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.
Latino children represent a significant proportion of all US children, and asthma is the most common chronic illness affecting them. Previous research has revealed surprising differences in health among Latino children with asthma of varying countries of family origin. For instance, Puerto Rican children have a higher prevalence of asthma than Mexican American or Cuban American children. In addition, there are important differences in family structure and socioeconomic status among these Latino populations: Cuban Americans have higher levels of education and family income than Mexican-Americans and Puerto Ricans; mainland Puerto Rican children have the highest proportion of households led by a single mother. Our review of past research documents differences in asthma outcomes among Latino children and identifies the possible genetic, environmental, and health care factors associated with these differences. Based on this review, we propose research studies designed to differentiate between mutable and immutable risk and prognostic factors. We also propose that the sociocultural milieus of Latino subgroups of different ethnic and geographic origin are associated with varying patterns of risk factors that in turn lead to different morbidity patterns. Our analysis provides a blueprint for future research, policy development, and the evaluation of multifactorial interventions involving the collaboration of multiple social sectors, such as health care, public health, education, and public and private agencies. 
We conducted a retrospective analysis of 1992 hospital discharge data to determine the incidence of mental illness hospitalizations among elementary-school-aged children and to analyze differences in hospital use by selected population characteristics. We analyzed population-based records of hospitalizations of 6- to 12-year-olds (n = 4,460) with a principal diagnosis of mental illness and calculated relative risks (RRs) for hospitalization by sex, race/ethnicity, and payment source. Mental illnesses accounted for 8.1% of hospitalizations and 28.9% of hospital days for 6- to 12-year-olds. Hospital charges totaled $85 million. Boys had a higher risk of mental illness hospitalization than girls (RR 1.96; 95% confidence interval [CI] 1.84-2.08). Latino children had a lower risk than whites (RR 0.22; 95% CI 0.20-0.24), as did children in the “Asian/other” group (RR 0.12, 95% CI 0.10-0.15). Inpatient hospitalizations for mental illness have a major impact on hospital morbidity for elementary-school-age children. Boys are overrepresented and Latinos and Asians/others are underrepresented among mental illness hospitalizations. Clinical implications for these findings and barriers to the delivery of inpatient mental health care are discussed.