High social vulnerability index scores associated with asthma among youth in Puerto Rico
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Key takeaways:
- Youth who lived in vulnerable communities were 1.65 times more likely to have asthma.
- Low annual household incomes and perceptions of being poor also were associated with asthma.
SAN DIEGO — High social vulnerability index scores were associated with persistent or new-onset asthma among youth in Puerto Rico, according to a study presented at the American Thoracic Society International Conference.
These associations were significant for youth with low household incomes or greater perceived poverty, Juan C. Celedón, MD, DrPH, ATSF, division chief, pulmonary medicine, UPMC Children’s Hospital of Pittsburgh, and colleagues wrote.
“Puerto Ricans are more likely to be both economically disadvantaged and disproportionately affected with asthma,” Celedón, who also is the Niels K. Jerne Professor of Pediatrics at the University of Pittsburgh, told Healio.
The researchers defined the social vulnerability index (SVI) as a quantitative indicator of the socioeconomic and demographic factors that affect the resilience of communities.
“Although higher social vulnerability has been associated with worse asthma outcomes, no study had evaluated SVI and asthma in Puerto Rican youth,” Celedón said.
The cohort included 405 children from San Juan, both with (n = 224) and without (n = 181) asthma who participated in the Prospective Study of Puerto Rican Youth and Asthma and were followed from ages 6 to 14 years to ages 9 to 20 years, with approximately 5 years between initial and follow-up visits.
The study also included SVI scores by census track from 2014 that were based on 15 social factors. Researchers ranked each tract by socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. Each track got an overall ranking as well. SVI scores of 0 represent the least vulnerable communities and scores of 1 represent the most vulnerable.
During the baseline visit, youth with asthma were significantly more likely to be male and have a parental history of asthma, an unhealthy diet, a higher overall SVI score and a higher BMI z score than those who did not have asthma. They also were more likely to have lower percent-predicted FEV1 and forced vital capacity than those without asthma.
Compared with youth who had overall SVI scores in the first quartile, those with overall SVI scores in the third and fourth quartiles had increased odds for asthma.
Youth who lived in more vulnerable communities, defined as overall SVI scores at or above the median, were 1.65 times (95% CI, 1.02-2.68) more likely to develop asthma than those who lived in less vulnerable communities, or those communities with overall SVI scores below the median.
When the researchers adjusted for residential proximity to a road, this association did not change.
“Most significantly, a high SVI score (indicating greater social vulnerability) was associated with 2.7 times higher odds of asthma in study participants living in household with an annual income below $15,000, but not in participants living in households with annual income of equal to or greater than $15,000,” Celedón said.
According to the researchers, $15,000 was the median household income in Puerto Rico in 2008 and 2009.
Youth who perceived themselves as poor or almost poor also experienced associations between overall SVI at or above the median and increased odds for asthma (OR = 5.28; 95% CI, 1.04-26.88), but youth who did not share these perceptions did not.
There were no associations between SVI score and serious adverse events, the researchers said.
“Our findings suggest that Puerto Rican children and adolescents who live in vulnerable communities and whose individual households are economically deprived are at highest risk of asthma, even after accounting for factors such as parental history of asthma, exposure to secondhand smoke, overweight or obesity, an unhealthy diet and outdoor air pollution,” Celedón said.
Although the researchers said their findings indicated an association between higher SVI and increased odds for asthma, as well as an interaction between neighborhood and individual factors in asthma prevalence, they also called for large longitudinal studies to confirm and expand their findings.
“Our results, together with those of other studies, support the development of programs paying special attention to asthma management in high-risk youth in underserved and marginalized populations such as Puerto Ricans, as this could reduce existing health disparities in asthma,” Celedón said.
“Identifying modifiable environmental factors most responsible for the SVI-asthma associations, and testing whether policies and clinical programs targeting and addressing prevention and treatment can improve asthma outcomes in Puerto Rican youth,” he added.
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For more information:
Juan C. Celedón, MD, DrPH, ATSF, can be reached at juan.celedon@chp.edu.