthma in Hispanics in the United States. Clin Chest Med. 2006;27:401–12. - PubMed
    1. Canino G, Koinis Mitchell D, Ortega A, McQuaid E, Fritz G, Alegria M. Asthma disparities in the prevalence, morbidity and treatment of Latino children. Soc Sci Med. 2006;63:2926–37. - PubMed

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