title: Heterogeneity of childhood asthma among Hispanic children: Puerto Rican children bear a disproportionate burden.
abstract: OBJECTIVE
  To estimate differences in asthma prevalence among Hispanic subgroups and non-Hispanic children living in the United States and to explore the association between these differences and risk factors.
  
  
  METHODS
  Weighted logistic regression analyses of merged 1997 to 2001 National Health Interview Survey data were used to estimate the prevalence of asthma diagnosis and asthma attacks in a sample of 46511 children (age: 2-17 years) living in the 50 states and the District of Columbia.
  
  
  RESULTS
  Puerto Rican children had the highest prevalence of lifetime asthma (26%) and recent asthma attacks (12%), compared with non-Hispanic black children (16% and 7%, respectively), non-Hispanic white children (13% and 6%, respectively), and Mexican children (10% and 4%, respectively). Adjustment for asthma risk factors did not change these comparisons appreciably. Compared with non-Hispanic white children, the adjusted odds ratios (ORs) for a lifetime asthma diagnosis were 2.33 (95% confidence interval [CI]: 1.90-2.84) for Puerto Rican children, 1.16 (95% CI: 1.04-1.29) for non-Hispanic black children, and 0.90 (95% CI: 0.79-1.03) for Mexican children. Birthplace influenced the association between ethnicity and lifetime asthma diagnosis differently for Puerto Rican and Mexican children. Compared with United States-born non-Hispanic white children with United States-born parents, the adjusted ORs were 1.95 (95% CI: 1.48-2.57) for Puerto Rican children in families with the child and parent(s) born in the 50 states/District of Columbia and 2.50 (95% CI: 1.51-4.13) for island-born Puerto Rican children with island-born parents. The corresponding adjusted ORs for Mexican children were 1.05 (95% CI: 0.90-1.22) for families born in the 50 states/District of Columbia and 0.43 (95% CI: 0.29-0.64) for those born in Mexico. The results were similar for recent asthma attacks.
  
  
  CONCLUSIONS
  The appreciably higher asthma morbidity rates experienced by Puerto Rican children cannot be explained by sociodemographic and other risk factors measured in the National Health Interview Survey. The heterogeneity of asthma among Hispanic subgroups should be considered in developing effective public health prevention and intervention strategies.
authors.affiliation: University of California, Los Angeles/RAND Program on Latino Children with Asthma, Los Angeles, California, USA. lara@rand.org
authors.forename: Marielena
authors.initials: M
authors.lastname: Lara
authors.forename: Lara
authors.initials: L
authors.lastname: Akinbami
authors.forename: Glenn
authors.initials: G
authors.lastname: Flores
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
mesh_terms: D000293:Adolescent; D001741:Black or African American; D001249:Asthma / Q000453:epidemiology / Q000208:ethnology*; D002648:Child; D002675:Child, Preschool; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015995:Prevalence; D011647:Puerto Rico / Q000208:ethnology; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People