Association between birthplace and current asthma: the role of environment and acculturation

Disaggregating Latino nativity in equity research using electronic health records

OBJECTIVE

To develop and validate prediction models for inference of Latino nativity to advance health equity research.

DATA SOURCES/STUDY SETTING

This study used electronic health records (EHRs) from 19,985 Latino children with self-reported country of birth seeking care from January 1, 2012 to December 31, 2018 at 456 community health centers (CHCs) across 15 states along with census-tract geocoded neighborhood composition and surname data.

STUDY DESIGN

We constructed and evaluated the performance of prediction models within a broad machine learning framework (Super Learner) for the estimation of Latino nativity. Outcomes included binary indicators denoting nativity (US vs. foreign-born) and Latino country of birth (Mexican, Cuban, Guatemalan). The performance of these models was compared using the area under the receiver operating characteristics curve (AUC) from an externally withheld patient sample.

DATA COLLECTION/EXTRACTION METHODS

Census surname lists, census neighborhood composition, and Forebears administrative data were linked to EHR data.

PRINCIPAL FINDINGS

Of the 19,985 Latino patients, 10.7% reported a non-US country of birth (5.1% Mexican, 4.7% Guatemalan, 0.8% Cuban). Overall, prediction models for nativity showed outstanding performance with external validation (US-born vs. foreign: AUC = 0.90; Mexican vs. non-Mexican: AUC = 0.89; Guatemalan vs. non-Guatemalan: AUC = 0.95; Cuban vs. non-Cuban: AUC = 0.99).

CONCLUSIONS

Among challenges facing health equity researchers in health services is the absence of methods for data disaggregation, and the specific ability to determine Latino country of birth (nativity) to inform disparities. Recent interest in more robust health equity research has called attention to the importance of data disaggregation. In a multistate network of CHCs using multilevel inputs from EHR data linked to surname and community data, we developed and validated novel prediction models for the use of available EHR data to infer Latino nativity for health disparities research in primary care and health services research, which is a significant potential methodologic advance in studying this population.

Undocumented Latino Immigrants and the Latino Health Paradox

INTRODUCTION

Despite having worse healthcare access and other social disadvantages, immigrants have, on average, better health outcomes than U.S.-born individuals. For Latino immigrants, this is known as the Latino health paradox. It is unknown whether this phenomenon applies to undocumented immigrants.

METHODS

This study used restricted California Health Interview Survey data from 2015 to 2020. Data were analyzed to test the relationships between citizenship/documentation status and physical and mental health among Latinos and U.S.-born Whites. Analyses were stratified by sex (male/female) and length of U.S. residence (<15 years/>= 15 years).

RESULTS

Undocumented Latino immigrants had lower predicted probabilities of reporting any health condition, asthma, and serious psychological distress and had a higher probability of overweight/obesity than U.S.-born Whites. Despite having a higher probability of overweight/obesity, undocumented Latino immigrants did not have probabilities of reporting diabetes, high blood pressure, or heart disease different from those of U.S.-born Whites after adjusting for having a usual source of care. Undocumented Latina women had a lower predicted probability of reporting any health condition and a higher predicted probability of overweight/obesity than U.S.-born White women. Undocumented Latino men had a lower predicted probability of reporting serious psychological distress than U.S.-born White men. There were no differences in outcomes when comparing shorter- with longer-duration undocumented Latino immigrants.

CONCLUSIONS

This study observed that the Latino health paradox may express patterns for undocumented Latino immigrants that are different from those for other Latino immigrant groups, emphasizing the importance of accounting for documentation status when conducting research on this population.

On the basis of visa type: Insights into incorporation and health among foreign-born people in the United States

Foreign-born people have different patterns of health, and several psychosocial and contextual factors may contribute to these differences. Type of visa with which one resettles is an important consideration because it is linked both with the reason for initially migrating and with experiences after arriving in the U.S. This study examines the association between visa type and health in terms of self-rated health and diagnosed chronic conditions. Using the New Immigrant Survey (NIS), a nationally representative study of foreign-born people at the time of receiving legal permanent residence in the U.S., we used logistic regression models to estimate the odds of having chronic conditions and the odds of reporting fair or poor health. People who had refugee, asylum, parole and post-arrival legalization visa types had the highest prevalence of any chronic condition; they were also most likely to report being in fair or poor self-rated health, even after controlling for other characteristics. Conversely, people who had diversity visas had the highest self-rated health and the fewest chronic conditions. Overall, the type of visa a person holds is associated with health and chronic disease even years after resettlement.

Five-Year Community Surveillance Study for Acute Respiratory Infections Using Text Messaging: Findings From the MoSAIC Study

BACKGROUND

Acute respiratory infections (ARI) are the most common infectious diseases globally. Community surveillance may provide a more comprehensive picture of disease burden than medically attended illness alone.

METHODS

In this longitudinal study conducted from 2012 to 2017 in the Washington Heights/Inwood area of New York City, we enrolled 405 households with 1915 individuals. Households were sent research text messages twice weekly inquiring about ARI symptoms. Research staff confirmed symptoms by follow-up call. If ≥2 criteria for ARI were met (fever/feverish, cough, congestion, pharyngitis, myalgias), staff obtained a mid-turbinate nasal swab in participants' homes. Swabs were tested using the FilmArray reverse transcription polymerase chain reaction (RT-PCR) respiratory panel.

RESULTS

Among participants, 43.9% were children, and 12.8% had a chronic respiratory condition. During the 5 years, 114 724 text messages were sent; the average response rate was 78.8% ± 6.8%. Swabs were collected for 91.4% (2756/3016) of confirmed ARI; 58.7% had a pathogen detected. Rhino/enteroviruses (51.9%), human coronaviruses (13.9%), and influenza (13.2%) were most commonly detected. The overall incidence was 0.62 ARI/person-year, highest (1.73) in <2 year-olds and lowest (0.46) in 18-49 year-olds. Approximately one-fourth of those with ARI sought healthcare; percents differed by pathogen, demographic factors, and presence of a chronic respiratory condition.

CONCLUSIONS

Text messaging is a novel method for community-based surveillance that could be used both seasonally as well as during outbreaks, epidemics and pandemics. The importance of community surveillance to accurately estimate disease burden is underscored by the findings of low rates of care-seeking that varied by demographic factors and pathogens.

Asthma Ambulatory Care Quality in Foreign-Born Latino Children in the United States

BACKGROUND

Foreign-born Latino children in the United States (US) have poor asthma outcomes, but the role of routine care utilization in these outcomes is unclear. Our objective was to compare select ambulatory care utilization measures for asthma between foreign-born Latino, US-born Latino, and non-Hispanic white children.

METHODS

Using a multistate network of clinics with a linked electronic health record, we compared the International Classification of Disease (ICD)-coded asthma diagnosis among those with respiratory symptoms, electronic health records documentation of diagnosis, prescriptions, and influenza vaccination of foreign-born and US-born Latino children, and non-Hispanic white children over a 10+ year study period. We also examined outcomes by country of birth in children from Mexico, Cuba, and Guatemala.

RESULTS

Among our study population (n = 155,902), 134,570 were non-Hispanic white, 19,143 were US-born Latino, and 2189 were foreign-born Latino. Among those with suspicious respiratory symptoms, there was no difference between these groups in the predicted probability of an ICD-coded asthma diagnosis. US-born Latino children with asthma were less likely to have asthma documented on their problem list, more likely to have an albuterol prescription, and less likely to have an inhaled steroid prescribed. All Latino children had higher rates of influenza vaccination than non-Hispanic white children.

CONCLUSIONS

In a national network, there were few disparities between Latino (US- and foreign-born) children and non-Hispanic white comparators in many common asthma care services, except some measures in US-born Latino children. Providers should understand that their US-born Latino children may be at elevated risk for not receiving adequate asthma care.

Latino-white disparities in ICD-coded asthma diagnosis among US children

INTRODUCTION

It is uncertain if disparities in asthma diagnosis between Latino and non-Hispanic white children stem from differences in diagnosis over time among children presenting with similar clinical scenarios suggestive of asthma.

METHODS

We evaluated the odds of International Classification of Disease (ICD)-coded asthma diagnosis in Latino (English and Spanish preferring) and non-Hispanic white children, overall (N = 524,456) and among those presenting with possible asthma indicators (N = 85,516) over a 13-year period, using electronic health record data from a multi-state network of community health centers.

RESULTS

Among those with possible asthma indicators, Spanish-preferring Latinos had lower adjusted odds of ICD-coded asthma diagnosis compared to non-Hispanic whites (OR = 0.87, 95%CI = 0.77-0.99); English-preferring Latinos did not differ from non-Hispanic whites. Differences in ICD-coded diagnosis between ethnicity/language groups varied by presenting symptom.

CONCLUSIONS

Spanish-preferring Latino children may be less-likely to have ICD-coded asthma documented in the EHR when presenting with certain clinical indicators suggestive of asthma. Clinicians should be cognizant of the need for the follow-up of these indicators in Spanish-preferring Latino children.

Health Problems and the Use of Medications and Traditional Therapies among Chinese Immigrants Living in Spain

In this study, we investigate the health problems and the use of medications and traditional therapies among Chinese immigrants in the Southern region of Spain. A qualitative study using semi-structured interviews and including 133 immigrants and 7 stakeholders was conducted in 2017. Transcription, literal reading, and theoretical categorization were performed, and a narrative content analysis was carried out. The most common health problems were musculoskeletal (28.6%) and allergies (25.6%) related to work activity and unhealthy lifestyles. Key informants also reported gastric problems, stress, and changes in eating habits, mostly related to their work activity. For these problems, a large number of traditional remedies (herbs, diet therapy, acupuncture, vitamins, etc.) were used, usually combined with pharmaceutical drugs used for colds, flu, general malaise (29%), pain and fever (23%), and allergy drugs (9.2%). Chinese immigrants reported health conditions associated with their working conditions and life habits in Spain, using Traditional Chinese Medicine instead of pharmacological drugs. Understanding these health problems and promoting awareness towards traditional therapies in the healthcare system may help to design public policies and Health Promotion strategies targeting this group.

Structural racism and its pathways to asthma and atopic dermatitis

Black, Latinx, and Indigenous people in the United States experience a disproportionate burden of asthma and atopic dermatitis. The study of these disease disparities has focused on proximal socioenvironmental exposures and on the biomechanistic (including genetic) differences between racial and ethnic groups. Although biomedical research in allergy and immunology stands to benefit from the inclusion of diverse study populations, the narrow focus on biologic mechanisms disregards the complexity of interactions across biologic and structural factors, including the effects of structural racism. Structural racism is the totality of ways in which society fosters discrimination by creating and reinforcing inequitable systems through intentional policies and practices sanctioned by government and institutions. It is embedded across multiple levels, including the economic, educational, health care, and judicial systems, which are manifested in inequity in the physical and social environment. In this review, we present a conceptual framework and pull from the literature to demonstrate how structural racism is a root cause of atopic disease disparities by way of residential segregation, socioeconomic position, and mass incarceration, which may lead to aberrations in the innate and adaptive immune response and the augmentation of physiologic stress responses, contributing to a disproportionate disease burden for racial and ethnic populations.

Understanding Asthma and Allergies by the Lens of Biodiversity and Epigenetic Changes

Exposure to different organisms (bacteria, mold, virus, protozoan, helminths, among others) can induce epigenetic changes affecting the modulation of immune responses and consequently increasing the susceptibility to inflammatory diseases. Epigenomic regulatory features are highly affected during embryonic development and are responsible for the expression or repression of different genes associated with cell development and targeting/conducting immune responses. The well-known, "window of opportunity" that includes maternal and post-natal environmental exposures, which include maternal infections, microbiota, diet, drugs, and pollutant exposures are of fundamental importance to immune modulation and these events are almost always accompanied by epigenetic changes. Recently, it has been shown that these alterations could be involved in both risk and protection of allergic diseases through mechanisms, such as DNA methylation and histone modifications, which can enhance Th2 responses and maintain memory Th2 cells or decrease Treg cells differentiation. In addition, epigenetic changes may differ according to the microbial agent involved and may even influence different asthma or allergy phenotypes. In this review, we discuss how exposure to different organisms, including bacteria, viruses, and helminths can lead to epigenetic modulations and how this correlates with allergic diseases considering different genetic backgrounds of several ancestral populations.

Age, period, and cohort effects on asthma prevalence in Canadian adults, 1994-2011

PURPOSE

To examine the age, period, and cohort effects on asthma prevalence among Canadian adults from 1994/1995 to 2010/2011.

METHODS

Using data from the National Population Health Survey, 13,616 Canadian adults were followed for 16 years. Age was limited to 18-80 years during follow-up. Modified Poisson regression models with generalized estimating equations were used to estimate age, period, and cohort effects on asthma and active asthma prevalence after accounting for sociodemographic factors. Model-based standardization was performed to estimate standardized rates.

RESULTS

Overall asthma prevalence increased from 5% in 1994/1995 to 11% in 2010/2011; decreasing from 12% for 20-year-olds to 6% for 50-60-year-olds and then increased to 8% for 80-year-olds. Individuals aged 20 years had the steepest increase in prevalence between 1994/1995 and 2010/2011. Active asthma prevalence increased from 5% in 1994/1995 to 8% in 2010/2011; decreasing from 8% for 20-year-olds to 5% for 50-60-year-olds and then increased to 6% for 80-year-olds.

CONCLUSIONS

Our findings suggest the presence of age, period, and cohort effects on prevalence of asthma overall and presence of age and period effects on active asthma prevalence in Canadian adults.

Structural and Functional Features on Quantitative Chest Computed Tomography in the Korean Asian versus the White American Healthy Non-Smokers

OBJECTIVE

Considering the different prevalence rates of diseases such as asthma and chronic obstructive pulmonary disease in Asians relative to other races, Koreans may have unique airway structure and lung function. This study aimed to investigate unique features of airway structure and lung function based on quantitative computed tomography (QCT)-imaging metrics in the Korean Asian population (Koreans) as compared with the White American population (Whites).

MATERIALS AND METHODS

QCT data of healthy non-smokers (223 Koreans vs. 70 Whites) were collected, including QCT structural variables of wall thickness (WT) and hydraulic diameter (Dh) and functional variables of air volume, total air volume change in the lung (ΔVair), percent emphysema-like lung (Emph%), and percent functional small airway disease-like lung (fSAD%). Mann-Whitney U tests were performed to compare the two groups.

RESULTS

As compared with Whites, Koreans had smaller volume at inspiration, ΔVair between inspiration and expiration (p < 0.001), and Emph% at inspiration (p < 0.001). Especially, Korean females had a decrease of ΔVair in the lower lobes (p < 0.001), associated with fSAD% at the lower lobes (p < 0.05). In addition, Koreans had smaller Dh and WT of the trachea (both, p < 0.05), correlated with the forced expiratory volume in 1 second (R = 0.49, 0.39; all p < 0.001) and forced vital capacity (R = 0.55, 0.45; all p < 0.001).

CONCLUSION

Koreans had unique features of airway structure and lung function as compared with Whites, and the difference was clearer in female individuals. Discriminating structural and functional features between Koreans and Whites enables exploration of inter-racial differences of pulmonary disease in terms of severity, distribution, and phenotype.

Asthma and Chronic Rhinosinusitis: Diagnosis and Medical Management

Asthma is a prevalent inflammatory condition of the lower airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchial hyperresponsiveness (BHR). Symptomatically, these patients may demonstrate wheezing, breathlessness, chest tightness, and coughing. This disease is a substantial burden to a growing population worldwide that currently exceeds 300 million individuals. This is a condition that is frequently encountered, but often overlooked in the field of otolaryngology. In asthma, comorbid conditions are routinely present and contribute to respiratory symptoms, decreased quality of life, and poorer asthma control. It is associated with otolaryngic diseases of the upper airways including allergic rhinitis (AR) and chronic rhinosinusitis (CRS). These conditions have been linked epidemiologically and pathophysiologically. Presently, they are considered in the context of the unified airway theory, which describes the upper and lower airways as a single functional unit. Thus, it is important for otolaryngologists to understand asthma and its complex relationships to comorbid diseases, in order to provide comprehensive care to these patients. In this article, we review key elements necessary for understanding the evaluation and management of asthma and its interrelatedness to CRS.

Acculturation is associated with asthma burden and pulmonary function in Latino youth: The GALA II study

BACKGROUND

Acculturation is an important predictor of asthma in Latino youth, specifically Mexican Americans. Less is known about acculturation and pulmonary function measures.

OBJECTIVE

We sought to estimate the association of acculturation measures with asthma and pulmonary function in Latino youth and determine whether this association varies across Latino subgroups.

METHODS

We included 1849 Latinos (302 Caribbean Spanish, 193 Central or South Americans, 1136 Mexican Americans, and 218 other Latino children) aged 8 to 21 years from 4 urban regions in the United States. Acculturation measures include nativity status, age of immigration, language of preference, and generation in the United States. We used multivariable logistic and linear regression models to quantify the association of acculturation factors with the presence of asthma (case-control study) and pulmonary function (case-only study), adjusting for demographic, socioenvironmental, and clinical variables.

RESULTS

For all acculturation measures (nativity status, age of immigration, language of preference, and generation in the United States), greater levels of acculturation were associated with greater odds of asthma. Among cases, high (English preference) and medium (equal preference for Spanish and English) levels of language acculturation were associated with decreased bronchodilator response compared with low (Spanish preference) levels (P = .009 and .02, respectively). Similarly, high language acculturation was associated with increased FEV₁ compared with low language acculturation (P = .02). There was insufficient evidence of heterogeneity for associations across Latino subgroups.

CONCLUSIONS

Acculturation was associated with diagnosed asthma and pulmonary function in Latino children and is an important factor to consider in the management of Latino youth with asthma.

An Examination of the Association of Multiple Acculturation Measures with Asthma Status Among Elementary School Students in El Paso, Texas

Some researchers posit that the lower prevalence of asthma among those of Mexican descent may result from an under-diagnosis and recommend a critical appraisal of factors related to race/ethnicity, like acculturation, and its influence on asthma status. Survey data were analyzed using multinomial logistic regression to examine the association of child's asthma status (no wheezing/no asthma symptoms, possible undiagnosed and diagnosed asthma) with measures of acculturation among Hispanic students (n = 1095). In this population, the prevalence of diagnosed asthma (15%) was higher than both national (7.6%) and state (6.8%) averages for Hispanic children in 2012. While bivariate analyses showed significant associations for asthma status and measures of acculturation, multivariate analyses did not. There is an underestimated burden of illness among Hispanic children in El Paso County. More research on the suitability of acculturation constructs is needed to delineate what they actually measure and how acculturation influences asthma status.

Country of Birth and Variations in Asthma and Wheezing Prevalence, and Emergency Department Utilization in Children: A NHANES Study

Asthma prevalence and asthma-related healthcare utilization differ across racial/ethnic groups and geographical areas. This study builds on previous research to examine the relationship between country of birth and asthma prevalence and healthcare utilization using a national data set. The National Health and Nutrition Examination Survey (NHANES) Demographic and Questionnaire Files from 2007 to 2012 were used for this study. We used SPSS complex sampling design to estimate the association between country of birth and asthma prevalence, wheezing and emergency department (ED) use. The sample size was 8272 children and adolescents between the ages of 5 and 19 years old. US-born children had more reported episodes of wheezing (p = 0.024) 95 % CI 1.06; 2.54. There was no association between country of birth and asthma and ED use. US-born children and adolescents compared to foreign-born children and adolescents are more likely to have episodes of wheezing.

Prevalence of Asthma in School Children on the Arizona-Sonora Border

BACKGROUND

Mexican-born children living in the United States have a lower prevalence of asthma than other US children. Although children of Mexican descent near the Arizona (AZ)-Sonora border are genetically similar, differences in environmental exposures might result in differences in asthma prevalence across this region.

OBJECTIVE

The objective of this study was to determine if the prevalence of asthma and wheeze in these children varies across the AZ-Sonora border.

METHODS

The International Study of Asthma and Allergy in Children written and video questionnaires were administered to 1753 adolescents from 5 middle schools: Tucson (school A), Nogales, AZ (schools B, C), and Nogales, Sonora, Mexico (schools D, E). The prevalence of asthma and symptoms was compared, with analyses in the AZ schools limited to self-identified Mexican American students.

RESULTS

Compared with the Sonoran reference school E, the adjusted odds ratio (OR) for asthma was significantly higher in US schools A (OR 4.89, 95% confidence interval [CI] 2.72-8.80), B (OR 3.47, 95% CI 1.88-6.42), and C (OR 4.12, 95% CI 1.78-9.60). The adjusted OR for wheeze in the past year was significantly higher in schools A (OR 2.19, 95% CI 1.20-4.01) and B (OR 2.67, 95% CI 1.42-5.01) on the written questionnaire and significantly higher in A (OR 2.13, 95% CI 1.22-3.75), B (OR 1.95, 95% CI 1.07-3.53), and Sonoran school D (OR 2.34, 95% CI 1.28-4.30) on the video questionnaire compared with school E.

CONCLUSIONS

Asthma and wheeze prevalence differed significantly between schools and was higher in the United States. Environmental factors that may account for these differences could provide insight into mechanisms of protection from asthma.

Pulmonary Disease and Age at Immigration among Hispanics. Results from the Hispanic Community Health Study/Study of Latinos

RATIONALE

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.

OBJECTIVES

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.

MEASUREMENTS AND MAIN 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.

Household Food Insecurity is Associated with Childhood Asthma

BACKGROUND

In 2013, 20% of U.S. households with children experienced food insecurity. Asthma afflicts over 7 million children; prevalence has steadily increased while incidence peaks in young children. Asthma and food insecurity share the determinants of poverty and race that are associated with weight, yet limited research on the relation between food insecurity and asthma exists.

OBJECTIVE

The objective of this study was to determine the association between food insecurity and asthma in a diverse sample of children.

METHODS

Cross-sectional data from grade 3 of the Early Childhood Longitudinal Study-Kindergarten Cohort were analyzed (n = 11,099). Food security based on the USDA module and asthma diagnosis were reported by parents; anthropometric factors were measured. Multivariate logistic regression models of food security and asthma were analyzed overall and by race/ethnicity.

RESULTS

Children in food-insecure households had a 4% higher adjusted odds of asthma (95% CI: 1.02, 1.06). Adjusted odds of asthma were also higher by 70% for males (95% CI: 1.69, 1.71), 53% for non-Hispanic black (NHB) children (95% CI: 1.51, 1.54), 20% for Hispanic children (95% CI: 1.19, 1.21), 38% for overweight children (95% CI: 1.36, 1.39), 67% for obese children (95% CI: 1.65, 1.68), 23% for low-birth weight children (95% CI: 1.21, 1.24), 24% if mothers had a high school diploma (95% CI: 1.23, 1.26), and 33% if mothers had some college education (95% CI: 1.32, 1.35). High-birth weight children (OR: 0.84; 95% CI: 0.83, 0.85) and those with foreign-born mothers (OR: 0.52; 95% CI: 0.51, 0.53) had lower odds of asthma. Being food-insecure remained positively associated with asthma in non-Hispanic whites and Hispanics but was inversely associated with odds among NHBs. Odds of asthma doubled (OR: 2.00; 95% CI: 1.97, 2.03) for all children in households that were both food-insecure and poor; this relation remained positive in race/ethnicity-specific models.

CONCLUSIONS

Food insecurity is positively associated with asthma in U.S. third graders, and household poverty strengthens the association.

Promising candidates for allergy prevention

Recent advances in understanding environmental risk factors for allergic diseases in children have led to renewed efforts aimed at prevention. Factors that modify the probability of developing allergies include prenatal exposures, mode of delivery, diet, patterns of medication use, and exposure to pets and farm animals. Recent advances in microbial detection techniques demonstrate that exposure to diverse microbial communities in early life is associated with a reduction in allergic disease. In fact, microbes and their metabolic products might be essential for normal immune development. Identification of these risk factors has provided new targets for prevention of allergic diseases, and possibilities of altering microbial exposure and colonization to reduce the incidence of allergies is a promising approach. This review examines the rationale, feasibility, and potential effect for the prevention of childhood allergic diseases and explores possible strategies for enhancing exposure to beneficial microbes.

Special considerations--asthma in children

BACKGROUND

Asthma is among the most common chronic diseases of childhood. Management of pediatric asthma requires an understanding of the issues that uniquely effect children. This review provides the reader with the current state and future directions of pediatric asthma.

METHODS

Review of the pediatric asthma literature was undertaken with emphasis on randomized controlled trials and systematic reviews.

RESULTS

The prevalence of pediatric asthma remains elevated and is increasingly being appreciated in select global regions. Effective treatment in any setting begins with a focused medical history that queries key asthma features that inform both diagnostic and monitoring strategies. A thorough medical history may yield comorbid upper airway disorders and allergic triggers that could potentially exacerbate airway inflammation. Pre-bronchodilator and post-bronchodilator lung function testing is a preferable diagnostic strategy to quantitatively assess obstructive pulmonary disease among children capable of performing the testing maneuvers. Pediatric asthmatics who continue to have poor disease control require monitoring of medication adherence and drug delivery techniques, because both are often linked with disease outcomes. Therapeutic strategies in children are notably distinct from adults due to the possible effects of inhaled corticosteroids on reduced bone mineral density and growth. Adolescents may also require more time to address the psychosocial complexities that may complicate the required daily usage of asthma medicines.

CONCLUSION

Asthmatic children are distinct from their adult counterparts due to limitations inherent in the pediatric age group. A unified and evidence-based approach to pediatric asthma may improve clinical outcomes.

Epidemiology and economic burden of asthma

BACKGROUND

The "asthma epidemic" is on the rise, with the Center for Disease Control (CDC) epidemiological studies reporting a 3.0% asthma prevalence in the United States in 1970, 5.5% in 1996, and 7.8% in 2006 to 2008. This results in an immense economic burden, with asthma costing an estimated $56 billion in the United States in 2007, which is a 6% increase from the $53 billion that was spent in 2002.

METHODS

A review of the current literature and CDC reports were used to thoroughly examine and summarize the epidemiology and economic burden of asthma domestically and globally.

RESULTS

Asthma shows a male predominance before puberty, and a female predominance in adulthood. Studies show Puerto Ricans to be the most commonly affected ethnicity, and a higher prevalence of asthma is found in lower income populations. Asthma is related to some of the more common otolaryngologic diseases such as allergy and obstructive sleep apnea. The condition results in significant morbidity, such as an increase in emergency department visits and a decrease in productivity due to missed school and works days.

CONCLUSION

Epidemiological statistics report an undisputable increase of asthma both domestically and worldwide, which means the economic burden of this disease is also on the rise. Better access to healthcare, improved asthma education, and bridging the gap between ethnic and racial disparities in the treatment and management of asthma may help to control this epidemic, promote better outcomes, and prevent continued rising costs related to the management of this widespread disease.

Inner city asthma

The inner city has long been recognized as an area of high asthma morbidity and mortality. A wide range of factors interact to create this environment. These factors include well-recognized asthma risk factors that are not specific to the inner city, the structure and delivery of health care, the location and function of the urban environment, and social inequities. In this article, these facets are reviewed, and successful and unsuccessful interventions are discussed, to understand what is needed to solve this problem.

The burden of asthma among the South Asian and Chinese population residing in Ontario

BACKGROUND

The South Asian and Chinese populations represent a significant portion of the population of Ontario; however, little is known about the burden of respiratory OBJECTIVE: To investigate the prevalence of asthma and the associated health care burden among South Asian and Chinese populations living in Ontario.

METHODS

Using administrative health data for Ontario, the authors identified individuals of South Asian and Chinese descent using a validated surname algorithm and compared the prevalence of asthma in these groups with the general population using an established asthma case definition for the period 2002 to 2010. Also compared were the rates of asthma-specific emergency department visits and hospitalizations among the ethnic groups.

RESULTS

In 2010, the prevalence of asthma in South Asians residing in Ontario was similar to that of the general population (12.1% versus 12.4%), and was increasing at a faster rate than in the general population (0.51%⁄year versus 0.34%⁄year). Compared with the general population, the South Asian population had fewer emergency department visits for asthma, whereas the asthma-related hospitalization rate was greatest among the South Asian population (0.45 per 100 person-years). The Chinese population had the lowest asthma prevalence and associated health care use.

CONCLUSION

The burden of asthma among South Asians in Ontario is increasing and warrants further investigation to determine the reasons for this rise.