Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Fla.
Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa.
J Allergy Clin Immunol. 2022 Nov;150(5):1106-1113.e10. doi: 10.1016/j.jaci.2022.05.026. Epub 2022 Jun 30.
Hispanic/Latinx (HL) ethnicity encompasses racially and culturally diverse subgroups. Studies suggest that Puerto Ricans (PR) may bear greater asthma-related morbidity than Mexicans, but these were conducted in children or had limited clinical characterization.
This study sought to determine whether disparities in asthma morbidity exist among HL adult subgroups.
Adults with moderate-severe asthma were recruited from US clinics, including from Puerto Rico, for the Person Empowered Asthma Relief (PREPARE) trial. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans [C&D]), the investigators compared baseline self-reported clinical characteristics between Caribbean HL (CHL) (PR and C&D: n = 457) and other HLs (OHL) (Mexicans, Spaniards, Central/South Americans; n = 141), and between CHL subgroups (C&D [n = 56] and PR [n = 401]). This study compared asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids, emergency department/urgent care (ED/UC) visits, hospitalizations, health care utilization) through negative binomial regression.
CHL compared to OHL were similar in age, body mass index, poverty status, blood eosinophils, and fractional exhaled nitric oxide but were prescribed more asthma controller therapies. Relative to OHL, CHL had significantly increased odds of asthma exacerbations (odds ratio [OR]: 1.84; 95% CI: 1.4-2.4), ED/UC visits (OR: 1.88; 95% CI: 1.4-2.5), hospitalization (OR: 1.98; 95% CI: 1.06-3.7), and health care utilization (OR: 1.91; 95% CI: 1.44-2.53). Of the CHL subgroups, PR had significantly increased odds of asthma exacerbations, ED/UC visits, hospitalizations, and health care utilization compared to OHL, whereas C&D only had increased odds of exacerbations compared to OHL. PR compared to C&D had greater odds of ED/UC and health care utilization.
CHL adults, compared with OHL, adults reported nearly twice the asthma morbidity; these differences are primarily driven by PR. Novel interventions are needed to reduce morbidity in this highly impacted population.
西班牙裔/拉丁裔（HL）涵盖了多种种族和文化背景的亚群。研究表明，波多黎各人（PR）的哮喘相关发病率可能高于墨西哥人，但这些研究是在儿童中进行的，或者临床特征有限。
本研究旨在确定 HL 成年亚群中是否存在哮喘发病率的差异。
从中美洲和加勒比地区（古巴和多米尼加[C&D]）的美国诊所招募了患有中重度哮喘的成年人参加 Person Empowered Asthma Relief（PREPARE）试验。考虑到 PR 与其他加勒比 HL（CHL）（PR 和 C&D：n=457）和其他 HL（墨西哥人、西班牙人、中/南美洲人；n=141）之间的共同遗产，研究人员比较了加勒比 HL（CHL）亚群（C&D [n=56]和 PR [n=401]）之间以及 CHL 亚群（C&D [n=56]和 PR [n=401]）之间的基线自我报告临床特征，通过负二项式回归比较哮喘发病率指标（自我报告需要全身皮质类固醇治疗的哮喘加重、急诊部/紧急护理（ED/UC）就诊、住院、卫生保健利用）。
与 OHL 相比，CHL 的年龄、体重指数、贫困状况、血嗜酸性粒细胞和呼出一氧化氮分数相似，但接受的哮喘控制治疗更多。与 OHL 相比，CHL 发生哮喘加重的几率显著增加（比值比[OR]：1.84；95%可信区间：1.4-2.4）、ED/UC 就诊（OR：1.88；95%可信区间：1.4-2.5）、住院（OR：1.98；95%可信区间：1.06-3.7）和卫生保健利用（OR：1.91；95%可信区间：1.44-2.53）。在 CHL 亚群中，与 OHL 相比，PR 发生哮喘加重、ED/UC 就诊、住院和卫生保健利用的几率显著增加，而 C&D 仅与 OHL 相比，发生哮喘加重的几率增加。与 C&D 相比，PR 发生 ED/UC 和卫生保健利用的几率更高。
与 OHL 相比，CHL 成年人报告的哮喘发病率几乎增加了一倍；这些差异主要是由 PR 引起的。需要新的干预措施来降低这一受影响严重人群的发病率。
