title: Pulmonary Disease and Age at Immigration among Hispanics. Results from the Hispanic Community Health Study/Study of Latinos.
abstract: BACKGROUND
  Asthma has been reported to be more prevalent among Hispanics of Puerto Rican heritage than among other Hispanics and among Hispanics born in the United States or who immigrated as children than among those who came as adults; however, direct comparisons across Hispanic groups are lacking.
  
  
  OBJECTIVE
  To test whether asthma is more prevalent among Hispanics of Puerto Rican heritage than among other Hispanic groups, whether asthma is associated with age of immigration, and whether chronic obstructive pulmonary disease varies by heritage in a large, population-based cohort of Hispanics in the United States.
  
  
  METHODS
  The Hispanic Community Health Study/Study of Latinos researchers recruited a population-based probability sample of 16,415 Hispanics/Latinos, 18-74 years of age, in New York City, Chicago, Miami, and San Diego. Participants self-reported Puerto Rican, Cuban, Dominican, Mexican, Central American, or South American heritage; birthplace; and, if relevant, age at immigration. A respiratory questionnaire and standardized spirometry were performed with post-bronchodilator measures for those with airflow limitation.
  
  
  RESULTS
  The prevalence of physician-diagnosed asthma among Puerto Ricans (36.5%; 95% confidence interval, 33.6-39.5%) was higher than among other Hispanics (odds ratio, 3.9; 95% confidence interval, 3.3-4.6). Hispanics who were born in the mainland United States or had immigrated as children had a higher asthma prevalence than those who had immigrated as adults (19.6, 19.4, and 14.1%, respectively; P < 0.001). Current asthma, bronchodilator responsiveness, and wheeze followed similar patterns. Chronic obstructive pulmonary disease prevalence was higher among Puerto Ricans (14.1%) and Cubans (9.8%) than among other Hispanics (<6.0%), but it did not vary across Hispanic heritages after adjustment for smoking and prior asthma (P = 0.22), by country of birth, or by age at immigration.
  
  
  CONCLUSIONS
  Asthma was more prevalent among Puerto Ricans, other Hispanics born in the United States, and those who had immigrated as children than among other Hispanics. In contrast, the higher prevalence of chronic obstructive pulmonary disease among Puerto Ricans and Cubans was largely reflective of differential smoking patterns and asthma.
authors.affiliation: 1 Department of Medicine and.|2 Department of Epidemiology, Columbia University Medical Center, New York, New York.
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
authors.affiliation: 3 Division of Cardiovascular Sciences, NHLBI, National Institutes of Health, Bethesda, Maryland.
authors.forename: Larissa
authors.initials: L
authors.lastname: Avilés-Santa
authors.affiliation: 4 Department of Biostatistics and.
authors.forename: Sonia M
authors.initials: SM
authors.lastname: Davis
authors.affiliation: 5 Department of Medicine and.
authors.forename: Tom K
authors.initials: TK
authors.lastname: Aldrich
authors.affiliation: 4 Department of Biostatistics and.
authors.forename: Franklyn
authors.initials: F
authors.lastname: Gonzalez
authors.affiliation: 6 Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Ashley G
authors.initials: AG
authors.lastname: Henderson
authors.affiliation: 7 Department of Epidemiology, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.affiliation: 4 Department of Biostatistics and.
authors.forename: Lisa
authors.initials: L
authors.lastname: LaVange
authors.affiliation: 8 Department of Preventative Medicine and.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: 9 Department of Medicine, University of California, San Diego, La Jolla, California; and.
authors.forename: Jose S
authors.initials: JS
authors.lastname: Loredo
authors.affiliation: 10 Department of Medicine, University of Miami, Miami, Florida.
authors.forename: Eliana S
authors.initials: ES
authors.lastname: Mendes
authors.affiliation: 4 Department of Biostatistics and.
authors.forename: Ai
authors.initials: A
authors.lastname: Ni
authors.affiliation: 9 Department of Medicine, University of California, San Diego, La Jolla, California; and.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ries
authors.affiliation: 10 Department of Medicine, University of Miami, Miami, Florida.
authors.forename: Matthias
authors.initials: M
authors.lastname: Salathe
authors.affiliation: 11 Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Smith
mesh_terms: D000328:Adult; D000367:Age Factors; D001249:Asthma / Q000453:epidemiology*; D002489:Central America / Q000208:ethnology; D015331:Cohort Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D004641:Emigration and Immigration; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000208:ethnology* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008800:Mexico / Q000208:ethnology; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012307:Risk Factors; D013020:South America / Q000208:ethnology; D013147:Spirometry; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014900:West Indies / Q000208:ethnology
keywords: asthma; chronic obstructive pulmonary disease; race/ethnicity; social determinants of health