Exposure to Violence and Asthma Endotypes in Puerto Rican Youth

Abstract

Background and objectives: Exposure to violence has been associated asthma and worse asthma outcomes in youth, but no study has tested for an association between exposure to violence and specific asthma endotypes including T helper (T)2-low endotypes. We sought to determine if exposures to violence are associated with T2-high, T17-high, and T2-low/T17-low endotypes.

Methods: We analyzed data from Puerto Rican youth aged 9-20 years with (cases) and without (controls) asthma in the Epigenetic Variation and Childhood Asthma in Puerto Ricans study (EVA-PR). Using nasal (airway) epithelial transcriptomic profiles, participants with asthma were categorized into T2-high, T17-high, or T2-low/T17-low endotypes. Lifetime exposure to violence (ETV), past year ETV, and gun violence exposure (assessed using the validated ETV Scale questionnaire) and violence-related distress, assessed using the validated Checklist Children's Distress Symptoms questionnaire, were our exposures of interest, and asthma endotype was our outcome of interest.

Results: There were 236 cases (69 (29%) T2-high, 82 (35%) T17-high, and 85 (36%) T2-low/T17-low) and 243 controls. In multivariable analyses, ETV was associated with T17-high asthma (odds ratio [OR]=1.13, 95% confidence interval [CI]=1.002-1.274), gun violence exposure was associated with both T2-high asthma (OR=2.49, 95% CI=1.22-5.08) and T17-high asthma (OR=1.99, 95% CI=1.05-3.74), and violence-related distress was associated with T2-high asthma (OR=1.69, 95% CI=1.11-2.59). Neither exposure to violence nor related distress was associated with T2-low/T17-low asthma.

Conclusions: Exposure to violence or related distress was associated with T2-high asthma and T17-high asthma, but not T2-low/T17-low asthma in Puerto Rican youth, a minoritized population with high asthma burden.