Psychosocial risk factors and asthma among adults in Puerto Rico

ABSTRACT

Objective: Asthma and psychosocial stressors are common among Puerto Rican adults living in the United States. We estimated the prevalence of current asthma, and examined potential psychosocial risk factors and current asthma, among adults in Puerto Rico. Methods: Cross-sectional study of 3,049 Puerto Ricans aged 18–64 years living in Puerto Rico between May 2014 and June 2016. A structured interview was conducted to obtain information on demographics, lifestyle, mental disorders, and respiratory health. Current asthma was defined as self-reported physician-diagnosed asthma and still having asthma. Multivariable logistic regression was used to examine psychosocial risk factors and current asthma. Results: The estimated prevalence of current asthma was 10.2%. In a multivariable analysis, exposure to violence (odds ratio [OR] for each 1-point increment in a validated scale = 1.14, 95% confidence interval [CI] = 1.07 to 1.21) and a lifetime history of at least one suicide attempt (OR = 3.01, 95% CI = 1.80 to 5.01) were significantly associated with current asthma, independently of major depressive disorder. Moreover, a lifetime history of at least one suicide attempt was associated with co-existing asthma and chronic obstructive pulmonary disease (i.e., asthma-COPD overlap syndrome or ACOS (OR = 9.05, 95% CI = 3.32–24.67). Conclusions: Our findings suggest that asthma is a major health problem among adults in Puerto Rico, with psychosocial risk factors playing a significant role in asthma and ACOS. Addressing chronic stressors and mental illness should be part of comprehensive strategies to reduce asthma burden in this population.

KEYWORDS:

• Exposure to violence
• asthma
• suicide attempt
• Puerto Rico

Declaration of interest

Dr. Celedón has received materials from Merck (inhaled steroids) and Pharmavite (vitamin D and placebo tablets) to provide medications at no cost to participants in two NIH-funded studies unrelated to the current report. The other authors report no conflicts of interest.

Acknowledgements

We thank all the study participants in Puerto Rico.

Authors' contributions

Conception and study design: Y-Y.H., G.C. and J.C.C.; Data analysis and interpretation: Y-Y.H., E.F., J.C.C., drafting of the manuscript for intellectual content: Y-Y.H., E.F., G.C., and J.C.C. All authors approved the final version of the manuscript prior to submission.

Supplementary material

Supplemental data for this article can be accessed on the publisher's website.

Additional information

Funding

This work was supported by the U.S. National Institutes of Health (grants HL125666, HL079966, HL117191, and HL119952), The Heinz Endowments, and the Klosterfrau Foundation.