Asthma Ambulatory Care Quality in Foreign-Born Latino Children in the United States

Published:October 21, 2021DOI:



      Foreign-born Latino children in the United States (US) have poor asthma outcomes, but the role of routine care utilization in these outcomes is unclear. Our objective was to compare select ambulatory care utilization measures for asthma between foreign-born Latino, US-born Latino, and non-Hispanic white children.


      Using a multistate network of clinics with a linked electronic health record, we compared the International Classification of Disease (ICD)-coded asthma diagnosis among those with respiratory symptoms, electronic health records documentation of diagnosis, prescriptions, and influenza vaccination of foreign-born and US-born Latino children, and non-Hispanic white children over a 10+ year study period. We also examined outcomes by country of birth in children from Mexico, Cuba, and Guatemala.


      Among our study population (n = 155,902), 134,570 were non-Hispanic white, 19,143 were US-born Latino, and 2189 were foreign-born Latino. Among those with suspicious respiratory symptoms, there was no difference between these groups in the predicted probability of an ICD-coded asthma diagnosis. US-born Latino children with asthma were less likely to have asthma documented on their problem list, more likely to have an albuterol prescription, and less likely to have an inhaled steroid prescribed. All Latino children had higher rates of influenza vaccination than non-Hispanic white children.


      In a national network, there were few disparities between Latino (US- and foreign-born) children and non-Hispanic white comparators in many common asthma care services, except some measures in US-born Latino children. Providers should understand that their US-born Latino children may be at elevated risk for not receiving adequate asthma care.


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        • Camacho-Rivera M
        • Kawachi I
        • Bennett GG
        • et al.
        Revisiting the Hispanic health paradox: the relative contributions of nativity, country of origin, and race/ethnicity to childhood asthma.
        J Immigr Minor Health. 2015; 17: 826-833
        • Eldeirawi KM
        • Persky VW.
        Associations of acculturation and country of birth with asthma and wheezing in Mexican American youths.
        J Asthma. 2006; 43: 279-286
        • Holguin F
        • Mannino DM
        • Anto J
        • et al.
        Country of birth as a risk factor for asthma among Mexican Americans.
        Am J Respir Crit Care Med. 2005; 171: 103-108
        • Iqbal S
        • Oraka E
        • Chew GL
        • et al.
        Association between birthplace and current asthma: the role of environment and acculturation.
        Am J Public Health. 2014; 104: S175-S182
        • Arcoleo KJ
        • McGovern C
        • Kaur K
        • et al.
        Longitudinal patterns of Mexican and Puerto Rican Children's Asthma Controller Medication Adherence and Acute Healthcare use.
        Ann Am Thorac Soc. 2019; 16: 715-723
        • Holguin F
        • Mannino DM
        • Antó J
        • et al.
        Country of birth as a risk factor for asthma among Mexican Americans.
        Am J Respir Crit Care Med. 2005; 171: 103-108
      1. British Thoracic Society. British Guideline on the Management of Asthma. Available at: Accessed March 1, 2021

      2. National Heart Lung, and Blood Institute. Guidelines From the National Asthma Education and Prevention Program. 2007. Available at: Accessed March 1, 2021

      3. Center for Medicare/Medicaid Services. Eligible Professional Meaningful Use Core Measures Measure 3 of 13. 2014. Available at: Accessed March 1, 2021

        • Kharat AA
        • Borrego ME
        • Raisch DW
        • et al.
        Assessing disparities in the receipt of inhaled corticosteroid prescriptions for asthma by Hispanic and non-Hispanic white patients.
        Ann Am Thorac Soc. 2015; 12: 174-183
        • Crocker D
        • Brown C
        • Moolenaar R
        • et al.
        Racial and ethnic disparities in asthma medication usage and health-care utilization: data from the National Asthma Survey.
        Chest. 2009; 136: 1063-1071
        • Grohskopf LA
        • Alyanak E
        • Broder KR
        • et al.
        Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices - United States, 2019-20 influenza season.
        MMWR Recomm Rep. 2019; 68: 1-21
        • Anandappa M
        • Adjei Boakye E
        • Li W
        • et al.
        Racial disparities in vaccination for seasonal influenza in early childhood.
        Public Health. 2018; 158: 1-8
        • Schuller KA
        • Probst JC.
        Factors associated with influenza vaccination among US children in 2008.
        J Infect Public Health. 2013; 6: 80-88
        • National Association of Community Health Centers
        Community Health Center Chartbook 2020.
        2020 (Available at: Accessed February 1, 2021)
        • Hueston W.
        BMJ Best Practice: Acute Bronchitis.
        2018 (Available at: Accessed February 1, 2021)
        • McCaffrey DF
        • Griffin BA
        • Almirall D
        • et al.
        A tutorial on propensity score estimation for multiple treatments using generalized boosted models.
        Stat Med. 2013; 32: 3388-3414
        • Kenyon CC.
        • et al.
        Variability in diagnosed asthma in young children in a large pediatric primary care network.
        Acad Pediatr. 2021; 20: 958-966
        • Heintzman J
        • Bailey SR
        • Cowburn S
        • et al.
        Pneumococcal vaccination in low-income Latinos: an unexpected trend in Oregon Community Health Centers.
        J Health Care Poor Underserved. 2016; 27: 1733-1744
        • Heintzman J
        • Hatch B
        • Coronado G
        • et al.
        Role of race/fthnicity, language, and insurance in use of cervical cancer prevention services among low-income Hispanic women, 2009-2013.
        Prev Chronic Dis. 2018; 15: E25
        • Sangaramoorthy M
        • Yang J
        • DeRouen MC
        • et al.
        Disparities in hepatocellular carcinoma incidence in California: an update.
        Cancer Epidemiol Biomark Prev. 2020; 29: 79-87
        • Fryar CD
        • Fakhouri TH
        • Carroll MD
        The association of nativity/length of residence and cardiovascular disease risk factors in the United States.
        Prev Med. 2020; 130105893
        • Jerschow E
        • Strizich G
        • Xue X
        • et al.
        Effect of relocation to the U.S. on asthma risk among Hispanics.
        Am J Prev Med. 2017; 52: 579-588
        • Nelson HS
        • Raine D
        • Doner HC
        • et al.
        Subsensitivity to the bronchodilator action of albuterol produced by chronic administration.
        Am Rev Respir Dis. 1977; 116: 871-878
        • Grohskopf LA
        • Liburd LC
        • Redfield RR.
        Addressing influenza vaccination disparities during the COVID-19 pandemic.
        JAMA. 2020; 324: 1029-1030
      4. Center for Medicare/Medicaid Services. Puerto Rico. 2021. Available at: Accessed February 1, 2021.

        • Rodríguez MA
        • Bustamante AV
        • Ang A.
        Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos.
        J Gen Intern Med. 2009; 24: 508-513
        • O’Malley JP
        • O’Keeffe-Rosetti M
        • Lowe RA
        • et al.
        Health care utilization rates after Oregon’s 2008 Medicaid expansion: within-group and between-group differences over time among new, returning, and continuously insured enrollees.
        Med Care. 2016; 54: 984-991
        • Weinstein SM
        • et al.
        Parent nativity and child asthma control in families of Mexican Heritage: the effects of parent depression and social support.
        Acad Pediatr. 2021; 20: 967-974
      5. BMJ Best Practice. Acute Bronchitis. 2018. Available at: Accessed February 1, 2021

        • Jolly SE
        • Navaneethan SD
        • Schold JD
        • et al.
        Chronic kidney disease in an electronic health record problem list: quality of care, ESRD, and mortality.
        Am J Nephrol. 2014; 39: 288-296
        • Wright A
        • McCoy AB
        • Hickman TT
        • et al.
        Problem list completeness in electronic health records: a multi-site study and assessment of success factors.
        Int J Med Inform. 2015; 84: 784-790
        • Coleman K
        • Austin BT
        • Brach C
        • et al.
        Evidence on the chronic care model in the new millennium.
        Health Aff (Millwood). 2009; 28: 75-85