Elevated Asthma Morbidity In Puerto Rican Children: Differences in Asthma Prevalence and Morbidity

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Research indicates that asthma prevalence rates vary among subgroups of Latino children, but little is known about differences in morbidity. Table 1 summarizes key studies indicating that mainland and island Puerto Rican children have the highest asthma prevalence of all Latino and non-Latino children in the United States.
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Using data from HHANES, Carter-Pokras and Gergen estimated a point prevalence of asthma for Mexican American children (2.7%) similar to that of non-Hispanic white children (3.3%), but much lower than that of mainland Puerto Rican children (11.2%), non-Hispanic black children (5.9%), and Cuban American сЫШгеп (5.2%). Lifetime prevalence of asthma was 20.1% among mainland Puerto Rican, 8.8% among Cuban American, and 4.5% among Mexican American children.

TABLE 1 .— Studies Estimating the Prevalence of Asthma Among US Latino Children: 1993-1996

				Lifetime Prevalence		Period Prevalence
Source	Age	Location	Ethnicity	Ever diagnosed? (%)	Ever wheezed? (%)	Had asthma in the last 12months?(%)	Wheezed in the last Umonths?(%)
Carter-Pokras (1993)	6 months-11 years	New York City	Mainland Puerto Rican	20.1	——–	11.2	————-
		Southwest Miami	Mexican American Cuban American	4.5 8.8	——–	2.7 5.2	———
			Non-Hispanic black	9.1	———–	5.9	———
			Non-Hispanic white	6.4	——–	3.3	———
Crain (1994)	0-17 years	New York City	Hispanicf	17.9	——–	10.0	12.9
			Black	11.6	——–	6,9	12.7
			White	8.2	——–	7.6	14.0
Orengo (1996)	6-7 years	Puerto Rico	Island Puerto Rican	45-7	48-51	———-	29-ЗЗ
	13-14 years			25-28	34-39	———-	23-25
Becket (1996)		Connecticut	Hispanict	18.4	———–	————–	———
			Black	11.3	——–	———-	———
			White	7.4	——–	———-	————-

Two additional studies corroborate the high prevalence of asthma among mainland Puerto Rican children. In the Bronx, New York, where most Latino children are mainland Puerto Rican, Crain found that the 12-month period prevalence of asthma was 10% among Hispanic children, as compared to 6.9% among blacks and 7.6% among whites. Lifetime asthma prevalence was 17.9% among Hispanic, 11.6% among black, and 8.2% among white children. These ethnic-specific differences in prevalence persisted after controlling for income and were based on a random-digit parent telephone survey. In Connecticut, where Hispanics are mostly Puerto Rican, Beckett reported a lifetime asthma prevalence of 18.4% among children of Hispanic mothers, compared to a lifetime prevalence of 11.3% among blacks and 7.4% among whites. These prevalence estimates were based on maternal reports in a statewide representative sample of English-speaking women who had recently given birth. The increased risk for physician-diagnosed asthma among Hispanics in this data set persisted after controlling for socioeconomic status and active smoking in the home. flomax canada

Orengo has also described very high prevalences of asthma among children on the island of Puerto Rico. Investigators used a parent and adolescent population-based school survey that followed the protocol of the International Study of Asthma and Allergies in Child Health (ISAAC). They found that the lifetime prevalence of asthma was about 50% for 6-to 7-year-olds, as reported by their parents, and about 30% for 13- to 14-year-olds, as reported by themselves. In addition, about one third of 6- to 7-year-olds and about one quarter of 13- to 14-year-old island Puerto Rican children had had symptoms of asthma in the last year. The investigators conducted the above study in two towns in Puerto Rico, the industrial town of Catano, where the community suspected asthma problems to be associated with high air pollution levels, and a control town. No appreciable differences in asthma prevalence were found between the two towns. buy Levaquin 500 mg

Other differences in asthma morbidity among Latino children have not been studied in national population-based samples. Data from clinical settings, however, indicate that Latino children experience significant asthma morbidity. Of Mexican American children with moderate to severe asthma who attended an outpatient clinic in Texas, 67% had been hospitalized previously, and 74% had experienced at least an occasional limitation in their ability to play. These children also missed an average of 13 days of school per year because of asthma. The results of the National Collaborative Inner-City Asthma Study (NCICAS) indicated that significant asthma morbidity occurred in Latino children, who formed about 20% of the total sample. They were predominantly mainland Puerto Rican children living in New York City or mainland Puerto Rican and Mexican American children living in Chicago. The 291 Latino children included in the NCICAS sample had experienced an average of 3.7 days of wheezing during the previous two weeks, compared to an average of 3.2 days experienced by African American children (P < 0.01). After comparisons between Latino and African American children were adjusted for the two cities where most Latino children lived, Chicago and New York, this difference in morbidity was no longer statistically significant in this small study sample.

Data on childhood asthma prevalence and morbidity in Latino subgroups are limited by possible measurement errors associated with differences between studies to date in selection methods, participation rates, and definitions of both asthma and Latino ethnicity. Studies have not reported consistent findings with regard to the effect of socioeconomic status on morbidity. Although asthma is probably caused by multiple risk factors, most research to date has observed only bivariate (crude) comparisons between asthma and one risk factor. In spite of these methodological limitations, the observed differences in prevalence are particularly large. We will review possible risk and prognostic factors that can be applied in future research to explain the above differences, although these factors have been identified in mostly non-Latino populations. buy Atomoxetine online