Background:

Hispanic/Latinx (HL) ethnicity encompasses racially and culturally diverse subgroups. Studies suggest that Puerto Ricans (PR) may bear greater asthma-related morbidity than Mexicans, but these were conducted in children or had limited clinical characterization.

Objective:

To determine whether disparities in asthma morbidity exist among HL adult subgroups METHODS: Adults with moderate-severe asthma were recruited from US clinics, including Puerto Rico, for the PREPARE trial. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans, C&D), we compared baseline self-reported clinical characteristics between Caribbean HL (PR and C&D: CHL; n=457) and other HLs (Mexicans, Spaniards, Central/South Americans, OHL; n=141), and between CHL subgroups [C&D (n=56) and PR (n=401)]. We compared asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids, ER/Urgent care (ER/UC) visits, hospitalizations, healthcare utilization) through negative binomial regression.

Results:

CHL compared to OHL were similar in age, BMI, poverty status, blood eosinophils and FeNO but were prescribed more asthma controller therapies. Relative to OHL, CHL had significantly increased odds of asthma exacerbations (OR=1.84, 95%CI=1.4-2.4), ER/UC visits (OR=1.88, 95%CI=1.4-2.5), hospitalization (OR=1.98, 95%CI=1.06-3.7), and healthcare utilization (OR=1.91, 95%CI=1.44-2.53). Of the CHL subgroups, PR had significantly increased odds of asthma exacerbations, ER/UC visits, hospitalizations, and healthcare utilization compared to OHL, whereas C&D only had increased odds of exacerbations compared to OHL. PR compared to C&D had greater odds of ER/UC and healthcare utilization.

Conclusion:

CHL adults reported nearly twice the asthma morbidity compared to OHL; these differences are primarily driven by PR. Novel interventions are needed to reduce morbidity in this highly impacted population.