Asthma in Children of Caribbean Descent Living in the Inner-City: Comparing Puerto Rican and Afro-Caribbean Children

Abstract

Background: Asthma is a widespread chronic disease, affecting children in the United States. Ethnic minority children living in the inner-city, bare a disproportionate amount of the asthma burden. The aim of this study was to compare asthma morbidity and health care utilization, as well as pulmonary function and asthma severity. The study focuses on two ethnic minority immigrant groups, Puerto Rican and Afro-Caribbean children. An exploratory aim assessed the relationship between circular migration of Puerto Rican caregivers and their children's asthma outcomes and health care use.;Method: Participants were 160 children with asthma and their caregivers recruited from inner-city hospitals in the Bronx, New York. The study included Puerto Rican (n = 113; child age M = 9.89 +/- 2.05) and Afro-Caribbean (n = 47; child age M = 10.35 +/- 2.08) participants. Caregivers answered a series of questions regarding children's asthma morbidity in the past year (Asthma Functional Severity Scale, school absences) as well as asthma-related health care utilization (doctor visits, emergency department visits) in the past year. Children completed spirometry testing to determine pulmonary function, and caregivers responded to questions on medication use and asthma control, which helped determine asthma severity. Within the Puerto Rican sample, circular migration was assessed through questions about caregivers' migration between Puerto Rico and the continental U.S.;Results: Puerto Rican children had significantly ( p < .05) worse asthma functional morbidity in the past year ( M= 1.85 +/- .76) compared to Afro-Caribbean children ( M= 1.55 +/- .78). Puerto Rican children also had significantly (p < .01) higher rates of asthma-related school absences in the past year (M = 12.56 +/- 15.99) than Afro-Caribbean children (M= 5.83 +/- 6.78). In terms of asthma-related health care use, Puerto Rican children had higher (p < .05) rates of asthma-related doctor visits in the past year (M= 4.12 +/- 6.12) than Afro-Caribbean children (M = 3.15 +/- 6.14). Puerto Rican children also had higher (p < .01) rates of asthma-related emergency department visits in the past year (M = 3.76 +/- 5.67) than Afro-Caribbean children (M= 1.60 +/- 1.97). Despite the worse asthma outcomes seen in Puerto Rican children, Puerto Rican children had better pulmonary function as determined by %FEV1. Pulmonary function (%FEV 1) was significantly (p < .001) higher in Puerto Rican children (M= 83.30 +/- 15.89) than in Afro-Caribbean children (M= 72.60 +/- 16.39). There was no significant difference (p = .24) in asthma severity between Puerto Rican children (14% mildlintermittent; 59% moderate; 27% severe) and Afro-Caribbean children (11% mildlintermittent; 48% moderate; 41% severe). The exploratory analyses failed to find a significant relationship between circular migration of Puerto Rican caregivers and their children's asthma outcomes.;Conclusions: Puerto Rican children had worse asthma morbidity and higher rates of asthma-related health care use than Afro-Caribbean children, despite having better %FEV1. The disparity between pulmonary function (an objective measure) and asthma morbidity determined by caregiver self-report, and health care utilization, has various clinical implications. It may indicate differences in health care utilization behaviors between Puerto Rican and Afro-Caribbean individuals. It suggests that cultural norms, attitudes toward health care professionals, and accessibility of health care resources, should be considered when treating children with asthma. Increased access to psycho-educational materials about the symptoms and treatment of asthma may be beneficial for these populations.