Socioeconomic Status, Diet, and Recurrent Severe Asthma Exacerbations in Puerto Rican Youth

Puerto Ricans are disproportionally burdened with asthma. This study aimed to identify which risk factors were associated with recurrent severe asthma exacerbations (SAEs) in young patients in Puerto Rico with asthma.Two hundred nine Puerto Rican youths (aged 6-20 years) with asthma and recurrent SAEs.The Puerto Rico Genetics of Asthma and Lifestyle study (PR-GOAL) was conducted between 2009 and 2010, using randomly selected households in San Juan and Caguas with at least 1 child aged 6 to 14 years with physician-diagnosed asthma. From 2014 to 2017, a second study titled Epigenetic Variation and Childhood Asthma in Puerto Rico (EVA-PR) was conducted. A total of 209 patients were enrolled in both phases and qualified for the Prospective Study of Puerto Ricans and Childhood Asthma (PROPRA). At all visits, patients filled out questionnaires including information on SAEs, food frequency, demographics, and other social and physical determinants of health. Blood samples and spirometry results were gathered. Logistic regression was used to determine which factors were linked to recurrent SAEs.Patients with recurrent SAEs are more likely to have low household income and low parental numeracy and are more likely to have used an inhaled corticosteroid in the previous 6 months. At the initial evaluation, patients with recurrent SAEs were more likely to live within 500 m of a major road, and at the second evaluation, they were more likely to lack private insurance, be overweight, and report a low level of outdoor activities.Researchers identified low household income, low parental numeracy, and consistently unhealthy diet as factors predicting recurrent SAEs in Puerto Rico over a 5.2-year period. The authors review the importance of improved access to medications and a healthy lifestyle in these patients.This study addresses important gaps in the current literature and highlights the importance of understanding which factors may contribute to worse outcomes in populations with recurrent SAEs. The findings enhance limited information on social determinants of health in asthma in a specific Latino population and underscore the importance of both tailored asthma management and informed public health policy to improve existing disparities in this patient population.