Area of residence, birthplace, and asthma in Puerto Rican children

RATIONALE: Puerto Ricans have the highest prevalence of asthma among all ethnic groups in the United States. There have been no studies that directly compare the burden of asthma between Puerto Ricans living in Puerto Rico and those living in the mainland United States. OBJECTIVE: To examine the relation between birthplace, area of residence, and asthma in Puerto Rican children. METHODS: Multistage population-based probability sample of children in the San Juan and Caguas metropolitan areas in Puerto Rico and in the Bronx, NY. Information was collected in a household survey of 2,491 children and their primary caretakers. RESULTS: The overall prevalence of asthma among Puerto Rican children in this study was very high (38.6%). Although children from Puerto Rico had higher socioeconomic status and lower rates of premature birth and prenatal smoke exposure, the prevalence of lifetime asthma was higher in Puerto Rican children living in Puerto Rico than in Puerto Rican children living in the South Bronx (41.3% vs 35.3%, p = 0.01). In multivariable analysis, residence in Puerto Rico was associated with increased odds of lifetime asthma (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.03 to 1.57) and lifetime hospitalization for asthma (OR, 1.47; 95% CI, 1.04-2.07). CONCLUSIONS: Puerto Rican children in Puerto Rico had a higher risk of asthma than Puerto Rican children in the South Bronx, highlighting the need for further examination of the roles of migration, acculturation, and environmental and psychosocial factors on the development of asthma in this high-risk population.     

Risk factors for asthma in US adults: results from the 2000 Behavioral Risk Factor Surveillance System.

BACKGROUND: Identifying populations at risk for having asthma is an essential step toward appropriately allocating resources and reducing the burden of this disease. To date, the impact of demographic and social factors on asthma prevalence has not been assessed in a nationally representative sample of U.S. adults. METHODS: We conducted weighted analyses using data from a random digit-dialed telephone survey of non-institutionalized persons > or = 18 years of age in 50 states, Puerto Rico, and the District of Columbia to assess risk factors for asthma prevalence. RESULTS: We found that women were more likely than men to report current asthma [odds/ratio (OR): 1.91, 95% confidence interval (CI): 1.77-2.06]; adults aged 35-64 and >65 were less likely than adults aged 18-34 to report current asthma (OR: 0.79, 95% CI: 0.73-0.85 and OR: 0.65, 95% CI: 0.58-0.72, respectively); persons from the lower socioeconomic status (SES) were more likely to report current asthma than those in other SES (OR: 1.36, 95% CI: 1.25-1.49); overweight and obese people were more likely to report current asthma than were those of normal weight (OR: 1.10, 95% CI: 1.02-1.20 and OR: 1.65, 95% CI: 1.51-1.80, respectively); and current and former smokers were more likely than never smokers to report current asthma (OR: 1.28, 95% CI: 1.18-1.39 and OR: 1.36, 95% CI: 1.24-1.48, respectively). CONCLUSIONS: While several important sociodemographic risk factors were associated with increased asthma prevalence in U.S. adults, the impact of generally modifiable risk factors such as elevated body mass index and cigarette smoking is of specific concern. These findings further underscore the need to target and diminish these risk factors among U.S. adults.     

Asthma prevalence among Hispanic adults in Puerto Rico and Hispanic adults of Puerto Rican descent in the United States – results from two national surveys

Abstract

Objective: To assess whether asthma prevalence differs between Hispanic adults living in Puerto Rico and Hispanic adults of Puerto Rican descent living in the United States. Methods: We used 2008–2010 Behavioral Risk Factor Surveillance System data, administered in Puerto Rico for Hispanic adults living in Puerto Rico (Hispanics in Puerto Rico), and 2008–2010 National Health Interview Survey data for Hispanic adults of Puerto Rican descent living in the United States (Puerto Rican Americans). We used 95% confidence intervals (CIs) to compare asthma prevalence between corresponding subgroups; non-overlapping CIs indicate statistical significance. Chi-square test and multivariate logistic regression were used to assess the association between current asthma status and socio-demographic factors and health risk behaviors within each Puerto Rican population. Results: Current asthma prevalence among Hispanics in Puerto Rico (7.0% [6.4%–7.7%]) was significantly lower than the prevalence among Puerto Rican Americans (15.6% [13.0%–18.1%]). The prevalence among almost all socio-demographic and health risk subgroups of Hispanics in Puerto Rico was significantly lower than the prevalence among the corresponding subgroups of Puerto Rican Americans. Adjusting for potential confounders did not alter the results. Asthma prevalence was significantly associated with obesity among Puerto Rican Americans (adjusted prevalence ratios [aPR]?=?1.5 [1.1–2.0]), and among Hispanics in Puerto Rico was associated with obesity (aPR?=?1.6 [1.3–1.9]), smoking (aPR?=?1.4 [1.1–1.9]) and being female (aPR?=?1.9 [1.5–2.4]). Conclusion: Asthma was more prevalent among Puerto Rican Americans than Hispanics in Puerto Rico. Although the observed associations did not explain all variations in asthma prevalence between these two populations, they may lay the foundation for future research.     

Variation in Adult Asthma Prevalence in Hispanic Subpopulations in New York City

Background. We compared asthma prevalence among New York City Hispanics–Puerto Rican, Dominican, and other Hispanics–in relation to nativity, socioeconomic status, and asthma risk factors. Methods. Weighted logistic regression analyses on telephone survey data for New York City (NYC) adults in 2003/2004. Results. Asthma prevalence was highest among Puerto Ricans (11.8%) compared with Dominicans and other Hispanics. Non–US-born Dominicans and other Hispanics were significantly less likely to report current asthma than were Puerto Ricans (OR = 0.27, 95% CI 0.18-0.41 and OR = 0.17, 95% CI 0.11-0.26, respectively). In multivariate analyses, US-born Dominicans and other Hispanics had rates comparable to Puerto Ricans. Conclusions. Puerto Ricans, both mainland- and native-born, report the highest rates of adult asthma. Non–US-born Hispanics report lower rates. Acculturation and patterns of residential settlement may account for this variation.     

Risk Factors for Asthma in US Adults: Results from the 2000 Behavioral Risk Factor Surveillance System

Background. Identifying populations at risk for having asthma is an essential step toward appropriately allocating resources and reducing the burden of this disease. To date, the impact of demographic and social factors on asthma prevalence has not been assessed in a nationally representative sample of U.S. adults. Methods. We conducted weighted analyses using data from a random digit-dialed telephone survey of noninstitutionalized persons ≥ 18 years of age in 50 states, Puerto Rico, and the District of Columbia to assess risk factors for asthma prevalence. Results. We found that women were more likely than men to report current asthma [odds/ratio (OR): 1.91, 95% confidence interval (CI): 1.77-2.06]; adults aged 35-64 and ≥ 65 were less likely than adults aged 18-34 to report current asthma (OR: 0.79, 95% CI: 0.73-0.85 and OR: 0.65, 95% CI: 0.58-0.72, respectively); persons from the lower socioeconomic status (SES) were more likely to report current asthma than those in other SES (OR: 1.36, 95% CI: 1.25-1.49); overweight and obese people were more likely to report current asthma than were those of normal weight (OR: 1.10, 95% CI: 1.02-1.20 and OR: 1.65, 95% CI: 1.51-1.80, respectively); and current and former smokers were more likely than never smokers to report current asthma (OR: 1.28, 95% CI: 1.18-1.39 and OR: 1.36, 95% CI: 1.24-1.48, respectively). Conclusions. While several important sociodemographic risk factors were associated with increased asthma prevalence in U.S. adults, the impact of generally modifiable risk factors such as elevated body mass index and cigarette smoking is of specific concern. These findings further underscore the need to target and diminish these risk factors among U.S. adults.     

Variation in Adult Asthma Prevalence in Hispanic Subpopulations in New York City

Background. We compared asthma prevalence among New York City Hispanics-Puerto Rican, Dominican, and other Hispanics-in relation to nativity, socioeconomic status, and asthma risk factors. Methods. Weighted logistic regression analyses on telephone survey data for New York City (NYC) adults in 2003/2004. Results. Asthma prevalence was highest among Puerto Ricans (11.8%) compared with Dominicans and other Hispanics. Non-US-born Dominicans and other Hispanics were significantly less likely to report current asthma than were Puerto Ricans (OR = 0.27, 95% CI 0.18-0.41 and OR = 0.17, 95% CI 0.11-0.26, respectively). In multivariate analyses, US-born Dominicans and other Hispanics had rates comparable to Puerto Ricans. Conclusions. Puerto Ricans, both mainland- and native-born, report the highest rates of adult asthma. Non-US-born Hispanics report lower rates. Acculturation and patterns of residential settlement may account for this variation.     

A Population-Based Study of Health Service Deficits for US Adults with Asthma

Objective. Asthma prevalence in the United States is higher than it is in many other countries and its impact in terms of healthcare expenditures and morbidity and mortality is staggering. In the United States, many groups bear a disproportionate burden of asthma. Understanding the epidemiology of adult asthma and deficits in health care can identify opportunities for improving care and effectively managing resources. Methods. The computed dependent variable, health service deficits, entails a lack of health insurance, not having a healthcare provider, deferring medical care because of cost, and having had no routine medical exam. Bivariate and multivariate analyses were performed on 2005 Behavioral Risk Factor Surveillance Survey data to examine the relationship between health service deficits experienced by adults with asthma and socioeconomic status (SES), race and ethnicity, and geographic locale. The variable was also calculated for each US state. Results. Hispanic (OR = 1.594, 95% CI = 1.588–1.599) and Other/Multiracial (OR = 1.447, 95% CI = 1.441–1.452) adults with current asthma had greater odds of having a health service deficit. Rural adults with current asthma had greater odds of having a health service deficit (OR = 1.086, 95% CI = 1.083–1.089) when compared with non-rural adult residents. Low-SES (OR = 1.976, 95% CI = 1.971–1.982) and middle-SES (OR = 1.596, 95% CI = 1.592–1.600) adults with current asthma had greater odds of having a health service deficit. The percentage of current asthma adults experiencing at least one health service deficit by state ranged from a low of 28.5% (Delaware) to a high of 58.8% (Wyoming). Conclusion. There are clear patterns of disparity associated with health services and asthma that can help target interventions.     

The +252A/G polymorphism in the Lymphotoxin‐α gene increases the risk of asthma: A meta‐analysis

Background and Objective: A number of studies have shown that the +252A/G polymorphism (rs909253) in the lymphotoxin‐α (LT‐α) gene is implicated in susceptibility to asthma. However, the findings have been inconclusive. The aim of this study was to investigate the association between the +252A/G polymorphism in the LT‐α gene and the risk of asthma by performing a meta‐analysis. Methods: The Pubmed and Embase databases were searched for all studies relating to this polymorphism and the risk of asthma. Statistical analyses were performed using the Revman4.2 and STATA 10.0 software. Results: Thirteen case‐control studies that included a total of 2220 cases and 6428 controls were included in the meta‐analysis. There was no significant association between this polymorphism and the risk of asthma in the all‐combined analysis (odds ratio (OR) 1.14, 95% confidence interval (CI): 0.89–1.45 for GG+GA vs AA). In a subgroup analysis by ethnicity, no significant association with asthma risk was identified in Asians (OR 1.31, 95% CI: 0.97–1.77) or Europeans (OR 1.08, 95% CI: 0.77–1.53). In a subgroup analysis by age, a significantly increased risk was identified among adults (OR 1.25, 95% CI: 1.03–1.50) but not children (OR 1.04, 95% CI: 0.28–3.89). In a subgroup analysis by atopic status, a significantly elevated risk was identified among atopic (OR 1.55, 95% CI: 1.28–1.87) but not non‐atopic individuals (OR 0.94, 95% CI: 0.53–1.68). Conclusions: This meta‐analysis suggested that the +252A/G polymorphism in the LT‐α gene is a risk factor for asthma in adults and atopic populations.     

Lower bronchodilator responsiveness in Puerto Rican than in Mexican subjects with asthma

In the United States, Puerto Ricans and Mexicans have the highest and lowest asthma prevalence, morbidity, and mortality, respectively. To determine whether ethnicity-specific differences in therapeutic response, clinical response, and/or genetic factors contribute to differences in asthma outcomes, we compared asthma-related clinical characteristics among 684 Mexican and Puerto Rican individuals with asthma recruited from San Francisco, New York City, Puerto Rico, and Mexico City. Puerto Ricans with asthma had reduced lung function, greater morbidity, and longer asthma duration than did Mexicans with asthma. Bronchodilator responsiveness, measured as percentage change from baseline FEV1, was significantly lower among Puerto Ricans with asthma than among Mexicans with asthma. Puerto Ricans with asthma had on average 7.3% (95% confidence interval [CI], 4.6 to 9.9; p < 0.001) lower bronchodilator reversibility in FEV1, higher risk of an emergency department visit in the previous year (odds ratio, 2.63; 95% CI, 1.6 to 4.3; p < 0.001), and of previous hospitalization for asthma (odds ratio, 1.94; 95% CI, 1.2 to 3.2; p = 0.009) than Mexicans. Subgroup analysis corroborated that Puerto Ricans with asthma had more severe disease than did Mexicans on the basis of lung function measurements, responsiveness to beta2-adrenergic agonists, and health care use. We conclude that Puerto Ricans with asthma respond less to albuterol than do Mexicans with asthma. These findings underscore the need for additional research on racial/ethnic differences in asthma morbidity and response to therapy.     

Association between Angiotensin-Converting Enzyme I/D Polymorphism and Asthma Risk: A Meta-Analysis Involving 11,897 Subjects

Background. Genetic susceptibility to asthma has been a research focus in the scientific community. Several studies have been conducted in recent years to evaluate the risk of asthma and insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE). However, the results remain conflicting rather than conclusive. Methods. We carried out a search in Medline, EMBASE, and Chinese National Knowledge Infrastructure (CNKI) database for relevant studies. Data were extracted using a standardized form and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the strength of the association. Results. Our meta-analysis on 11,897 subjects from all available studies showed that the DD genotype was associated with increased asthma risk than those with the II (OR = 1.59, 95% CI = 1.20–2.12) or ID/II (OR = 1.62, 95% CI = 1.24–2.10) genotype. Stratified analyses by ethnicity (Europeans and Asians) and age (adults and children) obtained statistically similar results in the two genetic models. In the subgroup analysis by source of controls, the DD genotype was associated with a significantly elevated risk of asthma among population-based controls (DD vs. II: OR = 2.27, 95% CI = 1.45–3.56) but not hospital-based controls (DD vs. II: OR = 1.18, 95% CI = 0.93–1.49). Conclusions. This meta-analysis provides strong evidence that the I/D polymorphism of ACE is associated with asthma risk. Additional well-designed large studies were required for the validation of our results, especially in African populations.     

Factors Associated with Asthma Control among Adults in Five New England States, 2006–2007

Background. Despite the National Asthma Education and Prevention Program (NAEPP) guidelines that specify the goals of asthma control and management strategies, the number of patients with uncontrolled asthma remains high, and factors associated with uncontrolled asthma are unknown. Objective. The aim was to examine the relationship between asthma control and socio-demographic characteristics, health-care access and use, asthma education, and medication use among adults with active asthma residing in New England. Methods. Data from the 2006–2007 Behavior Risk Factor Surveillance System Adult Asthma Call-Back Survey were analyzed using multinomial logistic regression. Asthma control was categorized as “well controlled,” “not well controlled,” or “very poorly controlled” according to the NAEPP guidelines. Results. Of the respondents (n = 3079), 30% met the criteria for well-controlled asthma, 46% for not well-controlled asthma, and 24% for very poorly controlled asthma. Being of Hispanic ethnicity (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.2–13.7), unemployed or unable to work (OR = 17.9; 95% CI = 6.0–53.4), high school educated or less (OR = 2.8; 95% CI = 1.6–4.7), current smokers (OR = 2.5; 95% CI = 1.3–5.1), or being unable to see a doctor or specialist for asthma care or unable to buy medication for asthma because of cost (OR = 7.6; 95% CI = 3.4–17.1) were associated with very poorly controlled asthma. In addition, having Coronary Obstructive Pulmonary Disease (COPD) (OR = 2.6; 95% CI = 1.5–4.5), two or more routine checkups for asthma (OR = 4.5; 95% CI = 2.3–8.9), or an emergency department visit, urgent care facility visit, and hospitalization in the past year (OR = 3.9; 95% CI = 2.1–7.3) were also associated with having very poorly controlled asthma. Using controller medication in the past year (OR = 2.6; 95% CI = 1.6–4.2) and taking a course on how to manage asthma (OR = 3.0; 95% CI = 1.2–7.8) were significantly associated with poor asthma control. Conclusion. The high prevalence (70%) of not well-controlled asthma and poorly controlled asthma in this study emphasizes the need to identify factors associated with poor asthma control for development of targeted intervention. A health policy of increasing asthma education, health-care access, and smoking cessation may be effective and result in better asthma control and management.     

Asthma,Current Wheezing,and Tobacco Use Among Adolescents and Young Adults in Costa Rica

Objectives. To examine the prevalence of asthma and the relation between tobacco use and asthma among university students in Costa Rica. Methods. Cross-sectional study of 1279 adolescents and young adults enrolled in careers in the health sciences in public and private universities in Costa Rica. Results. Of the 1279 study participants, 105 (8.2%) had current asthma, and 136 (10.6%) reported wheezing in the previous 12 months (current wheezing). Among individuals with either current wheezing or current asthma, none was using anti-inflammatory medications for asthma (e.g., inhaled corticosteroids). Approximately one third of the study participants reported any cigarette smoking. Young adults who had current wheezing were 5.8 times more likely to smoke at least 10 cigarettes per day than those who had no current wheezing [95% confidence interval (CI) for odds ratio (OR) = 3.3–10.2, p < 0.001]. Similar results were observed when an alternative definition of asthma (current asthma) was used in the analysis (OR for smoking at least 10 cigarettes per day = 4.4, 95% CI = 2.3–8.5, p < 0.001). Conclusions. Adequate public health measures are needed to prevent tobacco use in Costa Rican adolescents and to promote smoking cessation among young adults. Young adults with asthma living in Latin American countries with high asthma prevalence, such as Costa Rica, should be better educated with regard to asthma and the risks of tobacco use.     

Significant association between asthma risk and the GSTM1 and GSTT1 deletion polymorphisms: An updated meta‐analysis of case–control studies

Polymorphisms in GSTM1 and GSTT1 may be associated with asthma risk, yet several studies and meta‐analyses have reported inconclusive results. Therefore, an updated meta‐analysis was conducted. Literature searches were performed using the Pubmed, Embase and Web of Science databases until October 2012. Variant ‘null’ genotype was compared with wild‐type ‘present’ in the pooled data. All statistical analyses were performed using STATA 11.0. A total of 26 case–control studies were suitable for inclusion in the meta‐analysis. In the overall population, a significant association was found for both the GSTM1 (odds ratio (OR) = 1.452; 95% confidence interval (CI): 1.192–1.770) and GSTT1 polymorphism (OR = 1.792; 95% CI:1.293–2.483). For subgroup analysis by age, GSTM1 significantly increased risk for both children (OR = 1.368; 95% CI: 1.051–1.781) and adults (OR = 1.859; 95% CI: 1.183–2.921). For GSTT1, a significant association was only found in the adult population (OR = 2.312; 95%CI: 1.204–4.439). Based on subgroup analysis by ethnicity, a significant association for GSTM1 was found in Europe (OR = 1.303; 95% CI: 1.018–1.667), Africa (OR = 2.175; 95%CI: 1.560–3.031) and Latin America (OR = 2.265; 95%CI: 1.375–3.729). For GSTT1, significantly increased risk was found only for Asian (OR = 2.105; 95% CI: 1.101–4.025) and Russian (OR = 2.747; 95% CI: 1.071–7.046) populations. This meta‐analysis provides evidence that GSTM1 and GSTT1 polymorphisms may be risk factors for asthma.     

Ethnicity and skin test reactivity to aeroallergens among asthmatic children in Connecticut

OBJECTIVES: To examine the relationship between ethnicity and sensitization to allergens among children with asthma living in urban and suburban areas of Connecticut. STUDY DESIGN: Cross-sectional study. Study population: A total of 791 children with mild-to-severe asthma who received their medical care in the city of Hartford. RESULTS: Puerto Rican ethnicity was associated with skin test reactivity (STR) to cockroach (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.7 to 6.4), STR to dust mite (OR, 1.7; 95% CI, 1.2 to 2.4), STR to mixed grass pollen (OR, 1.7; 95% CI, 1.1 to 2.7), and STR to mugwort/sage (OR, 2.4; 95% CI, 1.4 to 4.1). African-American ethnicity was associated with STR to four outdoor allergens (ie, mixed tree pollen [OR, 2.3; 95% CI, 1.3 to 3.9], mixed grass pollen [OR, 2.7; 95% CI, 1.6 to 4.8], mugwort/sage [OR, 3.1; 95% CI, 1.6 to 6.0], and ragweed [OR, 2.1; 95% CI, 1.2 to 3.8]). Among all children, STR to outdoor allergens was strongly associated with the extent of allergen sensitization. As an example, children sensitized to mixed grass pollen had 34.7 times higher odds of having at least four positive skin tests to other allergens than nonsensitized children (95% CI for OR, 15.6 to 77.0). CONCLUSIONS: Our findings suggest that Puerto Rican ethnicity is associated with an increased risk of sensitization to indoor and outdoor allergens among children with asthma, and that allergy skin testing should be performed more often as part of the management of asthma in African-American children and in Puerto Rican children in the United States.     

Childhood Asthma Prevalence in Northern Puerto Rico,the Rio Grande,and Loíza Experience

Objective. Childhood asthma is highly prevalent in some areas of Puerto Rico. The objective of this study was to estimate the prevalence of asthma in two municipalities of Northern Puerto Rico. Methods. Children 6 to 7 and 13 to 14 years of age participated in the school-based cross-sectional study. Results. A total of 1,467 elementary school students and 1,334 junior-high school students were included in the survey. A high prevalence of asthma was observed; 46% in elementary schools and 24% in junior-high schools. In elementary schools, family history of asthma (FHA) was associated with ever wheezed (PR = 2.00, 95%CI 1.59, 2.52), wheeze during last year (PR = 2.02, 95%CI 1.54, 2.62), and asthma (PR = 2.33, 95%CI 1.86, 2.92). For junior-high schools FHA was associated with ever wheezed (PR = 2.01, 95%CI 1.56, 2.57), wheeze during previous year (PR = 2.00, 95%CI 1.47, 2.73), and asthma (PR = 2.72, 95%CI 2.06, 3.60). Conclusions. This study showed a high prevalence of asthma and related symptoms in Northern Puerto Rico. FHA was strongly associated with asthma and its symptoms. Further research is recommended to look at genetics, sensitivity levels, indoor and outdoor pollution, and gene-environment interactions.     

Maternal Mental Health and Childhood Asthma among Puerto Rican Youth: The Role of Prenatal Smoking

Rationale. Childhood asthma is a major public health problem, with mainland and island Puerto Rican children having the highest asthma rates of any ethnic group in the United States. Objectives. To examine the relationship between maternal mental health problems, prenatal smoking, and risk of asthma among children in Puerto Rico and the Bronx, New York. Methods. A cross-sectional community-based study was conducted in the South Bronx in New York City and the San Juan Standard Metropolitan Area in Puerto Rico. Participants were Puerto Rican children 5 to 13 years of age and their adult caretakers with probability samples of children 5 to 13 years of age and their caregivers drawn at two sites: the South Bronx in New York City (n = 1,135) and San Juan and Caguas, Puerto Rico (n = 1,351). Measurements. Self-reported maternal mental health, prenatal smoking, and rates of childhood asthma. Results. Maternal mental health problems were associated with significantly higher levels of prenatal smoking, compared with that among women without mental health problems (p < 0.0001). Both maternal mental health problems and prenatal smoking appear to make a contribution to increased odds of asthma among youth. After adjusting for prenatal smoking, the relationship between maternal mental health problems and childhood asthma was no longer statistically significant. Conclusions. Previous research suggests children of Puerto Rican descent are especially vulnerable to asthma. Our results suggest that maternal mental health problems and prenatal smoking are both associated with increased odds of asthma among Puerto Rican youth and that prenatal smoking may partly explain the observed relationship between maternal psychopathology and childhood asthma. Future longitudinal and geographically diverse epidemiological studies may help to identify the role of both maternal mental health problems and prenatal smoking in the health disparities in childhood asthma.     

Polymorphisms in the transforming growth factor‐β1 gene and the risk of asthma: A meta‐analysis

Background and objective: Polymorphisms in the transforming growth factor‐β1 (TGF‐β1) gene have been implicated in susceptibility to asthma, but a large number of studies have reported inconclusive results. A meta‐analysis was performed to investigate the association between polymorphisms in the TGF‐β1 gene and asthma susceptibility. Methods: Searches were performed of Medline (Ovid), PubMed, the Chinese Biological Medicine Database (CBM), the Chinese Journals Full‐text Database (CNKI), the Cochrane Library Database and the Web of Science, covering all papers published up to 30 April 2009. Statistical analysis was performed using Revman4.2.8 and STATA10.0 software. Results: Two polymorphisms (?509C/T and 915G/C(G25C)) were investigated in 14 studies, involving 2979 asthma patients and 4941 control subjects. The results showed that individuals carrying the ?509T allele (TT+TC) had a 36% increased risk of asthma, when compared with homozygotes (?509CC) (OR 1.36, 95% CI: 1.12–1.65). However, there was no significant association with risk of asthma in carriers of the 915C allele (GC+CC) compared with 915GG homozygotes (OR 1.05, 95% CI: 0.65–1.70). In a subgroup analysis by ethnicity, the risk of asthma associated with the ?509T allele was significantly elevated among Asians (OR 1.50, 95% CI: 1.04–2.17) but not Caucasians (OR 1.16, 95% CI: 1.00–1.36). In a subgroup analysis by age, the ?509T allele was associated with a significantly elevated risk of asthma among adults (OR 1.45, 95% CI: 1.09–1.92) but not children (OR 1.19, 95% CI: 0.96–1.46). Conclusions: This meta‐analysis suggested that the ?509C/T polymorphism in the TGF‐β1 gene may be a risk factor for asthma. To further evaluate gene–gene and gene–environment interactions between polymorphisms in the TGF‐β1 gene and asthma susceptibility, more studies involving thousands of patients are required.     

Factors associated with increased healthcare utilization among adults with asthma

Objective. To evaluate determinants of increased emergency room (ER) visit and hospitalization among adults with asthma, with emphasis on the role of psychological distress, self-efficacy, and obesity. Methods: For analysis 2009, 2011/2012 California Health Interview Survey was used. Adults who reported lifetime asthma were selected. Association between ER and overnight hospital stay with population characteristics were conducted using chi-square analysis. Multivariable binary logistic regression models, taking into account control variables, were utilized to assess the relationship between ER visit or overnight hospital stay with that of psychological distress, self-efficacy, and obesity. Results: Odds of ER visits were higher among those with mild-to-moderate psychological distress (adjusted odds ratio [aOR] = 1.94, 95% CI: 1.28, 2.94), and among those with serious psychological distress (aOR = 2.62, 95% CI: 1.65, 4.16). Mild-to-moderate distress was associated with two-fold increase in hospital overnight stay (aOR = 2.05, 95% CI: 1.29, 3.25). Adults with asthma who reported low self-efficacy had increased ER visits (aOR = 6.21, 95% CI: 3.63, 10.65) and hospitalization (aOR = 4.13, 95% CI: 2.63, 6.49). Finally, adults who had asthma and were obese had higher odds of ER visits (aOR = 1.60, 95% CI: 1.20, 2.13). Conclusions: Healthcare utilization is higher among asthma patients with psychological distress, low self-efficacy, and obesity. Interventions, such as incorporation of integrated care models, are critical to ensure early screening of mental health status among such patients. In addition, there is a need for patient education and improved weight management among adults with asthma.     

Interactions between psychosocial problems and management of asthma: who is at risk of dying?

Adjustment for psychosocial and family problems is common in epidemiological research. Recursive partitioning algorithms, such as CHi Square Automatic Interaction Detection (CHAID), can be used to explore complex interactions between these factors and predictor and outcome variables. We investigated the nature of interactions between asthma management variables and psychosocial problems and how these interactions changed the risk of asthma mortality; 50 cases of asthma death and 201 emergency department controls were recruited. A validated questionnaire was used to collect data. An extended version of CHAID was used to identify statistically significant (p < or = 0.05) interactions controlling for asthma severity. Family problems were associated with increased risk of mortality for patients aged > 31 years (OR = 6.5; 95% CI 2.6-16.1) but not for younger patients. Males were at increased risk overall, but females with family problems (OR = 4.3; 95% CI 1.7-10.7) were at greater risk then males (OR = 3.1; 95% CI 1.2-7.9) with family problems. Alcohol use increased risk of mortality for individuals with verbal instructions (OR = 5.4; 95% CI 1.5-19.5) or without a written action plan (OR = 4.4; 95% CI 1.0-19.4). Individuals with severe asthma and who reported having lung function tests were at increased risk for mortality if family (OR = 8.2; 95% CI 1.6-41.6) or financial problems (OR = 11.5; 95% CI 2.0-65.9) were present. This analysis highlights some important interactions and the magnitude of additional risk for mortality associated with psychosocial or family problems. Psychosocial problems need to be identified and addressed as part of asthma management, because even with best practice, these problems place patients at an increased risk of dying.     

Risk factors for Kaposi's sarcoma-associated herpesvirus infection among HIV-1-infected pregnant women in the USA

OBJECTIVES: We sought to identify risk factors for infection with the Kaposi's Sarcoma-associated herpesvirus (KSHV) among pregnant women and to examine a reported association of KSHV with injecting drug use (IDU) and hepatitis C virus (HCV) infection. DESIGN: Cross-sectional evaluation of questionnaire data and KSHV and HCV seroprevalence in the Women and Infants Transmission Study. METHODS: In sera collected from HIV-1-infected pregnant women (n = 887) and, at age 12 months, their offspring (n = 900) at six sites in the USA and Puerto Rico, KSHV and HCV antibodies were detected with sensitive and specific enzyme immunoassays. Risk of KSHV was estimated by the unadjusted and adjusted odds ratio (OR(adj)) and 95% confidence interval (CI). The geographic referent sites were Chicago and Boston. RESULTS: Forty-seven (5.3%) of the women and three (0.3%) of the infants were KSHV seropositive. In univariate and multivariate analyses, KSHV in the women was associated with enrollment in Puerto Rico, Houston or Brooklyn (OR(adj), 4.3; 95% CI, 1.8-10.4) or Manhattan (OR(adj), 9.8; 95% CI, 3.7-25.6); non-completion of high school (OR(adj), 1.8; 95% CI, 0.9-3.4); the number of sexually transmitted diseases (OR(adj), 1.4; 95% CI, 1.0-1.9 per disease); and especially with IDU and HCV infection (OR(adj), 3.5; 95% CI, 1.5-7.9). CONCLUSIONS: Transmission of KSHV by blood inoculation may be highly inefficient, but our data support the hypothesis that it does occur. Large formal studies to evaluate whether KSHV transmission occurs via transfusion are needed to inform decisions regarding screening volunteer blood donors to protect the blood supply.