Puerto Rican Children Report Worse Asthma Control Adherence than Mexican American Children

The 2 patient groups have often been grouped into a singular 'Latino' designation in previous pediatric asthma studies. These findings show it's not an accurate representation of either group.

Kimberly J. Arcoleo, PhD, MPH

Puerto Rican children with asthma are more likely than Mexican American children to report poor or worsened rates of inhaler medication adherence. The findings, from a new longitudinal observational study, could help clinicians better discern treatment adherence trends in a group far too often bunched and indistinguishably labeled as Latino patients.

The one-year study, which spanned across 123 children aged 5 to 12 years old living in either Phoenix, AZ, or Bronx, NY, came from a desire to better specify national asthma and treatment prevalence rates among different ethnicities. In an interview with MD Magazine®, study author Kimberly J. Arcoleo, PhD, MPH, explained the commonly-held perception of asthma among races: black patients are the most affect, white patients are the least affected, and Latinos fall in the middle.

“But if you take that (Latino) group and disentangle it, what you find is a totally different picture,” Arcoleo, an associate professor from the University of Rochester School for Nursing, said.

To better understand ethnicity disparity in pediatric treatment adherence, investigators assessed data collected by monitors attached to Mexican American and Puerto Rican patients’ inhaler devices. Patients were prescribed and given access to inhaled corticosteroids (ICS) to control their persistent asthma and prevent exacerbations.

Patient adherence was categorized as poor, moderate, declining, or increasing adherence. At each three-month follow-up after enrollment, between 23% and 32% of all children had poor adherence rates (<50% prescribed doses taken) and never more than 15% of all children had good adherence (>80% prescribed doses taken).

Puerto Rican children were more than 5 times more likely (OR= 5.62) as Mexican American children to report poor ICS adherence, and also significantly more likely to report decreasing adherence rates (OR= 2.86).

Among genders, females were significantly more likely to report decreasing (OR= 4.80) or poor (OR= 5.20) adherence rates than males. Children with poor adherence reported the greatest mean rate of emergency room visits or hospitalizations due to an asthma attack throughout the yearlong period.

Aside from shedding light on the disparity of adherence between the 2 patient groups, the study also gave Arcoleo and colleagues context as to how varying adherence rates can be in mere months. She advised clinicians and pulmonologists give more emphasis to the importance of adherence during routine patient visits.

“We need to come up with a very quick, easy-to-use, validated way for them to assess what the treatment pattern has been with this child,” Arcoleo said.

Moving forward, Arcoleo expressed interest in conducting a similar study involving quick-release therapy such as albuterol, over the same time period—in hopes of “triangulating” the use methods of quick-release therapy in pediatric asthma patients.

To the investigation team’s count, this is the first study to show differing levels of controller medication non-adherence risk among ethnicities within the Latino populations—not just the broad population itself. The findings could fit into prior research findings suggesting that adherence in Latino children is significantly influenced by the perception of symptoms by both the patient and their caregiver—a frequently inaccurate perception, at that. Cultural beliefs and other socio-economic factors may influence the rates in Latino children, as well.

“Given that pediatric adherence is heavily influenced by parental involvement, effective intervention may require tailoring to specific cultural needs at both adult (parent, grandparent) and child level,” they wrote.

The study, "Longitudinal Patterns of Mexican and Puerto Rican Children’s Asthma Controller Medication Adherence and Acute Healthcare Utilization," was published online in The Annals of The American Thoracic Society.