Esteban Cynthia A, Klein Robert B, McQuaid Elizabeth L, Fritz Gregory K, Seifer Ronald, Kopel Sheryl J, Santana Jose Rodriguez, Colon Angel, Alvarez Maria, Koinis-Mitchell Daphne, Ortega Alexander N, Martinez-Nieves Brenda, Canino Glorisa
Department of Pediatrics, Division of Allergy and Immunology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA.
J Allergy Clin Immunol. 2009 Aug;124(2):238-44, 244.e1-5. doi: 10.1016/j.jaci.2009.05.014. Epub 2009 Jul 16.
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.
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.
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.
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.
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.
波多黎各人自我报告的哮喘终生患病率非常高，哮喘住院、急诊就诊和死亡率均有所上升。然而，美国大陆和该岛屿之间哮喘严重程度的差异在很大程度上仍不为人知。
我们试图描述四组人群在哮喘严重程度和控制方面的差异：（1）岛上的波多黎各人，（2）罗德岛（RI）的波多黎各人，（3）罗德岛的多米尼加人，以及（4）罗德岛的白人。
805名7至15岁的儿童完成了一次诊断门诊，包括正式访谈、体格检查、肺功能测定和过敏测试。每个地点的哮喘专家使用根据全球哮喘防治创议改编的视觉网格确定哮喘严重程度分级。使用计算机算法确定相应的哮喘控制水平。
与罗德岛的波多黎各人、多米尼加人和白人相比，岛上的波多黎各人哮喘严重程度明显较轻（P < .001）。岛上的波多黎各人在哮喘控制方面与罗德岛的白人没有显著差异。与岛上的波多黎各人相比，罗德岛的波多黎各人显示出控制较差的趋势（P = .061）。罗德岛的多米尼加人哮喘控制率最低。矛盾的是，与其他三组罗德岛人群相比，岛上的波多黎各人在过去12个月中有更多的急诊就诊（P < .001）。
讨论了面对高医疗利用率，岛上波多黎各人哮喘较轻这一矛盾发现的潜在解释。在不同人群的背景下探讨了确定基于指南的严重程度与控制综合评级的困难。
