Advertisement

Burden of Illness, Primary Care Use, and Medication Utilization among US-México Border Children with Wheezing

  • Mónica Siañez
  • Linda Highfield
  • Timothy Collins
  • Sara GrineskiEmail author
Article

Abstract

Objective

Among high-risk, underserved populations, such as children living along the US-México border, suffering from asthma-like symptoms without an asthma diagnosis can result in a high burden of illness. We estimated the prevalence of physician-diagnosed and possible undiagnosed asthma among students with histories of wheezing in the US-México border community of El Paso, Texas, and evaluated their burden of illness, primary care use, and medication utilization.

Methods

We analyzed cross-sectional survey data collected in May 2012. The survey included validated International Study of Asthma and Allergies in Childhood (ISAAC) items. We performed bivariate and logistic regression analyses on data from 307 students who wheezed.

Results

Forty-two percent of students had possible undiagnosed asthma and 58% had physician-diagnosed asthma based on primary caretaker reports. Children of Mexican origin were more likely to report undiagnosed vs. diagnosed asthma (p < 0.05). Children with an asthma diagnosis were more likely to report any medication use for wheezing/asthma and to experience a higher burden of illness in the last year compared to students with possible undiagnosed asthma (p < 0.05).

Conclusions

The burden of illness among these children was high; however, children with asthma-like symptoms were not faring worse than children with asthma symptoms and a diagnosis. Undiagnosed children were being evaluated and receiving treatment for their symptoms; however, by not receiving a diagnosis, they were eliciting an ameliorative rather than preventive treatment strategy.

Keywords

Undiagnosed asthma Asthma burden Respiratory outcomes Racial disparities 

Notes

Funding

This study was jointly supported by the National Institute of Minority Health and Health Disparities (NIMHD) and the US Environmental Protection Agency [Award Number P20 MD002287-05S1].

Compliance with Ethical Standards

The Institutional Review Board (IRB) at the University of Texas at El Paso (UTEP), and then the University of Texas, School of Public Health (UTSPH) reviewed and approved the protocol for this study. Informed consent was obtained from all participants

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Centers for Disease Control and Prevention (2013) Asthma Facts—CDC’s National Asthma Control Program Grantees.Google Scholar
  2. 2.
    Gonzales M, Malcoe LH, Myers OB, Espinoza J. Risk factors for asthma and cough among Hispanic children in the southwestern United States of America, 2003–2004. Rev Panam Salud Publica. 2007;21:274–81.CrossRefGoogle Scholar
  3. 3.
    Washington DM, Curtis LM, Waite K, Wolf MS, Paasche-Orlow MK (2017) Sociodemographic factors mediate race and ethnicity-associated childhood asthma health disparities: a longitudinal analysis. J Racial Ethn Health Disparities. 5(5):928–938.Google Scholar
  4. 4.
    Crain EF, Weiss KB, Bijur PE, Hersh M, Westbrook L, Stein RE. An estimate of the prevalence of asthma and wheezing among inner-city children. Pediatrics. 1994;94:356–62.Google Scholar
  5. 5.
    Grant EN, Daugherty SR, Moy JN, Nelson SG, Piorkowski JM, Weiss KB. Prevalence and burden of illness for asthma and related symptoms among kindergartners in Chicago public schools. Ann Allergy Asthma Immunol. 1999;83:113–20.CrossRefGoogle Scholar
  6. 6.
    Falagas M, Vardakas K, Vergidis P. Under-diagnosis of common chronic diseases: prevalence and impact on human health. Int J Clin Pract. 2007;61:1569–79.CrossRefGoogle Scholar
  7. 7.
    Van Gent R, Van Essen LE, Rovers MM, Kimpen JL, Van Der Ent, Cornelis K, et al. Quality of life in children with undiagnosed and diagnosed asthma. Eur J Pediatr. 2007;166:843–8.CrossRefGoogle Scholar
  8. 8.
    Yeatts K, Johnston Davis K, Peden D, Shy C. Health consequences associated with frequent wheezing in adolescents without asthma diagnosis. Eur Respir J. 2003;22:781–6.CrossRefGoogle Scholar
  9. 9.
    US-Mexico Border Health Commission (2010) Health disparities and the US-Mexico border: Challenges and opportunities.Google Scholar
  10. 10.
    Doshi R, Aseltine RH, Sabina AB, Graham GN. Interventions to improve management of chronic conditions among racial and ethnic minorities. J Racial Ethn Health Disparities. 2017;4:1033–41.CrossRefGoogle Scholar
  11. 11.
    Texas Department of State Health Services (December 2014) 2012 Child Asthma Fact Sheet—Texas. http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF. Accessed April 1 2014.
  12. 12.
    Berchick ER, Hood E, Barnett JC (2018) Health Insurance Coverage in the United States: 2017.Google Scholar
  13. 13.
    Grineski S. Characterizing children's asthma hospitalizations on the Texas-Mexico border. J Asthma. 2007;44:783–7.CrossRefGoogle Scholar
  14. 14.
    Lara M, Akinbami L, Flores G, Morgenstern H. Heterogeneity of childhood asthma among Hispanic children: Puerto Rican children bear a disproportionate burden. Pediatrics. 2006;117:43–53.CrossRefGoogle Scholar
  15. 15.
    Markides KS, Coreil J. The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep. 1986;101:253–65.Google Scholar
  16. 16.
    Camacho-Rivera M, Kawachi I, Bennett GG, Subramanian S. Revisiting the Hispanic health paradox: the relative contributions of nativity, country of origin, and race/ethnicity to childhood asthma. J Immigr Minor Health. 2015;17:826–33.CrossRefGoogle Scholar
  17. 17.
    Quinn K, Shalowitz MU, Berry CA, Mijanovich T, Wolf RL. Racial and ethnic disparities in diagnosed and possible undiagnosed asthma among public-school children in Chicago. Am J Public Health. 2006;96:1599–603.CrossRefGoogle Scholar
  18. 18.
    Stephen GA, Mcrill C, Mack MD, O'Rourke MK, Flood TJ, Lebowitz MD. Assessment of respiratory symptoms and asthma prevalence in a US-Mexico border region. Arch Environ Health. 2003;58:156–62.CrossRefGoogle Scholar
  19. 19.
    Grineski SE, Collins TW, Chavez-Payan P, Jimenez AM, Clark-Reyna S, Gaines M, et al. Social disparities in children’s respiratory health in El Paso, Texas. Int J Environ Res Public Health. 2014;11:2941–57.CrossRefGoogle Scholar
  20. 20.
    Center for Health Statistics (CHS). Texas Behavioral Risk Factor Surveillance System Survey Data. Austin, Texas: Texas Department of State Health Services, 2012. Accessed February 19 2014 2014.Google Scholar
  21. 21.
    Neffen H, Fritscher C, Cuevas Schacht F, Levy G, Chiarella P, Soriano JB, et al. Asthma control in Latin America: the asthma insights and reality in Latin America (AIRLA) survey. Rev Panam Salud Publica. 2005;17:191–7.CrossRefGoogle Scholar
  22. 22.
    U.S. Census Bureau, 2010–2012 American Community Survey B0300101: Hispanic or Latino Origin by Specific Origin. http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_12_3YR_B03001&prodType=table. Accessed October 28th 2016.
  23. 23.
    U.S. Census Bureau’s American Community Survey Office, 2012. American FactFinder. “S1701: Poverty Status in the Past 12 months" 2012 American Community Survey. http://www.census.gov/quickfacts/table/IPE120213/48141,00,48. Accessed December 1 2014 2014.
  24. 24.
    Dillman DA, Smyth JD, Christian LM. Internet, phone, mail, and mixed-mode surveys: the tailored design method. Hoboken: John Wiley & Sons; 2014.Google Scholar
  25. 25.
    EPISD (2013) District information. http://wwwespidorg/_district Accessed February 19 2014 2014.
  26. 26.
    Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al. International study of asthma and allergies in childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8:483–91.CrossRefGoogle Scholar
  27. 27.
    Jenkins MA, Clarke JR, Carlin JB, Robertson CF, Hopper JL, Dalton MF, et al. Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma. Int J Epidemiol. 1996;25:609–16.CrossRefGoogle Scholar
  28. 28.
    Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children: associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999;159:1527–32.CrossRefGoogle Scholar
  29. 29.
    Hosmer DW Jr, Lemeshow S. Applied logistic regression. Hoboken: John Wiley & Sons; 2004.Google Scholar
  30. 30.
    Joseph CL, Foxman B, Leickly FE, Peterson E, Ownby D. Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren. J Pediatr. 1996;129:735–42.CrossRefGoogle Scholar
  31. 31.
    Dodge R. A comparison of the respiratory health of Mexican-American and non-Mexican-American white children. Chest. 1983;84:587–92.CrossRefGoogle Scholar
  32. 32.
    Finkelstein JA, Lozano P, Farber HJ, Miroshnik I, Lieu TA. Underuse of controller medications among Medicaid-insured children with asthma. Arch Pediatr Adolesc Med. 2002;156:562–7.CrossRefGoogle Scholar
  33. 33.
    Elward KS, Pollart SM. Medical therapy for asthma: updates from the NAEPP guidelines. Am Fam Physician. 2010;82:1242.Google Scholar
  34. 34.
    Smith M, Iqbal SMS, Rowe BH, N'Diaye T (2003) Corticosteroids for hospitalised children with acute asthma.Google Scholar
  35. 35.
    Garcia MLG, Wahn U, Gilles L, Swern A, Tozzi CA, Polos P. Montelukast, compared with fluticasone, for control of asthma among 6-to 14-year-old patients with mild asthma: the MOSAIC study. Pediatrics. 2005;116:360–9.CrossRefGoogle Scholar
  36. 36.
    Donahue JG, Weiss ST, Livingston JM, Goetsch MA, Greineder DK, Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA. 1997;277:887–91.CrossRefGoogle Scholar
  37. 37.
    Belhassen M, Langlois C, Laforest L, Dima AL, Ginoux M, Sadatsafavi M, et al. Level of asthma controller therapy before admission to the hospital. J Allergy Clin Immunol Pract. 2016;4:877–83.CrossRefGoogle Scholar
  38. 38.
    Holgate ST. Epithelium dysfunction in asthma. J Allergy Clin Immunol. 2007;120:1233–44.CrossRefGoogle Scholar
  39. 39.
    Sumi Y, Hamid Q. Airway remodeling in asthma. Allergol Int. 2007;56:341–8.CrossRefGoogle Scholar
  40. 40.
    Durrani SR, Viswanathan RK, Busse WW. What effect does asthma treatment have on airway remodeling? Current perspectives. J Allergy Clin Immunol. 2011;128:439–48.CrossRefGoogle Scholar
  41. 41.
    Joseph CL, Havstad S, Anderson EW, Brown R, Johnson CC, Clark NM. Effect of asthma intervention on children with undiagnosed asthma. J Pediatr. 2005;146:96–104.CrossRefGoogle Scholar
  42. 42.
    Gerald JK, Sun Y, Grad R, Gerald LB. Asthma morbidity among children evaluated by asthma case detection. Pediatrics. 2009;124:e927–33.CrossRefGoogle Scholar
  43. 43.
    Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care (with CD). Washington, D.C.: National Academies Press; 2009.Google Scholar
  44. 44.
    Groves RM. Nonresponse rates and nonresponse bias in household surveys. Public Opin Q. 2006;70:646–75.CrossRefGoogle Scholar
  45. 45.
    Arif A, Borders T, Patterson P, Rohrer J, Xu K. Prevalence and correlates of paediatric asthma and wheezing in a largely rural USA population. J Paediatr Child Health. 2004;40:189–94.CrossRefGoogle Scholar
  46. 46.
    Alker J, Pham O (2018) Nation’s Progress on Children’s Health Coverage Reverses Course. https://ccf.georgetown.edu/wpcontent/uploads/2018/11/UninsuredKids2018_Final_asof1128743pm.pdf. Accessed December 15 2018.

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of Management, Policy, and Community Health (MPACH)UTHealth School of Public HealthHoustonUSA
  2. 2.Departments of Sociology and GeographyUniversity of UtahSalt Lake CityUSA

Personalised recommendations