Asthma in Puerto Ricans: Lessons from a high-risk population

Szentpetery, Sylvia; Forno, Erick; Canino, Glorisa; Celedón, Juan C.

doi:10.1016/j.jaci.2016.08.047

Cited by 30 publications

(19 citation statements)

References 11 publications

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“…Indeed, current evidence suggests causal roles for potentially modifiable exposures or behaviors on asthma, including but not limited to secondhand smoke (SHS), overweight or obesity, unhealthy dietary patterns, changes in the gut microbiome, chronic pre- and perinatal stress, and indoor and outdoor pollutants (4). Although children in high-risk populations are often concurrently exposed to several of these risk factors, most published studies have focused on a single risk factor (adjusting for the presence of other risk factors) or on the interaction between two risk factors for asthma (5, 6). …”

Section: Introductionmentioning

confidence: 99%

Combined effects of multiple risk factors on asthma in school-aged children

Szentpetery

Gruzieva

Forno

et al. 2017

Respiratory Medicine

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Background Little is known about synergistic effects of several risk factors on asthma. We developed a risk score in Puerto Rican children, and then used this score to estimate the combined effects of multiple risk factors on asthma at school age in Puerto Rican and Swedish children. Methods Case-control study in 609 Puerto Rican children (aged 6–14 years) and longitudinal birth cohort study of 2,290 Swedish children followed up to age 12 years (The Children, Allergy, Milieu, Stockholm, Epidemiological Survey [BAMSE] Study). In both cohorts, there was data on parental asthma, sex, obesity, allergic rhinitis, and early-life second-hand smoke (SHS); data on diet and (in children ≥9 years) lifetime exposure to gun violence were also available in the Puerto Rico study. Asthma was defined as physician-diagnosed asthma and ≥1 episode of wheeze in the previous year. Results In a multivariable analysis in Puerto Rican children, male sex, parental asthma, allergic rhinitis, early-life SHS, an unhealthy diet and (in children ≥9 years) gun violence were each significantly associated with asthma. We next created a risk score using these variables (range, 0 to 5–6 in Puerto Rico and 0 to 4 in BAMSE). Compared with Puerto Rican children without any risk factors (i.e. a score of 0), Puerto Rican children with 2, 3, and at least 4 risk factors had 3.6 times (95% CI=1.4–9.2), 10.4 times (95% CI=4.0–27.0), and 21.6 times (95% CI=7.2–64.9) significantly higher odds of asthma, respectively. In BAMSE, the presence of 2, 3, and at least 4 risk factors was significantly associated with 4.1 times (95% CI=2.3–7.4), 6.3 times (95% CI=3.0–13.3), and 17.2 times (95% CI=4.1–73.2) increased odds of asthma at age 12 years. Conclusions Our findings emphasize the multifactorial etiology of asthma, and suggest that concurrent eradication or reduction of several modifiable risk factors may better prevent or reduce the burden of childhood asthma.

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Section: Introductionmentioning

confidence: 99%

Combined effects of multiple risk factors on asthma in school-aged children

Szentpetery

Gruzieva

Forno

et al. 2017

Respiratory Medicine

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“…(136) Primary prevention studies in asthma should strive to account for relevant social, cultural and demographic factors, as well as for the role of diet, stress and other lifestyle factors. (137)…”

Section: Introductionmentioning

confidence: 99%

NIAID, NIEHS, NHLBI, and MCAN Workshop Report: The indoor environment and childhood asthma—implications for home environmental intervention in asthma prevention and management

Gold

Adamkiewicz

Arshad

et al. 2017

Journal of Allergy and Clinical Immunology

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Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Environmental Health Sciences (NIEHS), National Heart, Lung, and Blood Institute (NHLBI), and Merck Childhood Asthma Network (MCAN) sponsored a joint workshop to discuss the current state of the science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included U.S. and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment and exposure reduction techniques. This informed a primary focus of the workshop-- to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in the scientific methodologies and knowledge, and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies.

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“…However, the burden of disease is higher in underrepresented minorities and low-income populations [2, 3]. The prevalence has been reported to be as high as 20–30% in some underrepresented minority communities (Blacks and certain Latino groups such as Puerto Ricans) [4–6]. These underrepresented minority groups are also more likely to experience higher rates of asthma morbidity, mortality, and healthcare utilization [7].…”

Section: Introductionmentioning

confidence: 99%

Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap

Louisias

Phipatanakul

2017

Curr Allergy Asthma Rep

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Purpose of Review In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. Recent Findings Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Summary Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.

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Asthma in Puerto Ricans: Lessons from a high-risk population

Cited by 30 publications

References 11 publications

Combined effects of multiple risk factors on asthma in school-aged children

Combined effects of multiple risk factors on asthma in school-aged children

NIAID, NIEHS, NHLBI, and MCAN Workshop Report: The indoor environment and childhood asthma—implications for home environmental intervention in asthma prevention and management

Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap

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