1. Introduction
Results Conclusion Asthma Staff
Asthma in Puerto Rico,
Puerto Rico Asthma Project Chronic Disease Division
Puerto Rico Department of Health
Abril, 2016
Puerto Rico Asthma Project

2. Introduction
Results Conclusion Asthma Staff
Objectives Background Data Source
Objectives
Present and compare asthma prevalence among children and adults by covariates in Puerto Rico and the United States
Present data related to uncontrolled asthma among children and adults in Puerto Rico
Puerto Rico Asthma Project

3. Introduction
Results Conclusion Asthma Staff
Objectives Background Data Source
Asthma
Asthma is a complex chronic disorder characterized by episodes of airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation, which are often reversible either spontaneously or with treatment (NAEPP, 2007)
Represents a burden to government, health care systems, caregivers and patients (Masoli, 2004)
Patients with asthma have impaired quality of life (Ford, 2003)
Puerto Rico Asthma Project

4. BRFSS Puerto Rico Behavioral Risk Factor Surveillance Survey
Introduction
Results Conclusion Asthma Staff
Objectives Background Data Source
BRFSS
Puerto Rico Behavioral Risk Factor Surveillance Survey
World largest Random Dial Telephone Survey
Complex Sampling Survey for extrapolation
About 6,000 interviews per year
Random Child Selection
Over 1,000 children living in households per year
Puerto Rico Asthma Project

5. Introduction
Results Conclusion Asthma Staff
Objectives Background Data Source
BRFSS
Health Outcomes
Adult current asthma prevalence: Do you still have asthma?
Child random selection: How many children less than 18 years of age live in your household?
Children current asthma prevalence: Does the child still have asthma?
Puerto Rico Asthma Project

6. Introduction
Results Conclusion Asthma Staff
Objectives Background Data Source
ACB
Asthma Call-Back
Comprehensive asthma health survey in adult with current asthma
data aggregation
800 participants with current asthma
Puerto Rico Asthma Project

7. Introduction
Results Conclusion Asthma Staff
Objectives Background Data Source
ACB
Health Outcomes
Asthma control: Calculated using the NAEPP Guidelines Intermittent asthma: Calculated using the NAEPP Guidelines (data not shown)
Puerto Rico Asthma Project

8. Results Childhood Asthma Prevalence Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Results
Childhood Asthma Prevalence
Puerto Rico Asthma Project

9. Child Current Asthma Prevalence Trend in PR and USA, 2005 - 2012 2
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Child Current Asthma Prevalence Trend in PR and USA,
16.7
13.7
14.0
13.8
9.0
8.9
8.6
8.4
9.3
16.2 15
13.7
13.8
11.9
12.2 10
Country PR
USA
Prevalence * 100 5
Survey Year
2Unadjusted
Puerto Rico Asthma Project

10. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence among Children by Gender and Country,
Puerto Rico
USA
14.7
12.9
10.4 10
7.9
Prevalence * 100 5
Male
Female
Male
Female
Gender
Puerto Rico Asthma Project

11. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Children by Age Group,
Puerto Rico
USA
19.3
13.2
11.3
11.8 15
11.6
10.2
10.2
Prevalence * 100 10
5.57 5
00−04
05−09
10−14
15−17
00−04
05−09
10−14
15−17
Age groups
Puerto Rico Asthma Project

12. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence among Children by Respondent Demographic Status
Puerto Rico Asthma Project

13. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Children by Respondent Annual Household Income,
Puerto Rico
USA
16.5
13.7
13.9
13.1
10.0
12.7 15
10.9
9.57
9.15
7.72
Prevalence * 100 10 5
<15k
50+k
<15k
50+k
15k−<25k
25k−<35k
35k−<50k
15k−<25k
25k−<35k
35k−<50k
Respondent Annual Income
Puerto Rico Asthma Project

14. Respondent Smoking Status
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Children by Respondent Smoking Status, 20 15 10 5
Puerto Rico
USA
17.1
14.4
10.8
9.0
Prevalence * 100 No
Yes No
Respondent Smoking Status
Yes
Puerto Rico Asthma Project

15. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Children by Respondent's Marital Status, 25 20 15 10 5
Puerto Rico
USA
19.3
15.2
13.5
11.6
10.0
13.5
12.2
12.1
10.6
11.9
Prevalence * 100
7.98
8.16
Married
Divorced
Widowed
Separated
Married
Divorced
Widowed
Separated
Never married
Never married
Un-married couple
Un-married couple
Respondent‘s Marital Status
Puerto Rico Asthma Project

16. Current Asthma Prevalence Among Adults
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Adults
Puerto Rico Asthma Project

17. Adult Current Asthma Prevalence Among Adults in PR and USA,
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Adult Current Asthma Prevalence Among Adults in PR and USA,
10.3
10.6
10.1
7.9
8.2
8.5
8.4
8.6
7.5
8.1
8.9
9.0
6.1
5.2
8.9 9
8.8
8.3
7.6
Country PR USA
Prevalence * 100 6 3
Survey Year
4Unadjusted
Puerto Rico Asthma Project

18. Current Asthma Prevalence Among Adult by Gender and Country, 2012-2014
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Adult by Gender and Country,
Puerto Rico
USA
12.5
11.3 10
6.91
6.33
Prevalence * 100 5
Male
Female
Male
Female
Gender
Puerto Rico Asthma Project

19. Current Asthma Prevalence Among Adults by Age Group, 2012-2014
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Adults by Age Group,
Puerto Rico
USA
11.2
11.4
9.86
9.36
9.82
9.98
9.60
8.43
8.39
9.18 10
8.41
8.30
Prevalence * 100 5
18− − − − − >
18− − − − − >
Age groups
Puerto Rico Asthma Project

20. Current Asthma Prevalence Among Adults by Socio-Demographic Status
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Adults by Socio-Demographic Status
Puerto Rico Asthma Project

21. Current Asthma Prevalence Among Adults by Employment Status,
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Adults by Employment Status, 20 15 10 5
Puerto Rico
USA
22.8
17.3
11.4
11.5
11.7
10.9
8.6
10.0
Prevalence * 100
7.60
8.49
8.11
7.18
Retired
Retired
Employed
Student
Student
Out of work
Homemaker
Employed
Out of work
Unable to work
Homemaker
Unable to work
Employment status
Puerto Rico Asthma Project

22. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA
Current Asthma Prevalence Among Adults in PR and USA
Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Adults by Annual Household Income,
Puerto Rico
14.3
USA 15
11.4
9.69
9.11
8.58
10.4 10
6.77
8.53
7.71
7.16
Prevalence * 100 5
<15k
50+k
<15k
50+k
15k−<25k
25k−<35k
35k−<50k
15k−<25k
25k−<35k
35k−<50k
Household‘s Annual Income
Puerto Rico Asthma Project

23. Current Asthma Prevalence Among Adults by Smoking Status,
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Current Asthma Prevalence Among Adults by Smoking Status,
Puerto Rico
USA
12.0
11.6
9.67 10 5
8.39
Prevalence * 100 No
Yes No
Smoking Status
Yes
Puerto Rico Asthma Project

24. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Figure:Current Asthma Prevalence Among Adults by Marital Status,
Puerto Rico
USA
11.5
10.9
11.4
12.0
9.54
10.3
11.6
9.97
9.99
8.64
9.32 10
7.52
Prevalence * 100 5
Married
Divorced
Widowed
Separate
Married
Divorced
Widowed
Separate
Never married
Never married
Un-married couple
Un-married couple
Marital Status
Puerto Rico Asthma Project

25. Asthma Control Among Children in Puerto Rico
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Asthma Control Among Children in Puerto Rico
Puerto Rico Asthma Project

26. Days with asthma symptoms in the last 30 days
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Days with Asthma Symptoms During the Last 30 Days, 2012
63.6 60
prevalence * 100 40
12.2
9.53 20
9.21
8.12
13+
1−2 3−6 7−12
Days with asthma symptoms in the last 30 days
Puerto Rico Asthma Project

27. Days that couldn't sleep due to asthma symptoms in the last month
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Days with Difficulty to Stay Asleep because of Symptoms of Asthma during the Last 30 Days, 2012
84.5 75
Prevalence * 100 50 25
7.55
4.34
3.87
3.54
13+
1−2 3−6 7−12
Days that couldn't sleep due to asthma symptoms in the last month
Puerto Rico Asthma Project

28. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Limitation of Usual Activities Due to Asthma During the Past 12 Months, 2012
75.8 80 60
Prevalence * 100 40
13.8 20
7.74
5.21
Not at all
A little
A moderate
amount
A lot
Activity limitation
Puerto Rico Asthma Project

29. Missed School Days due to Asthma During the Past 12 Month, 2012
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Missed School Days due to Asthma During the Past 12 Month, 2012
44.7
18.1
18.7
10.6
5.57
2.32
Puerto Rico Asthma Project

30. 71.6 28.4 Health care utilization among children, 2012
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Health care utilization among children, 2012 80
71.6 60
28.4
Prevalence* 100 40 20
Yes No
Health care utilization
Puerto Rico Asthma Project

31. Asthma Control Among Adults in Puerto Rico
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Puerto Rico Asthma Project

32. Days with asthma symptoms in the last 30 days
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Days with Asthma Symptoms During the Last 30 Days,
42.1 40
26.1 30
prev * 100
14.1 20
9.89
7.81 10
13+
1−2 3−6 7−12
Days with asthma symptoms in the last 30 days
Puerto Rico Asthma Project

33. Days that couldn't sleep due to asthma symptoms in the last month
Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Days with Difficulty to Stay Asleep because of Symptoms of Asthma during the Last 30 Days,
61.9 60 40
prev * 100
14.3
11.0 20
10.6
2.20
1−2 3−6 7−12
Days that couldn't sleep due to asthma symptoms in the last month
13+
Puerto Rico Asthma Project

34. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Limitation of Usual Activities Due to Asthma During the Past 12 Months, 50
44.8 40
24.9 30
prev * 100
17.9 20
12.5 10
Not at all
A little
A moderate amount
A lot
Activity limitation
Puerto Rico Asthma Project

35. Introduction
Results Conclusion Asthma Staff
Current Asthma Prevalence Among Children in PR and USA Current Asthma Prevalence Among Adults in PR and USA Asthma Control Among Children in Puerto Rico
Asthma Control Among Adults in Puerto Rico
Missed Work Days due to Asthma During the Last 12 Months,
48.2 40
20.1
prev * 100 20
12.6
11.9
5.12
1.11
1 2 3−5 5−10
Missed work days due to asthma symptoms in the last 12 months
11+
Puerto Rico Asthma Project

36. Introduction
Results Conclusion Asthma Staff
Discussion Next steps
An estimated 14 of every 100 Puerto Rican children currently have asthma
Puerto Rico still has higher current asthma prevalence among children than the USA
Current asthma prevalence among children seems to be greater in males, and in those years of age
Data suggests that certain socio-demographic respondent's characteristics are associated to having a child with asthma living in the household
Nearly half of adults (47.5% of males and 47.1% of females) in Puerto Rico with asthma, had their condition uncontrolled
Puerto Rico Asthma Project

37. Introduction
Results Conclusion Asthma Staff
Discussion Next steps
Continue with analysis and procedures of health outcomes indicators in children with asthma (ACB and Administrative data)
Expand discussion surrounding previous research, peer reviews and policy implications
Disseminate results
Puerto Rico Asthma Project

38. Dra. Madeline Reyes García Dra. Jessica Irizarry Ramos
Introduction
Results Conclusion Asthma Staff
Asthma Group
Dra. Madeline Reyes García
Dra. Jessica Irizarry Ramos
Lcda. Wanda Hernández
Sr. Eliseo Acevedo Díaz
Sra. Myribel Santiago
PR-BRFSS
Dra. Ruby Serrano
Puerto Rico Asthma Project