Conundrums in childhood asthma severity, control, and health care use: Puerto Rico versus Rhode Island.
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.
Esteban
Cynthia A
CA
Department of Pediatrics, Division of Allergy and Immunology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA. Cesteban@Lifespan.org
Klein
Robert B
RB
McQuaid
Elizabeth L
EL
Fritz
Gregory K
GK
Seifer
Ronald
R
Kopel
Sheryl J
SJ
Santana
Jose Rodriguez
JR
Colon
Angel
A
Alvarez
Maria
M
Koinis-Mitchell
Daphne
D
Ortega
Alexander N
AN
Martinez-Nieves
Brenda
B
Canino
Glorisa
G
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D044382:Population Groups / Q000208:ethnology / Q000706:statistics & numerical data; D011647:Puerto Rico / Q000453:epidemiology; D012237:Rhode Island / Q000453:epidemiology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors
D018927:Anti-Asthmatic Agents