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Elizabeth Perez, BS1, Kelly A. Quinn, MPH1, Madeleine U. Shalowitz, MD, MBA1, and Carolyn A Berry, PhD2. (1) Research Institute, Evanston Northwestern Healthcare, 1001 University Place, Evanston, IL 60201, 224-364-7460, elperez@enh.org, (2) Wagner Graduate School of Public Service, New York University, 726 Broadway, 5th Floor, New York City, NY 10003
Asthma prevalence is high among low-income minorities and studies show that underdiagnosis is common. Furthermore, the "immigrant paradox" may account for initially lower prevalence among some populations. To better understand high rates and racial/ethnic disparities, we screened for asthma in 15 urban elementary schools.
Methods
We distributed the Brief Pediatric Asthma Screen (BPAS+), a validated screen with 73% sensitivity and 74% specificity, to students to be completed by caregivers. The screen, in English and Spanish, identifies diagnosed and possible undiagnosed children.
Results
Surveys (n=13,139, 88% response rate) were scored as no asthma (74%), possible asthma (14%), and diagnosed asthma (12%). Children's race included 49% Hispanic, 24% Black, 15% White, and 12% other. Data showed significant differences by race (p<.001): African-Americans had highest rates (18% diagnosed, 15% possible) followed by Hispanics (10% diagnosed, 15% possible), and Whites (9% diagnosed, 13% possible). Hispanics showed significant differences by language: children of English speakers were more likely to be diagnosed (14%) than Spanish speakers (8%) (n=6353, p<.001). However, possible rate for Spanish speakers (15%) was very similar to English-speaking Hispanics (14%).
Conclusion. The difference between English- and Spanish-speaking respondents in terms of diagnosed but not undiagnosed asthma suggests two possible explanations. Spanish speakers are likely to be more recent immigrants, and lack of diagnosis may reflect barriers to care for immigrants. Alternatively, recent immigrants are a group in transition, reflective of an emerging, still milder form of asthma (immigrant paradox). In either case, the findings underline the importance of attending to language, ethnicity, immigrant status and diagnosed and undiagnosed illness in considering prevalence.
Learning Objectives:
Keywords: Asthma, Hispanic
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.