Caribbean Latinx with moderate-severe asthma bear greater asthma morbidity than other Latinx

Juan Carlos Cardet¹, Kartik Shenoy², Ahmet Baydur³, Jennifer K Carroll⁴, Juan Carlos Celedón⁵, Jing Cui⁶, Prajwal Dara⁷, Brianna Ericson⁸, Victoria E Forth⁸, Maureen Fagan⁹, Anne L Fuhlbrigge¹⁰, Rohit Gupta², Mary K Hart¹¹, Michelle L Hernandez¹², Paulina Arias Hernandez⁸, Jean Kruse⁸, Nancy E Maher⁸, Brian K Manning¹³, Victor M Pinto-Plata¹⁴, Janet Robles¹⁵, Jacqueline Rodriguez-Louis⁸, Joel B Shields¹³, Bonnie S Telon Sosa¹⁶, Michael E Wechsler¹⁷, Elliot Israel¹⁸

Affiliations

¹ Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla.
² Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa.
³ Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
⁴ American Academy of Family Physicians National Research Network, Leawood, Kan; Department of Family Medicine, University of Colorado School of Medicine, University of Colorado, Aurora, Colo.
⁵ Division of Pediatric Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pa.
⁶ Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass.
⁷ Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla.
⁸ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass.
⁹ University of Miami Health System, Miami, Fla.
¹⁰ Department of Medicine, Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, University of Colorado, Aurora, Colo.
¹¹ Allergy and Asthma Network, Vienna, Va.
¹² Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC.
¹³ American Academy of Family Physicians National Research Network, Leawood, Kan.
¹⁴ Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Mass.
¹⁵ Patient partner/advisor, New York, NY.
¹⁶ Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico: Medical Sciences Campus, San Juan, Puerto Rico.
¹⁷ Department of Medicine, NJH Cohen Family Asthma Institute, National Jewish Health, Denver, Colo.
¹⁸ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass. Electronic address: eisrael@bwh.harvard.edu.

PMID: 35779669
PMCID: PMC9643605
DOI: 10.1016/j.jaci.2022.05.026

Caribbean Latinx with moderate-severe asthma bear greater asthma morbidity than other Latinx

Juan Carlos Cardet et al. J Allergy Clin Immunol. 2022 Nov.

. 2022 Nov;150(5):1106-1113.e10.

doi: 10.1016/j.jaci.2022.05.026. Epub 2022 Jun 30.

Authors

Affiliations

¹ Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla.
² Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa.
³ Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
⁴ American Academy of Family Physicians National Research Network, Leawood, Kan; Department of Family Medicine, University of Colorado School of Medicine, University of Colorado, Aurora, Colo.
⁵ Division of Pediatric Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pa.
⁶ Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass.
⁷ Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla.
⁸ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass.
⁹ University of Miami Health System, Miami, Fla.
¹⁰ Department of Medicine, Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, University of Colorado, Aurora, Colo.
¹¹ Allergy and Asthma Network, Vienna, Va.
¹² Division of Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC.
¹³ American Academy of Family Physicians National Research Network, Leawood, Kan.
¹⁴ Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Mass.
¹⁵ Patient partner/advisor, New York, NY.
¹⁶ Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico: Medical Sciences Campus, San Juan, Puerto Rico.
¹⁷ Department of Medicine, NJH Cohen Family Asthma Institute, National Jewish Health, Denver, Colo.
¹⁸ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass. Electronic address: eisrael@bwh.harvard.edu.

PMID: 35779669
PMCID: PMC9643605
DOI: 10.1016/j.jaci.2022.05.026

Abstract

Background: Hispanic/Latinx (HL) ethnicity encompasses racially and culturally diverse subgroups. Studies suggest that Puerto Ricans (PR) may bear greater asthma-related morbidity than Mexicans, but these were conducted in children or had limited clinical characterization.

Objectives: This study sought to determine whether disparities in asthma morbidity exist among HL adult subgroups.

Methods: Adults with moderate-severe asthma were recruited from US clinics, including from Puerto Rico, for the Person Empowered Asthma Relief (PREPARE) trial. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans [C&D]), the investigators compared baseline self-reported clinical characteristics between Caribbean HL (CHL) (PR and C&D: n = 457) and other HLs (OHL) (Mexicans, Spaniards, Central/South Americans; n = 141), and between CHL subgroups (C&D [n = 56] and PR [n = 401]). This study compared asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids, emergency department/urgent care (ED/UC) visits, hospitalizations, health care utilization) through negative binomial regression.

Results: CHL compared to OHL were similar in age, body mass index, poverty status, blood eosinophils, and fractional exhaled nitric oxide but were prescribed more asthma controller therapies. Relative to OHL, CHL had significantly increased odds of asthma exacerbations (odds ratio [OR]: 1.84; 95% CI: 1.4-2.4), ED/UC visits (OR: 1.88; 95% CI: 1.4-2.5), hospitalization (OR: 1.98; 95% CI: 1.06-3.7), and health care utilization (OR: 1.91; 95% CI: 1.44-2.53). Of the CHL subgroups, PR had significantly increased odds of asthma exacerbations, ED/UC visits, hospitalizations, and health care utilization compared to OHL, whereas C&D only had increased odds of exacerbations compared to OHL. PR compared to C&D had greater odds of ED/UC and health care utilization.

Conclusions: CHL adults, compared with OHL, adults reported nearly twice the asthma morbidity; these differences are primarily driven by PR. Novel interventions are needed to reduce morbidity in this highly impacted population.

Trial registration: ClinicalTrials.gov NCT02995733.

Keywords: Cubans; Dominicans; ED visits; Health care disparities; Puerto Ricans; asthma exacerbations; health care utilization; hospitalizations; minority health; severe persistent asthma.

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Figures

**Figure 1:**
Forest plot comparing Caribbean Hispanic/Latinx (Puerto Ricans, Cubans, and Dominicans) vs. Other Hispanic/Latinx (Mexicans, Central and South Americans, and Spaniards) using negative binomial regression and controlling for age, sex, BMI, household income, preferred language, asthma controller therapy, medical comorbidities, perceived stress, employment, education, smoking status, and depression. Values to the right of the vertical line mean greater odds of outcomes for Caribbean Hispanic/Latinx.

**Figure 2:**
Forest plot comparing Puerto Ricans vs. Other Hispanic/Latinx (Mexicans, Central and South Americans, and Spaniards) using negative binomial regression controlling for age, sex, BMI, household income, preferred language, asthma controller therapy, medical comorbidities, perceived stress, employment, education, smoking status, and depression. Values to the right of the vertical line mean greater odds of outcomes for Puerto Ricans.

**Figure 3:**
Cubans and Dominicans vs. Other Hispanic/Latinx (Mexicans, Central and South Americans, and Spaniards) using negative binomial regression controlling for age, sex, BMI, household income, preferred language, asthma controller therapy, medical comorbidities, perceived stress, employment, education, smoking status, and depression. Values to the right of the vertical line mean greater odds of outcomes for Cubans and Dominicans.

**Figure 4:**
Puerto Ricans vs. Cubans and Dominicans using negative binomial regression controlling for age, sex, BMI, household income, preferred language, asthma controller therapy, medical comorbidities, perceived stress, employment, education, smoking status, and depression. Values to the right of the vertical line mean greater odds of outcomes for Puerto Ricans.

**Figure 5:**
Mainland Puerto Ricans vs. island Puerto Ricans using negative binomial regression controlling for age, sex, BMI, household income, preferred language, asthma controller therapy, medical comorbidities, perceived stress, employment, education, smoking status, and depression. Values to the right of the vertical line mean greater odds of outcomes for mainland Puerto Ricans.

See this image and copyright information in PMC

References

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Caribbean Latinx with moderate-severe asthma bear greater asthma morbidity than other Latinx

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Caribbean Latinx with moderate-severe asthma bear greater asthma morbidity than other Latinx

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