Association between asthma and obesity in the pediatric population Gilberto Ramos-Valencia, DrPH, Orquidea Frias, MSc, Department of Biostatistics and Epidemiology, University of Puerto Rico Graduate School of Public Health, PO Box 365067, San Juan, PR 00936, 787-758-2525 ext 1427, gramos@rcm.upr.edu ABSTRACT RESULTS The main objective of this study was to determine the association between childhood asthma and obesity in the Puerto Rican population. In the U.S the prevalence of asthma in this age group is 8.7 percent (2004). In Puerto Rico asthma is the most common health condition among the 17 year or younger population with a prevalence of 21 percent (2003), representing more than twice the prevalence in the U.S. Data for this study was obtained from the Puerto Rico Health Interview Survey, conducted by the UPR Graduate School of Public Health. A probability sample of households representative of each of the 78 municipalities was selected using a multistage stratified cluster sample design. The interviewed sample in 2003 consisted of 16,617 households, which yielded information about 47,962 persons. The estimated prevalence of asthma was 20.1 percent (95% CI 18.8%; 21.5%) for ages 2 -17years, 23.6% (95%CI 19.8%; 28.0%) for ages 2 -4 years, 24.9% (95%CI 22.6%; 27.4%) for ages 5 – 10 years, and 17.3% (95%CI 15.8%; 18.9%) for ages 11-17. The prevalence of overweight or obese is 49.6% in ages 2-4 years old, 45.8% in ages 5-10, and 17.7% in ages 11-17. The adjusted POR obtained from the association between asthma and obesity was 1.25 for males and 1.34 for females, which indicated an statistically significant relationship between asthma and obesity. Findings suggest that children with asthma are more likely to be obese. More research is needed to explain specific mechanisms that intervene between asthma and obesity. Nevertheless, when there is an intervention with either one, the other condition should be taken into consideration. children with and without asthma Prevalence of obesity (BMI > 95 percentile) among Gender Children with asthma % (95% CI) Children without asthma % (95% CI) Male 39.2 (35.0 – 43.7) 32.8 (30.5 – 35.1) Female 27.3 (22.8 – 32.5) 22.9 (20.9 – 25.1) Unadjusted Prevalence Odds Ratio for the Association between asthma, obesity and gender Gender POR for asthma (95% CI) POR for obesity Male 1.59 (1.39 – 1.84) 1.76 (1.54 – 2.02) Female 1.00 Prevalence of Asthma Prevalence (%) 95% CI General 20.1 18.8 – 21.5 Male 23.8 22.0 – 25.7 Female 16.4 14.8 – 18.0 Gender Age (years) Prevalence (%) 95% CI 2 – 4 27.5 21.9 – 33.8 Male 5 – 10 29.2 25.7 – 32.9 11 – 17 20.5 18.2 – 22.9 19.6 15.3 – 24.9 Female 20.1 17.3 – 23.2 14.2 12.4 – 16.2 Unadjusted Prevalence Odds Ratio for the Association between obesity and asthma by gender Gender POR 95% IC Male 1.31 1.06 – 1.62 Female 1.27 0.98 – 1.66 OBJECTIVES Age (years) Prevalence (%) 95% CI 2 – 4 23.6 19.8 – 28.0 5 – 10 24.9 22.6 – 27.4 11 – 17 17.3 15.8 – 18.9 Describe the prevalence of asthma and overweight/obesity in the pediatric population of Puerto Rico Determine the association between childhood asthma and overweight/obesity in the pediatric population of Puerto Rico Adjusted Prevalence Odds Ratio for the Association between asthma and obesity BACKGROUND Gender Adjusted POR * 95% IC p-value Male 1.25 1.23 – 1.28 < 0.001 Female 1.34 1.31 – 1.37 *Adjusted for age, family history of obesity, physical activity and limitation of activity Asthma is the most prevalent health condition among the 17 year or younger population in Puerto Rico, with a prevalence of 21 percent (2003). Asthma is the most common cause of hospitalizations, visits to physician and lost of school days in the pediatric population of Puerto Rico (2003). Prevalence of Overweight /Obesity (BMI > 95 percentile) Prevalence (%) 95% CI General 29.0 27.5 – 30.6 Male 34.3 32.3 – 36.4 Female 23.7 21.7 – 25.7 Gender Age (years) Prevalence (%) 95% CI Male 2 – 4 59.9 52.8 – 66.6 5 – 10 49.4 45.3 – 53.6 11 – 17 22.4 20.2 – 24.6 Female 38.9 32.8 – 45.5 41.8 37.6 – 46.0 13.2 11.3 – 15.2 METHODOLOGY Study design: Retrospective – Cross-sectional Universe: Non-institutionalized Civil Population In Puerto Rico during 2003 Sample design: Multistage Cluster Sample Stratified by municipalities Sample framework: List of all census blocks listed by the Census Bureau of Puerto Rico in 2000. Primary sample unit: census’s blocks Total sample: 22,187 households for an effective sample of 16,617 households 47,962 persons, from which 12,280 were aged 2 -17 years CONCLUSIONS Puerto Rican children have a higher prevalence of asthma compared with the US. Consistent with previous studies, our data shows a higher than expected prevalence of obesity in children with asthma. Age (years) Prevalence (%) 95% CI 2 – 4 49.6 45.0 – 54.2 5 – 10 45.8 42.7 – 48.9 11 – 17 17.7 16.3 – 19.3 RECOMMENDATIONS To conduct analytical studies to assess the association between overweight/obesity and asthma incorporating other measures of abdominal adiposity, eating habits and clinical evaluation of asthma. Preventing obesity in children is a public health priority, as children who are overweight and obese are most likely to be adults with obesity. ACKNOWLEDGEMENTS: Thanks to Cynthia Pérez, PhD, Cruz M. Nazario, PhD, Patricia Otón LLM, JD, MPHE, Anabelle León, Lisette Gaona, MS and Angélica Larios for their contribution to this presentation.