Exploring the Links Between Socioeconomic Factors and Asthma Severity in Puerto Rican Youths

The Celedón Laboratory for Pediatric Asthma Research in the Division of Pediatric Pulmonary Medicine at UPMC Children’s Hospital of Pittsburgh published new insights into how and what socioeconomic factors contribute to more severe asthma manifestations of asthma in Puerto Rican children. 

The study, titled, “Socioeconomic Status, Diet, and Recurrent Severe Asthma Exacerbations in Puerto Rican Youth,” was published in the Journal of Allergy and Clinical Immunology: Global. Kristina Gaietto, MD, MPH, instructor of Pediatrics was the study’s lead author. Juan C. Celedón, MD, DrPH, ATSF, division chief and principal investigator of the Celedón Laboratory at UPMC Children’s was the senior author. Collaborating with the Celedón Lab on this study were Edna Acosta-Pérez, PhD, and Glorisa Canino, PhD, from the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico.

Background: Epidemiological Context of Asthma in U.S. Children

Asthma remains the most common chronic respiratory disease of childhood in the United States, affecting more than 4 million children and their families. While asthma impacts children across various geographies and ethnicities, Puerto Rican children are disproportionately affected by the condition. They exhibit the highest prevalence rates compared to other Hispanic groups as well as non-Hispanic whites. The disparity in prevalence is driven by a complex dynamic of genetic, environmental, and socio-economic factors.

Prior research from the Celedón Lab and others studying the condition have shown that Puerto Rican children not only have higher rates of asthma than other populations but also experience more severe symptomatic expression of the condition, with correspondingly increased rates of emergency room visits and hospitalizations, among other negative outcomes.

The long-term health implications for Puerto Rican children suffering from asthma are significant. Chronic asthma can lead to reduced lung function growth, which may persist into adulthood, impacting overall health and quality of life. Additionally, the frequent exacerbations and severe symptoms contribute to higher absenteeism from school, which can affect educational outcomes and future socio-economic status.

Research Aims

For this new study, Dr. Gaietto and colleagues focused on identifying the factors contributing to recurrent severe asthma exacerbations (SAEs) among Puerto Rican youths. Understanding these factors is important for developing targeted interventions to improve health outcomes in this vulnerable population.

“Exacerbation-prone asthma is a unique asthma phenotype. We clearly know that asthma is not a single disease but instead a heterogenous syndrome, and we believe it’s important to study factors associated with specific types of asthma so that we better personalize treatment for an individual’s asthma,” says Dr. Gaietto. “For this study, we were interested in investigating which factors are associated with exacerbation-prone asthma in Puerto Rican youth.”

Study Highlights and Important Findings

The research found that low household income and poor diet significantly influenced the frequency of severe asthma attacks among the children studied. Children from economically disadvantaged backgrounds experienced asthma exacerbations more frequently, which suggests that financial instability may impact their ability to manage asthma effectively. Additionally, a persistently unhealthy diet was linked to persistently increased risk of SAEs, highlighting nutrition as a critical area for intervention.

Environmental factors such as proximity to major roads and exposure to pollutants also played a role in increased frequency of asthma exacerbations, suggesting that both indoor and outdoor environments significantly affect asthma outcomes.

Clinical Implications of the Research

The findings from Dr. Gaietto and colleague’s research suggest that interventions should not only focus on medical treatment but also consider socioeconomic and environmental improvements. Policies aimed at reducing poverty, improving access to healthy foods, and minimizing exposure to environmental pollutants could be effective in reducing the burden of asthma in Puerto Rican children. These strategies require a collaborative approach involving health care providers, community planners, and policymakers to create a supportive environment that promotes the health and well-being of children and their families living with asthma.

"In this study, we showed that multiple factors were independently associated with exacerbation-prone asthma among Puerto Rican youth,” explains Dr. Gaietto. “This highlights multiple targetable factors that, if ameliorated, may improve exacerbation rates among Puerto Rican youth with asthma. It will be interesting to examine these factors in other cohorts of youth with asthma to see if our findings translate to other populations - I suspect they largely do.”

Learn More About the Celedón Laboratory for Pediatric Asthma Research at UPMC Children's Hospital of Pittsburgh.

Reference

To learn more about the study, read or download a full copy of the open access paper using the following link:

Gaietto K, Han Y-Y, Rosser FJ, Acosta-Pérez E, Forno E, Canino G, & Celedón JC. Socioeconomic Status, Diet, and Recurrent Severe Asthma Exacerbations in Puerto Rican Youth. J Allergy Clin Immunol Glob. 2024 Jan 28;3(2): 100220.