Area of Residence, Birthplace, and Asthma in Puerto Rican Children

doi:10.1378/chest.06-1917

Chest

Volume 131, Issue 5, May 2007, Pages 1331-1338

https://doi.org/10.1378/chest.06-1917 Get rights and content

Rationale

Puerto Ricans have the highest prevalence of asthma among all ethnic groups in the United States. There have been no studies that directly compare the burden of asthma between Puerto Ricans living in Puerto Rico and those living in the mainland United States

Objective

To examine the relation between birthplace, area of residence, and asthma in Puerto Rican children.

Methods

Multistage population-based probability sample of children in the San Juan and Caguas metropolitan areas in Puerto Rico and in the Bronx, NY. Information was collected in a household survey of 2,491 children and their primary caretakers.

Results

The overall prevalence of asthma among Puerto Rican children in this study was very high (38.6%). Although children from Puerto Rico had higher socioeconomic status and lower rates of premature birth and prenatal smoke exposure, the prevalence of lifetime asthma was higher in Puerto Rican children living in Puerto Rico than in Puerto Rican children living in the South Bronx (41.3% vs 35.3%, p = 0.01). In multivariable analysis, residence in Puerto Rico was associated with increased odds of lifetime asthma (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.03 to 1.57) and lifetime hospitalization for asthma (OR, 1.47; 95% CI, 1.04–2.07).

Conclusions

Puerto Rican children in Puerto Rico had a higher risk of asthma than Puerto Rican children in the South Bronx, highlighting the need for further examination of the roles of migration, acculturation, and environmental and psychosocial factors on the development of asthma in this high-risk population.

Section snippets

Materials and Methods

This was a population-based prospective cohort study of the prevalence of antisocial behaviors and associated comorbid conditions (eg, asthma) among Puerto Rican children in each of two sites. Children in the South Bronx (New York) and the standard metropolitan areas of San Juan and Caguas (Puerto Rico) were enrolled from July 2001 through August 2003. The study was approved by the Institutional Review Boards of the New York State Psychiatric Institute and the University of Puerto Rico Medical

Procedures

Families were invited to participate by trained interviewers who visited each randomly selected household. Initial contact was attempted up to six times per household. Informed consent was obtained from the parents of each participant. Structured questionnaire interviews were conducted in English and/or Spanish based on the preferences of the participants.

Measures

All measures included in this analysis were based on parent/guardian responses to interview questions. The study instrument was part of the Service Utilization and Risk Factors interview that was developed for the Epidemiology of Childhood and Mental Disorders Study⁷ for the purposes of assessing the presence of risk factors associated with mental illness. Psychometric properties of the specific components of the Service Utilization and Risk Factors interview (ie, medical history,

Data Analysis

The samples were weighted to represent the age and gender distribution of the populations of Puerto Rican children in the South Bronx and the standard metropolitan areas in Puerto Rico on the basis of the 2000 US Census. Weighted analysis was conducted (SUDAAN Software, Version 8; Research Triangle Institute; Research Triangle Park, NC) to adjust SEs for intraclass correlations induced by multistage sampling, with children nested within households and households nested within primary sampling

Results

Figure 1 shows the schema for enrollment into the study by individual study site. Based on the sampling design, a total of 21,185 households were randomly selected for inclusion in the study; 20,681 households (97.6%) were successfully contacted. Of these 20,681 households, 1,853 households (9.0%) with 2,940 children were eligible for the study. However, 449 of 2,940 eligible children did not participate in the study because of parental refusal or repeated unavailability (three or more

Discussion

In our study, Puerto Rican children from the South Bronx were more likely to be born prematurely, to have mothers who smoked during pregnancy, and to have families with lower SES than island Puerto Rican children. Surprisingly, however, children living in Puerto Rico were more likely to have asthma and to have been hospitalized for asthma than Puerto Rican children living in the South Bronx.

Previous studies have demonstrated a high prevalence of asthma among children in Puerto Rico. Two

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Hispanic/Latinx (HL) ethnicity encompasses racially and culturally diverse subgroups. Studies suggest that Puerto Ricans (PR) may bear greater asthma-related morbidity than Mexicans, but these were conducted in children or had limited clinical characterization.
This study sought to determine whether disparities in asthma morbidity exist among HL adult subgroups.
Adults with moderate-severe asthma were recruited from US clinics, including from Puerto Rico, for the Person Empowered Asthma Relief (PREPARE) trial. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans [C&D]), the investigators compared baseline self-reported clinical characteristics between Caribbean HL (CHL) (PR and C&D: n = 457) and other HLs (OHL) (Mexicans, Spaniards, Central/South Americans; n = 141), and between CHL subgroups (C&D [n = 56] and PR [n = 401]). This study compared asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids, emergency department/urgent care (ED/UC) visits, hospitalizations, health care utilization) through negative binomial regression.
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CHL adults, compared with OHL, adults reported nearly twice the asthma morbidity; these differences are primarily driven by PR. Novel interventions are needed to reduce morbidity in this highly impacted population.
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Effect of Relocation to the U.S. on Asthma Risk Among Hispanics
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Citation Excerpt :
It was also observed that although Puerto Ricans were more likely to relocate as children, the association between relocation to the U.S. and asthma in that group was not strong, suggesting that other factors play a role in asthma development, and that these findings cannot be explained by early age at immigration alone. Findings of one previous study suggest that Puerto Rican children born in and residing in Puerto Rico had higher asthma prevalence than children of Puerto Rican descent residing in the Bronx.30 Recently, more than double the prevalence of current asthma was observed in surveys of Hispanic adults in U.S. mainland Puerto Ricans compared with residents in Puerto Rico.40
Asthma prevalence is reportedly higher among U.S.-born relative to foreign-born Hispanics/Latinos. Little is known about rates of asthma onset before and after relocation to the U.S. in Latinos. Asthma rates were examined by U.S. residence and country/territory of origin.
In 2015–2016, age at first onset of asthma symptoms was analyzed, defined retrospectively from a cross-sectional survey in 2008–2011, in relation to birthplace and U.S. residence among 15,573 U.S.-dwelling participants (aged 18–76 years) in the Hispanic Community Health Study/Study of Latinos.
Cumulative incidence of asthma through age 30 years ranged from 7.9% among Mexican background individuals to 29.4% among those of Puerto Rican background. Among those born outside the U.S. mainland, the adjusted hazard for asthma was 1.52-fold higher (95% CI=1.25, 1.85) after relocation versus before relocation to the U.S. mainland, with heterogeneity in this association by Hispanic/Latino background (p-interaction<0.0001). Among foreign-born Dominicans and Mexicans, rates of asthma were greater after relocation versus before relocation (adjusted hazard ratio [AHR] for after versus before relocation, 2.42, 95% CI=1.44, 4.05 among Dominicans; AHR=2.90, 95% CI=2.02, 4.16 among Mexicans). Puerto Ricans had modestly increased asthma onset associated with U.S. mainland residence (AHR=1.52, 95% CI=1.06, 2.17). No similar increase associated with U.S. residence was observed among Central/South American immigrants (AHR=0.94, 95% CI=0.53, 1.67). Asthma rates among Cuban immigrants were lower after relocation (AHR=0.45, 95% CI=0.24, 0.82).
The effect of relocation to the U.S. on asthma risk among Hispanics is not uniform across Hispanic/Latino groups.
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Reductions of zooplankton biomasses and grazing pressures were observed during overfishing-induced trophic cascades and concurrent oil spills at global scales. Recent phytoplankton increments followed, once Fe-, P-, and N-nutrient limitations of commensal diazotrophs and dinoflagellates were also eliminated by respective human desertification, deforestation, and eutrophication during climate changes. Si-limitation of diatoms instead ensued during these last anthropogenic perturbations of agricultural effluents and sewage loadings. Consequently, ~ 15% of total world-wide annual asthma trigger responses, i.e. amounting to ~ 45 million adjacent humans during 2004, resulted from brevetoxin and palytoxin poisons in aerosol forms of western boundary current origins. They were denoted by greater global harmful algal bloom [HAB] abundances and breathing attacks among sea-side children during prior decadal surveys of asthma prevalence, compiled here in ten paired shelf ecosystems of western and eutrophied boundary currents. Since 1965, such inferred onshore fluxes of aerosolized DOC poisons of HABs may have served as additional wind-borne organic carriers of toxic marine MeHg, phthalate, and DDT/DDE vectors, traced by radio-iodine isotopes to potentially elicit carcinomas. During these exchanges, as much as 40% of mercury poisonings may instead have been effected by inhalation of collateral HAB-carried marine neurotoxic aerosols of MeHg, not just from eating marine fish. Health impacts in some areas were additional asthma and pneumonia episodes, as well as endocrine disruptions among the same adjacent humans, with known large local rates of thyroid cancers, physician-diagnosed pulmonary problems, and ubiquitous high indices of mercury in hair, pesticides in breast milk, and phthalates in urine.
Gun Violence, African Ancestry, and Asthma A Case-Control Study in Puerto Rican Children
2016, Chest
Citation Excerpt :
For the multivariate analysis, we used a stepwise approach to build the logistic (for asthma) or linear (for total IgE) regression models. Because of their previously established association with the exposure or outcomes of interest, all models included age,2 sex,36 household income (< vs ≥ $15,000/y [near the median income for households in Puerto Rico in 2008-200937]),38 maternal history of asthma,39 early-life exposure (in utero or before 2 years of age) to environmental tobacco smoke (ETS),40 exposure to gun violence,21 and (for the analysis of the combined cohort) study site.3 The model for total IgE was further adjusted for case-control status.
Exposure to gun violence and African ancestry have been separately associated with increased risk of asthma in Puerto Rican children.
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This is a case-control study of 747 Puerto Rican children aged 9 to 14 years living in San Juan, Puerto Rico (n = 472), and Hartford, Connecticut (n = 275). Exposure to gun violence was defined as the child’s report of hearing gunshots more than once, and the percentage of African ancestry was estimated using genome-wide genotypic data. Asthma was defined as parental report of physician-diagnosed asthma and wheeze in the previous year. Serum total IgE (IU/mL) was measured in study participants. Multivariate logistic and linear regressions were used for the analysis of asthma and total IgE, respectively.
In multivariate analyses, there was a significant interaction between exposure to gun violence and African ancestry on asthma (P = .001) and serum total IgE (P = .04). Among children exposed to gun violence, each quartile increase in the percentage of African ancestry was associated with approximately 45% higher odds of asthma (95% CI, 1.15-1.84; P = .002) and an approximately 19% increment in total IgE (95% , 0.60-40.65, P = .04). In contrast, there was no significant association between African ancestry and asthma or total IgE in children not exposed to gun violence.
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Of the 45,594 subjects, 2792 were ascertained as having anxiety during a mean (SD) follow-up period of 5.3 (2.5) years. Asthma, females, older age, rural residence, depression disorder, and prednisone use were independent risks on anxiety in the fully adjusted model. Anxiety, older age, rural residence, and prednisone use were independent risks on asthma in the fully adjusted model.
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

This study was supported by the National Institute of Mental Health through grant RO1 MH56401 “Antisocial Behaviors in U.S. and Island Puerto Rican Youth” (The Boricua Youth Study) [H.R.B., Principal Investigator]; the National Center for Minority Health and Health Disparities grant P20 MD000537–01 (to G.J.C.); and by National Heart, Lung, and Blood Institute grants 5 T32 HL07424 (to R.T.C.) and HL04370 and HL073373 (to J.C.C.).

None of the authors have received financial support from or have involvement with an organization with any actual or potential financial interest in the subject matter of this article.

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Chest

Original Research: AsthmaArea of Residence, Birthplace, and Asthma in Puerto Rican Children

Rationale

Objective

Methods

Results

Conclusions

Section snippets

Materials and Methods

Procedures

Measures

Data Analysis

Results

Discussion

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Psychosomatics

Chest

Ann Epidemiol

J Pediatr

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

Chest

Heterogeneity of childhood asthma among Hispanic children: Puerto Rican children bear a disproportionate burden

Pediatrics

Asthma prevalence and control characteristics by race/ethnicity: United States, 2002

MMWR Morb Mortal Wkly Rep

Asthma mortality in U.S. Hispanics of Mexican, Puerto Rican, and Cuban heritage, 1990–1995

Am J Respir Crit Care Med

Prevalencia de asma y utilizacion de servicios medicos en asgurados de una compania de servicios de salud en Puerto Rico, 1996–1997

Boletin Asociacion Medica de Puerto Rico

Prevalence and correlates of asthma in the Puerto Rican population: Behavioral Risk Factor Surveillance System, 2000

J Asthma

Measurement of risk for mental disorders and competence in a psychiatric epidemiologic community survey: the National Institute of Mental Health Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study

Soc Psychiatry Psychiatr Epidemiol

The Spanish translation and cultural adaptation of five mental health outcome measures

Cult Med Psychiatry

A cross-cultural adaptation of a psychiatric epidemiologic instrument: the diagnostic interview schedule's adaptation in Puerto Rico

Cult Med Psychiatry

Childhood asthma, chronic illness, and psychiatric disorders

J Nerv Ment Dis

An estimate of the prevalence of asthma and wheezing among inner-city children

Pediatrics

The Hispanic Population in the United States: March 2002

Asthma and Latino cultures: different prevalence reported among groups sharing the same environment

Am J Public Health

Association of psychiatric disorders and different indicators of asthma in island Puerto Rican children

Soc Psychiatry Psychiatr Epidemiol

Infant health among Puerto Ricans: Puerto Rico and U.S. mainland, 1989–2000

MMWR Morb Mortal Wkly Rep

Original Research: Asthma
Area of Residence, Birthplace, and Asthma in Puerto Rican Children