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. 2020 Aug;57(8):886-897.
doi: 10.1080/02770903.2019.1612907. Epub 2019 Jun 12.

Characterizing environmental asthma triggers and healthcare use patterns in Puerto Rico

Lillianne M Lewis  1   2 , Maria C Mirabelli  1 , Suzanne F Beavers  1 , Caitlin M Kennedy  3 , Jennifer Shriber  3 , Dorothy Stearns  1 , Jonathan J Morales González  4 , Marimer Soto Santiago  5 , Ibis Montalvo Félix  6 , Krystel Ruiz-Serrano  6 , Emilio Dirlikov  2   5 , Matthew J Lozier  7 , Kanta Sircar  1 , W Dana Flanders  8 , Brenda Rivera-García  5 , Jessica Irizarry-Ramos  6 , Benjamin Bolaños-Rosero  9
Affiliations

Characterizing environmental asthma triggers and healthcare use patterns in Puerto Rico

Lillianne M Lewis et al. J Asthma. 2020 Aug.

Abstract

Objective: Asthma carries a high burden of disease for residents of Puerto Rico. We conducted this study to better understand asthma-related healthcare use and to examine potential asthma triggers.Methods: We characterized asthma-related healthcare use in 2013 by demographics, region, and date using outpatient, hospital, and emergency department (ED) insurance claims with a primary diagnostic ICD-9-CM code of 493.XX. We examined environmental asthma triggers, including outdoor allergens (i.e., mold and pollen), particulate pollution, and influenza-like illness. Analyses included descriptive statistics and Poisson time-series regression.Results: During 2013, there were 550,655 medical asthma claims reported to the Puerto Rico Healthcare Utilization database, representing 148 asthma claims/1,000 persons; 71% of asthma claims were outpatient visits, 19% were hospitalizations, and 10% were ED visits. Females (63%), children aged ≤9 years (77% among children), and adults aged ≥45 years (80% among adults) had the majority of asthma claims. Among health regions, Caguas had the highest asthma claim-rate at 142/1,000 persons (overall health region claim-rate = 108). Environmental exposures varied across the year and demonstrated seasonal patterns. Metro health region regression models showed positive associations between increases in mold and particulate matter <10 microns in diameter (PM10) and outpatient asthma claims.Conclusions: This study provides information about patterns of asthma-related healthcare use across Puerto Rico. Increases in mold and PM10 were associated with increases in asthma claims. Targeting educational interventions on exposure awareness and reduction techniques, especially to persons with higher asthma-related healthcare use, can support asthma control activities in public health and clinical settings.

Keywords: management/ control; Epidemiology; prevention.

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Conflict of interest statement

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Figures

Figure 1.
Figure 1.
Inclusion criteria flowchart for asthma-related healthcare use.
Figure 2.
Figure 2.
Environmental monitoring stations and the municipalities of the Metro Health Region, Puerto Rico, 2013. Abbreviations: AAAAI-NAB = American Academy of Allergy, Asthma, and Immunology National Allergen Bureau; PM = Particulate Matter.
Figure 3.
Figure 3.
Regional variations in asthma claim-rates by healthcare setting, Puerto Rico, 2013.
Figure 4.
Figure 4.
Influenza-like illness rates by Health Region, Puerto Rico, 2013.
Figure 5.
Figure 5.
Environmental exposures and asthma claims by healthcare setting, Puerto Rico, 2013*. Abbreviations: PM = Particulate Matter; ED = Emergency Department. * Mold levels are represented in thousands, ILI counts are represented in hundreds.
See this image and copyright information in PMC

References

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