1. 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 , San Juan, PR 00936, ext 1427,
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 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 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 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.