Conundrums in childhood asthma severity, control, and health care use: Puerto Rico versus Rhode Island - 20/08/11
, Robert B. Klein, MD a, Elizabeth L. McQuaid, PhD b, Gregory K. Fritz, MD b, Ronald Seifer, PhD f, Sheryl J. Kopel, MSc b, Jose Rodriguez Santana, MD d, Angel Colon, MD d, Maria Alvarez, MD d, Daphne Koinis-Mitchell, PhD b, Alexander N. Ortega, PhD e, Brenda Martinez-Nieves, PhD c, Glorisa Canino, PhD c
Reprint requests: Cynthia Esteban, MSN, MPH, Asthma and Allergy Center, 1 Hoppin St, Suite 304A, Providence, RI 02903.Abstract |
Background |
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.
Objective |
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.
Methods |
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.
Results |
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.
Conclusions |
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.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, severity, control, clinical guidelines, Global Initiative for Asthma, Latino, Puerto Rican, Dominican, Rhode Island, health care use
Abbreviations used : ED, EPR-2, EPR-3, GALA, GINA, PR, RI, RIPRAC
Plan
| Supported by U01-H1072438 (G. C. and G. F, P.I.s) from the National Heart, Lung, and Blood Institute. G. C.’s time is also supported by 5P60 MD002261-02 from the National Center of Minority Health and Health Disparities. |
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| Disclosure of potential conflict of interest: E. L. McQuaid has received research support from the National Institute of Nursing Research, National Institute of Children’s Health and Development, and the National Heart, Lung, and Blood Institute. G. K. Fritz has received research support from the National Heart, Lung, and Blood Institute and National Institute of Mental Health, and is an editor at Wiley-Blackwell Publishing. R. Seifer has received research support from the National Institutes of Health, the Administration for Children and Families, the National Science Foundation, and the Substance Abuse and Mental Health Services Administration. D. Koinis-Mitchell has received research support from the National Institute of Allergy and Infectious Diseases and the National Heart, Lung, and Blood Institute. A. N. Ortega has received research support from the National Institute of Mental Health. The rest of the authors have declared that they have no conflict of interest. |
Vol 124 - N° 2
P. 238 - août 2009 Retour au numéro
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