CARIBBEAN LATINX ADULTS WITH MODERATE-SEVERE ASTHMA BEAR GREATER ASTHMA MORBIDITY COMPARED TO OTHER LATINX SUBGROUPS

TOPIC: Allergy and Airway TYPE: Original Investigations PURPOSE: Hispanic/Latinx (HL) ethnicity incorporates many subgroups from diverse racial and cultural backgrounds. Studies suggest that Puerto Ricans (PR) have a greater asthma prevalence and asthma-related morbidity relative to White and Mexican counterparts. However, these studies were in children or limited in clinical and phenotypic characterization. Our purpose was to determine whether clinical, phenotypic differences, and disparities in asthma-related morbidity exist across adult HL subgroups. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans, C&D), we hypothesized that Caribbean HL (CHL; PR and C&D) adults would have greater asthma morbidity compared to other HLs (OHL; Mexicans, Spaniards, Central/South Americans). METHODS: Adults with moderate-severe persistent asthma were recruited from primary care/specialty clinics across the United States, including Puerto Rico, for the PREPARE trial, an open-label pragmatic trial testing a patient directed treatment strategy compared to usual care in Black and HL adults. We examined baseline differences in self-reported clinical characteristics between CHL (n= 457) and OHL (n=141) and between CHL subgroups C&D (n=56) and PR (n=401). These were evaluated through Chi-square or t-tests. Differences in asthma morbidity measures (self-reported exacerbations requiring steroids, ER visits, hospitalizations) were tested with multivariate logistic and ordinal regression models, with adjustment for age, gender, BMI, controller therapy and poverty measure. RESULTS: CHL compared to OHL were more likely to be female (84% vs 77% p=0.04) and to be prescribed more asthma controller therapies (ICS + >2 controllers 50% vs 22% p<0.001) but were similar in age (48 vs 46 years p=0.16), BMI (33 vs 32 p=0.18), poverty measure (46% vs 43% p=0.14), blood eosinophils (263 vs 290 p=0.37) and FeNO (27 vs 31 ppb p=0.2). Relative to OHL, CHL had 7.9-fold greater odds of more asthma exacerbations (95%CI 2.4 to 26.6-fold greater p<0.001), 10.3-fold greater odds of more ER visits (95%CI 3.1 to 34.1-fold greater p<0.001), and trended towards greater odds of hospitalizations (OR=5.4 p=0.08). While PR (n=401) exhibited similar morbidity measures relative to OHL, C&D (n=56) had greater odds of exacerbations than OHL (2.0, 95% 1.1 to 3.5-fold greater p=0.03) but not ER visits or hospitalizations. PR had greater odds of more ER visits than C&D but not exacerbations overall. CONCLUSIONS: CHL adults exhibit increased asthma morbidity relative to OHL. While both PR and C&D have more asthma exacerbations relative to OHL, PR have greater odds of ER visits relative to C&D. Geography, healthcare access, ancestry and culture may underlie these differences. CLINICAL IMPLICATIONS: Adult CHL have worse asthma morbidity relative to OHL. Further research is needed to understand and find interventions to address this disparity. 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