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

• Published in: Journal of allergy and clinical immunology Vol. 124; no. 2; pp. 238 - 244.e5
• Main Authors: Esteban, Cynthia A., Klein, Robert B., McQuaid, Elizabeth L., Fritz, Gregory K., Seifer, Ronald, Kopel, Sheryl J., Santana, Jose Rodriguez, Colon, Angel, Alvarez, Maria, Koinis-Mitchell, Daphne, Ortega, Alexander N., Martinez-Nieves, Brenda, Canino, Glorisa
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.2009; Elsevier; Elsevier Limited
• 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; Central America; Rhode Island; Puerto Rico; United States; America; West Indies; North America; United States > US; severity; Rhode Island; PR; clinical guidelines; health care use; control; RIPRAC; Dominican; Puerto Rican; GALA; Asthma; GINA; Global Initiative for Asthma; Latino; RI; EPR-3; EPR-2; ED; Puerto Rico; Genetics of Asthma in Latino Americans; Rhode Island–Puerto Rico Asthma Center; Emergency department; Expert Panel Report 2; Expert Panel Report 3; Latinamerican; Immunology; Bronchus disease; Obstructive pulmonary disease; Diagnosis; Child; Human; Lung disease; Immunopathology; Respiratory disease; Health; Use; Severity; Ethnic group; Recommendation; Care; Comparative study
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2009.05.014

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. 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. 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. 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. 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.