My Canadian Pharmacy about Asthma in Puerto Rican Children

 multivariable analysisFigure 1 shows the schema for enrollment into the study by individual study site. Based on the sampling design, a total of 21,185 households were randomly selected for inclusion in the study; 20,681 households (97.6%) were successfully contacted. Of these 20,681 households, 1,853 households (9.0%) with 2,940 children were eligible for the study. However, 449 of 2,940 eligible children did not participate in the study because of parental refusal or repeated unavailability (three or more unsuccessful attempts). The final study population consisted of 2,491 children in 1,643 households. There were households with one (n = 1,009), two (n = 420), and three (n = 214) eligible children.

Table 1 summarizes the characteristics of the study population. The denominator indicates the number of participants who provided valid information; missing values and “don’t know” were excluded from the calculations. Site of residence and birthplace were highly correlated: 90.2% of participants living in the Bronx were born in the mainland United States, and 94.6% of those living in Puerto Rico were born in Puerto Rico. Children living in Puerto Rico were more likely to have four grandparents who were born in Puerto Rico than Puerto Rican children living in the South Bronx. Families of Puerto Rican children in Puerto Rico were more likely to have household incomes < $25,000 per year but less likely to receive public assistance in the past year than families of Puerto Rican children in the South Bronx. Mothers of Puerto Rican children in Puerto Rico were more likely to have completed high school (HS) or a general equivalency diploma (GED) and less likely to smoke during pregnancy than mothers of Puerto Rican children in the South Bronx. Premature birth was lower in Puerto Rican children in Puerto Rico than in Puerto Rican children in the Bronx.

Table 2 shows bivariate analyses of the relation between variables of interest and asthma outcomes. Residence in Puerto Rico, birth in Puerto Rico, and premature birth were each significantly associated with increased odds of having had asthma and having been hospitalized for asthma. In contrast, female gender and age were inversely associated with asthma and successful treatment of it with My Canadian Pharmacy via https://mycanadian-pharmacy.net/effective-methods-to-combat-asthma.html and having been hospitalized for asthma. SES indicators such as household income, maternal education, and parental marital status were not associated with asthma. However, marital status was inversely associated with a history of hospitalization for asthma. Maternal smoking during pregnancy was not associated with asthma or hospitalization for asthma.

Table 3 shows the results of the multivariable analysis of the relation between the predictors and outcomes of interest. After adjustment for relevant covariates, residence in Puerto Rico and birth in Puerto Rico remained significant predictors of asthma explained by My Canadian Pharmacy. Residence in Puerto Rico was the primary predictor of interest in model 1, and birth in Puerto Rico was the primary predictor of interest in model 2. Similarly, in adjusted models, residence in Puerto Rico (model 3) and birth in Puerto Rico (model 4) were each significant predictors of asthma hospitalization among study participants (Table 4).

Fig1

Figure 1. Enrollment of subjects.

Table 1—Characteristics of the Study Population

Variables Bronx Site Puerto Rico Site Total
Mean age, yr 10.02 ± 2.58 9.77 ± 2.55 9.89 ± 2.56
Female gender 549/1,138 (48.2) 658/1,353 (48.6) 1,207/2,491 (48.4)
Born in Puerto Ricoj 111/1,135 (9.8) 1,279/1,352 (94.6) 1,390/2,487 (55.9)
All four grandparents born in Puerto Ricoj 560/924 (60.6) 1,084/1,204 (89.7) 1,644/2,132 (77.1)
Premature birthi (< 37 wk gestational age) 238/1,068 (22.3) 206/1,307 (15.8) 444/2,375 (18.7)
Mother smoked while pregnantj 214/1,069 (20.0) 124/1,315 (9.4) 338/2,384 (14.2)
Household annual income, $
< 6,000 298/1,075 (27.7) 365/1,318 (27.7) 663/2,393 (27.7)
6,000-11,999 227/1,075 (21.1) 302/1,318 (22.9) 529/2,393 (22.1)
12,000-24,999 253/1,075 (23.5) 384/1,318 (29.1) 637/2,393 (26.6)
25,000-54,999 241/1,075 (22.4) 196/1,318 (14.9) 437/2,393 (18.3)
> 55,000 56/1,075 (5.2) 71/1,318 (5.4) 127/2,393 (5.3)
Income <$25,000i 778/1,075 (72.4) 1,051/1,318 (79.7) 1,829/2,393 (76.4)
Received public assistance in past yeari 517/1,128 (45.8) 492/1,350 (36.4) 1,009/2,478 (40.7)
Maternal education
Less than HS 573/1,065 (53.8) 332/1,320 (25.2) 905/2,385 (38.0)
HS graduate 248/1,065 (23.3) 409/1,320 (31.0) 657/2,385 (27.6)
Some college 197/1,065 (18.5) 349/1,320 (26.4) 546/2,385 (22.9)
College graduate 47/1,065 (4.4) 230/1,320 (17.4) 277/2,385 (11.6)
HS graduate or GEDj 574/1,066 (53.9) 998/1,315 (75.9) 1,572/2,381 (66.0)
Parents marriedj 167/1,067 (15.7) 594/1,321 (45.0) 761/2,388(31.9)
Primary caretaker biological mother 974/1,126 (86.5) 1,222/1,349 (90.6) 2,196/2,475 (88.7)
Seen for primary care in past yearj 1,072/1,134 (94.5) 1,049/1,349 (77.8) 2,121/2,483(85.4)
Asthma everi 401/1,135 (35.3) 557/1,350 (41.3) 958/2,485 (38.6)
Hospitalized for asthma everi 146/400 (36.5) 271/556 (48.7) 417/956 (43.6)

Table 2—Bivariable Predictors of Asthma and Hospitalizations for Asthma

Variables Has Asthma Has Been Hospitalized for Asthma
OR (95% CI) p Value OR (95% CI) p Value
Residence in Puerto Rico 1.28(1.05-1.55) 0.0145 1.60(1.19-2.15) 0.0023
Born in Puerto Rico 1.28(1.06-1.54) 0.0105 1.88(1.38-2.55) 0.0001
All four grandparents born in Puerto Rico 1.20 (0.96-1.50) 0.1102 1.01 (0.67-1.54) 0.9538
Female gender 0.69 (0.54-0.87) 0.0025 0.74(0.52-1.07) 0.1070
Age 0.95 (0.91-0.98) 0.0053 0.96(0.90-1.01) 0.1348
Premature birth (< 37 wk gestational age) 1.48(1.12-1.95) 0.0062 1.24 (0.82-1.87) 0.2958
Maternal smoking during pregnancy 0.96 (0.71-1.30) 0.7888 0.74(0.42-1.31) 0.2996
Household income, $ 0.6539* 0.4400*
< 6,000 1.03 (0.61-1.75) 0.9101 0.96 (0.36-2.57) 0.9348
6,000-11,999 0.99 (0.56-1.75) 0.9700 1.02 (0.38-2.75) 0.9679
12,000-24,999 1.19(0.69-2.07) 0.5270 1.25 (0.48-3.25) 0.6488
25,000-54,999 0.87 (0.50-1.52) 0.6203 1.21 (0.74-3.13) 0.6925
>$55,000 (reference)
Household income <$25,000 1.20 (0.92-1.56) 0.1860 0.92 (0.60-1.41) 0.7077
Public assistance in past year 1.21 (0.99-1.48) 0.0678 1.03(0.73-1.46) 0.8687
Maternal education 0.9241* 0.7699
Less than HS 1.03 (0.70-1.52) 0.8754 0.93(0.48-1.82) 0.8310
HS graduate 0.98 (0.67-1.43) 0.9308 1.10 (0.50-2.41) 0.8115
Some college 1.09 (0.75-1.59) 0.6705 0.96 (0.40-2.48) 0.9209
College graduate (reference)
HS graduate or GED 0.95 (0.74-1.22) 0.6850 1.12 (0.76-1.64) 0.5684
Parents married 0.99 (0.74-1.32) 0.9302 0.67 (0.45-0.98) 0.0403
Primary caretaker biological mother 1.24 (0.88-1.73) 0.2095 1.03(0.64-1.64) 0.9137
Seen for primary care in past year 1.20 (0.85-1.69) 0.3030 1.03(0.63-1.69) 0.9083

Table 3—Multivariable Analysis of the Association Between Area of Residence, Birthplace, and Asthma in Puerto Rican Children

Variables Lifetime Asthma Prevalence
Model 1, Residence (n = 2,286*) Model 2, Birthplace (n = 2,364)
‘ OR (95% CI) p Value ‘ OR (95% CI) p Value
Residence in Puerto Rico 1.27(1.03-1.57) 0.0267 1.30(1.08-1.57) 0.0061
Premature birth 1.40(1.06-1.87) 0.0200 1.46(1.10-1.92) 0.0082
Female gender 0.68 (0.53-0.87) 0.0028 0.70 (0.55-0.89) 0.0043
Age 0.95 (0.91-0.98) 0.0071 0.95 (0.91-0.99) 0.0092
Receives public assistance 1.22 (0.98-1.53) 0.0763 1.25 (1.01-1.55) 0.0401
Income < $25,000 1.11 (0.83-1.49) 0.4859

Table 4—Multivariable Analysis of the Association Between Area of Residence, Birthplace, and Hospitalization for Asthma in Puerto Rican Children

Variables Lifetime Asthma Hospitalizations!
Model 3, Residence (n = 918*) Model 4, Birthplace (n = 956)
‘ OR (95% CI) p Value ‘ OR (95% CI) p Value
Residence in Puerto Rico 1.47(1.04-2.07) 0.0292 1.88(1.38-2.55) 0.0001
Parents not married 0.75 (0.49-1.15) 0.1779
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