Exposure to Violence and Asthma Endotypes in Puerto Rican Youth

Rationale: Exposure to violence has been associated with asthma and worse asthma outcomes in youth, but no study has tested for an association between exposure to violence and specific asthma endotypes, including T helper (T)2-low endotypes. Objectives: We sought to determine if exposures to violence are associated with T2-high, T17-high, and T2-low/T17-low endotypes. Methods: We analyzed data from Puerto Rican youth aged 9-20 years with (cases) and without (controls) asthma in the EVA-PR (Epigenetic Variation and Childhood Asthma in Puerto Ricans) study. Using nasal (airway) epithelial transcriptomic profiles, participants with asthma were categorized into T2-high, T17-high, or T2-low/T17-low endotypes. Lifetime exposure to violence (ETV), past year ETV, and gun violence exposure (assessed using the validated ETV Scale questionnaire) and violence-related distress, assessed using the validated Checklist of Children's Distress Symptoms questionnaire, were our exposures of interest, and asthma endotype was our outcome of interest. Results: There were 236 cases (69 [29%] T2-high, 82 [35%] T17-high, and 85 [36%] T2-low/T17-low) and 243 controls. In multivariable analyses, ETV was associated with T17-high asthma (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.002-1.274), gun violence exposure was associated with both T2-high asthma (OR, 2.49; 95% CI, 1.22-5.08) and T17-high asthma (OR, 1.99; 95% CI, 1.05-3.74), and violence-related distress was associated with T2-high asthma (OR, 1.69; 95% CI, 1.11-2.59). Neither exposure to violence nor related distress was associated with T2-low/T17-low asthma. Conclusions: Exposure to violence or related distress was associated with T2-high asthma and T17-high asthma but not T2-low/T17-low asthma in Puerto Rican youth, a minoritized population with high asthma burden.