Document Type

Article

Date of Original Version

2019

Department

Nursing

Abstract

Rationale: Researchers tend to study Latinos as a single group but recent asthma research confirmed differences among Latino subgroups. Variations in controller medication adherence may be a factor in the observed health disparities between Mexican and Puerto Rican children. Adherence is not a stable phenomenon, however, there is a paucity of data on patterns of adherence, sociodemographic predictors of patterns, and variations in asthma-related acute healthcare utilization by adherence pattern among Latino sub-groups.

Objectives: Identify patterns of inhaled corticosteroid medication adherence over twelve months among Mexican and Puerto Rican children with persistent asthma; examine sociodemographic predictors of adherence patterns by ethnicity; and investigate asthma-related acute healthcare utilization based on these patterns.

Methods: We analyzed controller medication Doser data from Mexican and Puerto Rican children (n=123; ages 5-12 years) with persistent asthma who participated with their caregivers in a longitudinal, non-intervention study (Phoenix, AZ and Bronx, NY). Interview and medical record data were collected at enrollment, 3, 6, 9, and 12 months post-enrollment.

Results: 47%-53% of children had poor adherence (<50%) over each of the follow-up periods (cross-sectional). Children with lowest adherence were Puerto Rican, from non-poor families, or female. Longitudinal latent class analysis yielded 4 adherence classes: poor; moderate; declining adherence; and increasing adherence. Puerto Rican children had significantly higher odds of “Decreasing” (OR=2.86; 95% CI, 0.40 to 20.50) and “Poor” (OR=5.62; 95% CI, 1.44 to 21.90) adherence compared to Mexican children. Females had significantly greater odds of “Decreasing” (OR=4.80; 95% CI, 0.73 to 31.74) and “Poor” (OR=5.20; 95% CI, 1.77 to 15.30) adherence group membership compared to Males. The “Decreasing” adherence group was comprised of only poor children. Children in the “Poor” adherence class had the highest mean number of acute visits and ED visits/hospitalizations across all assessment periods.

Conclusions: This study demonstrated that unique ethnicity within Latino populations may be associated with different risk levels for suboptimal controller medication adherence which may be a factor in the observed asthma health disparities between Mexican and Puerto Rican children. Increased understanding of and attention to children’s controller medication adherence patterns will provide evidence needed to identify children at highest risk for acute healthcare utilization and offer more intensive intervention using less-intensive approaches for those at low risk.

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