Distribution of Preterm Birth History Among Puerto Rican Children With Asthma: A Rural-Urban Comparison in a Pediatric Pulmonology Cohort

Preterm birth (<37 weeks of gestation) has been associated with altered lung development and increased risk of childhood asthma. Puerto Rico has a high burden of both prematurity and childhood asthma; however, the distribution of prematurity among children with asthma across geographic regions remains insufficiently characterized. We conducted a retrospective cross-sectional study of children aged 2-11 years with a confirmed asthma diagnosis followed at a pediatric pulmonology clinic in Bayamón, Puerto Rico. Demographic, clinical, environmental, and gestational data were extracted from electronic medical records. The proportion of preterm births was calculated with 95% CIs, and rural-urban differences were assessed using a chi-square test and ORs. Among 294 eligible participants, gestational age data were available for 281 children. Forty-one children (14.6%; 95% CI: 10.5%-19.8%) were born preterm. Prematurity occurred in 16.3% of rural participants and 12.4% of urban participants, with no statistically significant difference detected (χ² = 0.54, p = 0.46; OR = 0.73, 95% CI: 0.37-1.45). These findings describe the distribution of preterm birth history among children with asthma followed at a pediatric pulmonology clinic and do not demonstrate a statistically significant rural-urban difference, though the estimate was imprecise and a clinically meaningful difference cannot be excluded.