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Language Disparities Among Minority Patients with Poor Asthma Control
AB74 Abstracts
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Language Disparities Among Minority Patients with Poor Asthma Control Dr. Jose R. Zaragoza-Buxo, MD1, Dr. Efren L. Rael, MD, FAAAAI2; 1 Penn State University College of Medicine, Hershey, PA, 2Allergy/ Immunology, Penn State University College of Medicine, Hershey, PA. RATIONALE: In 2011, 3.6 million Hispanic had asthma, and were 30 percent more likely to be hospitalized for asthma flares. African-American were 20% more likely to have asthma than non-Hispanic Whites. We evaluate the associations between limited English proficiency, Emergency Department (ED) visits, and hospitalization on asthma control in Minority groups. METHODS: After IRB consent was obtained, a telephone survey was conducted in a cohort of randomly selected minority subjects of all ages with moderate to severe persistent asthma. Subjects were classified into 3 groups, English-proficient African-American (1), English proficient Hispanic (2) and non-English proficient Hispanic (3). RESULTS: Of 30 patients contacted, 73% responded, 59% were Hispanic and 41% were African Americans. Among Hispanics 38% where nonEnglish fluent and considered this to affect their asthma. Hispanics were more likely to present to the ED during the last year as compared with African Americans (53% vs. 11%), had more E.R. visits last year (3.5 vs. 1), and had a 23% higher rate of hospitalization for asthma. Among group 3 subjects, 80% presented to the ED for asthma flares and 40% were hospitalized for an average of 2.5 days. Of group 2 subjects, 29% presented to the ED for asthma flares and 6% were hospitalized for an average of 1.5 days. CONCLUSIONS: Language barrier is associated with increased ED visits, hospitalizations for asthma among Hispanic patients in our cohort. Further analysis is needed to asses social factors associated with asthma management in minority populations.
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Race/Ethnicity and SES Are Predictors Of Allergic Sensitization To Environmental and Food Allergens Dr. Amina Abdeldaim, MD1, Dr. Supinda Bunyavanich, MD, MPH2, Ms. Sheryl Rifas-Shiman, MPH3, Thomas A. E. Platts-Mills, MD, PhD, FAAAAI4, Dr. Diane R. Gold, MD, MPH5, Dr. Carlos Camargo, Jr, MD, DrPH6, Dr. Emily Oken, MD7, Dr. Matthew Gillman, MD, SM3, Dr. Augusto A. Litonjua, MD, MPH8; 1Channing Division of Network Medicine, Brigham and Women’s Hospital, MA, 2Division of Pediatric Allergy & Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 3Harvard Medical School, Boston, MA, 4Division of Asthma, Allergy & Immunology, University of Virginia Health System, Charlottesville, VA, 5Channing Laboratory, Brigham and Women’s Hospital, Boston, MA, 6Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 7 Harvard Medical School, 8Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA. RATIONALE: We investigated the relationship between race/ethnicity, socioeconomic factors and allergen sensitization. METHODS: In Project Viva, a prospective cohort study examining the effects of prenatal and perinatal factors on maternal and child health, we evaluated 605 children ages 6.7-10.6 years for specific IgE levels to Alternaria, Aspergillus, cat and dog dander, cockroach, Dermatophagoides farinae, ragweed, rye grass, egg white, milk, peanut, sesame, soybean and wheat. Predictors included mother-reported race/ethnicity of the child, household income and maternal education. Covariates included child’s age; sex; diagnosis of asthma, hay fever and eczema; and maternal history of asthma and/or atopy. Logistic regression was utilized for the analyses. RESULTS: Among the children, 12(2%) were Asian, 104(17%) black, 25(4%) Hispanic, 358(59%) white and 65(11%) other race/ethnicity. 353(62%) and 86(15%) came from households with income >$70,000 and <5$40,000, respectively. 259(43%) were sensitized to any environmental allergen and 168(28%) to any food allergen. Compared to white children, Hispanic children had 10.6 times the odds (95% CI 1.9-199) of having any environmental sensitization and black children had 2.2 times the odds (95% CI 1.3-3.6) of any food sensitization. Compared to children
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
from households with income >$70,000, children from households with income <5$40,000 had 2.2 times (95% CI 1.1-4.4) and 2.1 times (95% CI 1.2-3.5) the odds of being sensitized to environmental and food allergens, respectively. We found no significant association between mother’s level of education and sensitization. CONCLUSIONS: Children who are Black, Hispanic or members of households with low family income were more likely to be sensitized to both environmental and food allergens.
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Unrecognized Allergic Rhinoconjunctivitis and Allergic Sensitization Among Latino Youth (GALA II Study) Ulysses Burley, MPH1, Dr. Joy Hsu, MD, MSCI2, Duanny Alva, MDIMG, MPH1, Ms. Elizabeth Nguyen, BS3, Ms. Lindsey Roth, MA4, Dr. Joshua Galanter, MD4, Dr. Sam Oh, PhD, MPH4, Ms. Celeste Eng, BS4, Mr. Fred Lurmann, MS5, Dr. Rajesh Kumar, MD, MS, FAAAAI6, Dr. Harold J. Farber, MD, MSPH7, Dr. Denise Serebrisky, MD8, Dr. Luisa Borrell, DDS, PhD9, Dr. Saunak Sen, PhD10, Dr. William Rodriguez-Cintron, MD11, Dr. Jose RodriguezSantana, MD12, Dr. Esteban Gonza Burchard, MD, MPH4, Prof. Pedro C. Avila, MD, FAAAAI1; 1Feinberg School of Medicine, Northwestern University, Chicago, IL, 2Department of Medicine, Division of AllergyImmunology, Northwestern University Feinberg School of Medicine, Chicago, IL, 3Department of Medicine, University of California, San Francisco, California, San Francisco, CA, 4Department of Medicine, University of California, San Francisco, San Francisco, CA, 5Sonoma Technology, Inc., Petaluma, CA, 6Pediatric allergy, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 7Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, 8Pediatric Pulmonary Division, Jacobi Medical Center, Bronx, NY, 9Department of Health Sciences, Graduate Program in Public Health, Lehman College, City University of New York, Bronx, NY, 10Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 11Veterans Caribbean Health Care System, San Juan, PR, 12Centro de Neumologia Pediatrica, San Juan, PR. RATIONALE: Allergic rhinoconjunctivitis (ARC) can be unrecognized and may impair school performance in children. We investigated ARC frequency in reportedly healthy Latino children. METHODS: Hispanic children aged 8-21 years were recruited as nonallergic control and asthmatic subjects from five cities in the mainland United States (US) and Puerto Rico for the GALA II Study (2008-2011). Controls denied physician diagnosis of ARC at screening before undergoing a study visit when we administered an extensive questionnaire and performed skin prick test (SPT to 14 aeroallergens) and venipuncture. We used logistic regression to identify variables associated with atopy and ARC, adjusting for demographics, socioeconomic status, ethnicity, recruitment site, and smoking history. RESULTS: Of 1552 control subjects (mean+SD age 5 13.9+3.6 years,43% males), 50% were of Mexican descent, 30% Puerto Rican, and 20% other Latino ethnicity. Atopy based on >1 positive SPT was present in 48% of subjects (n5743) and unrecognized ARC in 13% (n5202), based on atopy plus questionnaire report of nasocular symptoms in the absence of colds or flu. Sensitization to indoor allergens predominated and testing for 7 allergens identified >95% of atopic subjects. Mexicans were more often atopic than Puerto Ricans (51% vs. 38%,p<0.0005), but fewer reported rhinoconjunctivitis (18% vs. 42%,p<0.0005). Logistic regression showed that atopy was associated with male gender (odds ratio[OR]51.59; 95% confidence interval [1.232.04]), city living (OR51.58[1.02-2.46]), living in mainland US (OR52.49[1.94-3.19]), and in the Northeast region (OR52.87[1.854.44]). CONCLUSIONS: Atopy and allergic rhinoconjunctivitis were common in Latino children reportedly healthy. Unrecognized ARC might affect child quality of life or school performance.
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Language Disparities Among Minority Patients with Poor Asthma Control Dr. Jose R. Zaragoza-Buxo, MD1, Dr. Efren L. Rael, MD, FAAAAI2; 1 Penn State University College of Medicine, Hershey, PA, 2Allergy/ Immunology, Penn State University College of Medicine, Hershey, PA. RATIONALE: In 2011, 3.6 million Hispanic had asthma, and were 30 percent more likely to be hospitalized for asthma flares. African-American were 20% more likely to have asthma than non-Hispanic Whites. We evaluate the associations between limited English proficiency, Emergency Department (ED) visits, and hospitalization on asthma control in Minority groups. METHODS: After IRB consent was obtained, a telephone survey was conducted in a cohort of randomly selected minority subjects of all ages with moderate to severe persistent asthma. Subjects were classified into 3 groups, English-proficient African-American (1), English proficient Hispanic (2) and non-English proficient Hispanic (3). RESULTS: Of 30 patients contacted, 73% responded, 59% were Hispanic and 41% were African Americans. Among Hispanics 38% where nonEnglish fluent and considered this to affect their asthma. Hispanics were more likely to present to the ED during the last year as compared with African Americans (53% vs. 11%), had more E.R. visits last year (3.5 vs. 1), and had a 23% higher rate of hospitalization for asthma. Among group 3 subjects, 80% presented to the ED for asthma flares and 40% were hospitalized for an average of 2.5 days. Of group 2 subjects, 29% presented to the ED for asthma flares and 6% were hospitalized for an average of 1.5 days. CONCLUSIONS: Language barrier is associated with increased ED visits, hospitalizations for asthma among Hispanic patients in our cohort. Further analysis is needed to asses social factors associated with asthma management in minority populations.
262
Race/Ethnicity and SES Are Predictors Of Allergic Sensitization To Environmental and Food Allergens Dr. Amina Abdeldaim, MD1, Dr. Supinda Bunyavanich, MD, MPH2, Ms. Sheryl Rifas-Shiman, MPH3, Thomas A. E. Platts-Mills, MD, PhD, FAAAAI4, Dr. Diane R. Gold, MD, MPH5, Dr. Carlos Camargo, Jr, MD, DrPH6, Dr. Emily Oken, MD7, Dr. Matthew Gillman, MD, SM3, Dr. Augusto A. Litonjua, MD, MPH8; 1Channing Division of Network Medicine, Brigham and Women’s Hospital, MA, 2Division of Pediatric Allergy & Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 3Harvard Medical School, Boston, MA, 4Division of Asthma, Allergy & Immunology, University of Virginia Health System, Charlottesville, VA, 5Channing Laboratory, Brigham and Women’s Hospital, Boston, MA, 6Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 7 Harvard Medical School, 8Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA. RATIONALE: We investigated the relationship between race/ethnicity, socioeconomic factors and allergen sensitization. METHODS: In Project Viva, a prospective cohort study examining the effects of prenatal and perinatal factors on maternal and child health, we evaluated 605 children ages 6.7-10.6 years for specific IgE levels to Alternaria, Aspergillus, cat and dog dander, cockroach, Dermatophagoides farinae, ragweed, rye grass, egg white, milk, peanut, sesame, soybean and wheat. Predictors included mother-reported race/ethnicity of the child, household income and maternal education. Covariates included child’s age; sex; diagnosis of asthma, hay fever and eczema; and maternal history of asthma and/or atopy. Logistic regression was utilized for the analyses. RESULTS: Among the children, 12(2%) were Asian, 104(17%) black, 25(4%) Hispanic, 358(59%) white and 65(11%) other race/ethnicity. 353(62%) and 86(15%) came from households with income >$70,000 and <5$40,000, respectively. 259(43%) were sensitized to any environmental allergen and 168(28%) to any food allergen. Compared to white children, Hispanic children had 10.6 times the odds (95% CI 1.9-199) of having any environmental sensitization and black children had 2.2 times the odds (95% CI 1.3-3.6) of any food sensitization. Compared to children
J ALLERGY CLIN IMMUNOL FEBRUARY 2014
from households with income >$70,000, children from households with income <5$40,000 had 2.2 times (95% CI 1.1-4.4) and 2.1 times (95% CI 1.2-3.5) the odds of being sensitized to environmental and food allergens, respectively. We found no significant association between mother’s level of education and sensitization. CONCLUSIONS: Children who are Black, Hispanic or members of households with low family income were more likely to be sensitized to both environmental and food allergens.
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Unrecognized Allergic Rhinoconjunctivitis and Allergic Sensitization Among Latino Youth (GALA II Study) Ulysses Burley, MPH1, Dr. Joy Hsu, MD, MSCI2, Duanny Alva, MDIMG, MPH1, Ms. Elizabeth Nguyen, BS3, Ms. Lindsey Roth, MA4, Dr. Joshua Galanter, MD4, Dr. Sam Oh, PhD, MPH4, Ms. Celeste Eng, BS4, Mr. Fred Lurmann, MS5, Dr. Rajesh Kumar, MD, MS, FAAAAI6, Dr. Harold J. Farber, MD, MSPH7, Dr. Denise Serebrisky, MD8, Dr. Luisa Borrell, DDS, PhD9, Dr. Saunak Sen, PhD10, Dr. William Rodriguez-Cintron, MD11, Dr. Jose RodriguezSantana, MD12, Dr. Esteban Gonza Burchard, MD, MPH4, Prof. Pedro C. Avila, MD, FAAAAI1; 1Feinberg School of Medicine, Northwestern University, Chicago, IL, 2Department of Medicine, Division of AllergyImmunology, Northwestern University Feinberg School of Medicine, Chicago, IL, 3Department of Medicine, University of California, San Francisco, California, San Francisco, CA, 4Department of Medicine, University of California, San Francisco, San Francisco, CA, 5Sonoma Technology, Inc., Petaluma, CA, 6Pediatric allergy, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 7Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, 8Pediatric Pulmonary Division, Jacobi Medical Center, Bronx, NY, 9Department of Health Sciences, Graduate Program in Public Health, Lehman College, City University of New York, Bronx, NY, 10Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 11Veterans Caribbean Health Care System, San Juan, PR, 12Centro de Neumologia Pediatrica, San Juan, PR. RATIONALE: Allergic rhinoconjunctivitis (ARC) can be unrecognized and may impair school performance in children. We investigated ARC frequency in reportedly healthy Latino children. METHODS: Hispanic children aged 8-21 years were recruited as nonallergic control and asthmatic subjects from five cities in the mainland United States (US) and Puerto Rico for the GALA II Study (2008-2011). Controls denied physician diagnosis of ARC at screening before undergoing a study visit when we administered an extensive questionnaire and performed skin prick test (SPT to 14 aeroallergens) and venipuncture. We used logistic regression to identify variables associated with atopy and ARC, adjusting for demographics, socioeconomic status, ethnicity, recruitment site, and smoking history. RESULTS: Of 1552 control subjects (mean+SD age 5 13.9+3.6 years,43% males), 50% were of Mexican descent, 30% Puerto Rican, and 20% other Latino ethnicity. Atopy based on >1 positive SPT was present in 48% of subjects (n5743) and unrecognized ARC in 13% (n5202), based on atopy plus questionnaire report of nasocular symptoms in the absence of colds or flu. Sensitization to indoor allergens predominated and testing for 7 allergens identified >95% of atopic subjects. Mexicans were more often atopic than Puerto Ricans (51% vs. 38%,p<0.0005), but fewer reported rhinoconjunctivitis (18% vs. 42%,p<0.0005). Logistic regression showed that atopy was associated with male gender (odds ratio[OR]51.59; 95% confidence interval [1.232.04]), city living (OR51.58[1.02-2.46]), living in mainland US (OR52.49[1.94-3.19]), and in the Northeast region (OR52.87[1.854.44]). CONCLUSIONS: Atopy and allergic rhinoconjunctivitis were common in Latino children reportedly healthy. Unrecognized ARC might affect child quality of life or school performance.