Asthma prevalence varies between groups of Asian American, Pacific Islander children
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Key takeaways:
- Asthma prevalence ranged from 8% among South Asian children to 31% among Native Hawaiian and Pacific Islander children.
- Prevalence was 28% lower for Chinese adolescents vs. non-Hispanic white adolescents.
SAN DIEGO — Asthma prevalence varies widely among Asian American and Pacific Islander children, a group that often is aggregated in studies, according to an abstract presented at the American Thoracic Society International Conference.
“Few studies have characterized ethnic differences in asthma burden among Asian American and Pacific Islander children,” Julia Costantini, MD, internal medicine resident, Kaiser Permanente Medical Center, said during her presentation.
National surveys have reported lower prevalence of asthma among AAPI children, but Costantini and her colleagues had observed higher incidence among Filipino, native Hawaiian and Pacific Islander, and South Asian children aged 3 to 7 years compared with non-Hispanic white children.
“We wanted to expand on those results and examine cross-sectional trends in asthma prevalence among Asian American and Pacific Islander (AAPI) ethnic groups across three childhood stages,” Costantini said.
Researchers defined middle childhood as age 5 to 8 years, pre-teen as age 9 to 12 years and adolescence as age 13 to 17 years.
Costantini and her colleagues identified 792,853 children aged 5 to 17 years with a well child visit at Kaiser Permanente between 2016 and 2019, including 168,977 (21%) who identified as AAPI. Other percentages included 34% non-Hispanic white, 28% Hispanic, 9% Black and 8% other/unknown.
Percentages among the AAPI group included 17% Filipino (n = 28,014), 12% Chinese (n = 20,795), 10% South Asian (n = 16,572) and 5% Native Hawaiian or Pacific Islander (n = 7,666).
“These were the focus of our analyses,” Costantini said.
The AAPI group also included 4% Vietnamese, 2% other Southeast Asian, 1% Japanese, 1% Korean and 48% other, mixed or unspecified.
Approximately 50% of the cohort were boys, which was consistent across all the subgroups, Costantini said. Also, overall, 16.5% of these children had obesity, defined as BMI greater than the 95th percentile.
Prevalence of obesity included 26% among Native Hawaiian and Pacific Islander children, 17% among Filipino children, 10% among South Asian children and 6% among Chinese children. Also, prevalence included 25% among Hispanic children, 22% among Black children and 12% among non-Hispanic white children.
Although 25% of the overall cohort resided within the fourth neighborhood deprivation index quartile, indicating they were among the most deprived, prevalence again varied.
Percentages of groups in the fourth quartile included 31% of Native Hawaiian and Pacific Islander children, 20% of Filipino children, 10% of Chinese children and 8% of South Asian children. By comparison, 43% of Hispanic children, 42% of Black children and 13% of white children were in the fourth quartile.
The researchers looked at the prevalence of asthma by sex and childhood stage as well. Chinese boys and girls alike had the lowest prevalence, with substantial variations between the sexes among the other groups.
Among boys, asthma was most prevalent for Filipino children, followed by Black children. Prevalence decreased through adolescence, which Costantini called expected. Among girls, asthma was most prevalent among Black children and then Filipino children.
“Adjusted asthma prevalence was 71%, 66% and 33% higher for Filipino children compared to non-Hispanic white children across middle childhood, preteen and adolescence,” Costantini said.
Similarly, adjusted asthma prevalence was 74%, 65% and 39% higher for Black children compared with non-Hispanic white children across the middle childhood, preteen and adolescence subgroups.
Also compared with non-Hispanic white children, adjusted asthma prevalence was 23% and 22% for South Asian children in the middle childhood and preteen years, in addition to 38% and 27% higher for Native Hawaiian and Pacific Islander children in middle childhood and in the preteen years.
Chinese children reported 28% lower adjusted asthma prevalence during adolescence, compared with non-Hispanic white children.
Overall adjusted prevalence ratios for asthma among children aged 5 to 8 years vs. non-Hispanic white children included 1.71 for Filipino children, 1.38 for Native Hawaiian and Pacific Islander children and 1.23 for South Asian children.
“As expected, higher BMI and male sex were associated with higher asthma prevalence, and sex differences were no longer evident during adolescence,” Costantini said.
Costantini cited the large size of the cohort, including more than 28,000 Filipino children, more than 20,000 Chinese children, more than 16,000 South Asian children and more than 7,000 Native Hawaiian and Pacific Islander children, as one of the study’s strengths.
“We also identified asthma using electronic health record sources, rather than survey data,” she added.
However, Costantini noted that the study only investigated the four largest AAPI ethnic groups in the cohort and that the cohort was localized to a health care system in Northern California.
Yet Costantini said that she and her colleagues still concluded that “wide variation in asthma prevalence exists among Asian American and Pacific Islander ethnic groups, which really emphasizes the heterogeneity of this frequently aggregated population.”
In the future, she continued, “studies should examine risk factors among Asian American subgroups that are associated with higher asthma burden.”