PC2077: Asthma Prevalence in a Heterogenous Asian American Adolescent Population in California

Background: Comprising a growing U.S. population of >20 ethnic groups, the Asian American/Pacific Islander (AAPI) pediatric population is quite diverse. While AAPI children have been noted to have lower prevalence of asthma compared to Non-Hispanic White (NHW) children, little is known about the prevalence of asthma among AAPI subgroups. Disaggregating data among AAPI children may unmask significant health disparities. Our objective was to examine the prevalence of asthma in a community-based adolescent population with a large and diverse AAPI population and to examine associations between race/ethnicity and asthma.

Methods: We analyzed data from adolescents aged 13-17 years in a large integrated healthcare system in California who had a well-child visit between 2016-2019. Race/ethnicity was determined from health record data: NHW, Black, Hispanic, AAPI, and Other/unknown. Adolescents from AAPI subgroups were further examined: Chinese, Filipino, South Asian, Southeast Asian, Native Hawaiian/Pacific Islander (PI). Other variables included body mass index (BMI, classified as < 85th, 85th to < 95th, and ≥95th percentile) and neighborhood deprivation index (NDI). Asthma was defined by primary diagnosis in ≥2 clinical encounters using codes ICD-9/10-CM 493.X/J45.X. Multivariable logistic regression models were constructed, adjusting for age, sex, BMI, and NDI.

Results: Among 275,119 adolescents (mean age 14.6±1.4, 50.5% male), 33.6% were NHW, 9.2% Black, 28.8% Hispanic, 21.6% AAPI, and 6.9% Other/unknown. There were 26,809 adolescents with asthma, with an overall prevalence of 9.7% that was higher in male versus female adolescents (10.3% vs 9.2%). The prevalence of asthma was lowest among AAPI (8.3% of 59,388) compared to NHW (9.7% of 92,317), Black (14.5% of 25,367) and Hispanic (9.9% of 79,163) adolescents (Figure 1). However, disaggregation of AAPI subgroups revealed large variations in asthma prevalence, with higher prevalence among Filipino adolescents (14.0% of 10,685) followed by South Asian (10.2% of 3,781), Hawaiian/PI (10.0% of 2,472), Southeast Asian (8.3% of 2,479), Chinese (7.6% of 7,941), and all Other/unknown AAPI ethnicity (6.3% of 32,030). Compared with NHW adolescents, Black adolescents (OR=1.50, 95%CI 1.44-1.56) had higher odds of asthma, while AAPI (OR=0.86, 95%CI 0.83-0.89) and Hispanic (OR=0.96, 95%CI 0.93-0.99) adolescents had lower odds of asthma, adjusted for age, sex, BMI category, and NDI quartiles (Figure 2). Among AAPI adolescents, Filipino (OR=1.78, 95%CI 1.61-1.97) and South Asian (OR=1.32, 95%CI 1.15-1.51) had higher odds of asthma compared to Chinese, Hawaiian/PI (OR=1.17, 95%CI 1.00-1.37) had non-significantly higher odds, and Southeast Asian (OR=1.01, 95%CI 0.85-1.19) adolescents had similar odds.

Conclusion: In a large population of adolescents receiving primary care, we identified wide variation in asthma prevalence by race/ethnicity. Within AAPI subgroups, Filipino and South Asian adolescents had higher risk of asthma than Chinese adolescents, highlighting the heterogeneity of the AAPI population. Further investigation is still needed regarding the risk and burden of asthma among children from these different AAPI subgroups.