Introduction Results Conclusion Asthma Staff Asthma in Puerto Rico, 2012-2014 Puerto Rico Asthma Project Chronic Disease Division Puerto Rico Department of Health Abril, 2016 Puerto Rico Asthma Project

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

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

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

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

Introduction Results Conclusion Asthma Staff Objectives Background Data Source ACB Asthma Call-Back Comprehensive asthma health survey in adult with current asthma 2012-2014 data aggregation 800 participants with current asthma Puerto Rico Asthma Project

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

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

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, 2005 - 2012 2 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 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Survey Year 2Unadjusted Puerto Rico Asthma Project

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, 2012-2014 Puerto Rico USA 14.7 12.9 10.4 10 7.9 Prevalence * 100 5 Male Female Male Female Gender Puerto Rico Asthma Project

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, 2012-2014 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

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

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, 2012-2014 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

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, 2012-2014 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

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, 2012-2014 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

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

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, 2005 - 20124 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 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Survey Year 4Unadjusted Puerto Rico Asthma Project

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, 2012-2014 Puerto Rico USA 12.5 11.3 10 6.91 6.33 Prevalence * 100 5 Male Female Male Female Gender Puerto Rico Asthma Project

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, 2012-2014 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 18−24 25−34 35−44 45−54 55−64 65> 18−24 25−34 35−44 45−54 55−64 65> Age groups Puerto Rico Asthma Project

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

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, 2012-2014 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

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, 2012-2014 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

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, 2012-2014 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

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, 2012-2014 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

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

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

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

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

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

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

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

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, 2011-2013 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

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, 2011-2013 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

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, 2011-2013 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

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, 2011-2013 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

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 10 - 14 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

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

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