The risk of asthma hospitalization among Hispan-ics in California—comprised predominantly of Mex-ican-Americans—was greater than whites but consistently lower than blacks across all income and age groups. Moreover, the rate of asthma hospitalization among the California Hispanic population was lower than that reported for Hispanies of Puerto Rican descent, which is consistent with the body of literature reporting the increased prevalence and case severity of asthma among Puerto Ricans as compared with Cubans and Mexican-Americans For example, Carter-Pokras and Cergen, using 1982 to 1984 National Health and Nutrition Examination Survey results, reported that the highest prevalence of active asthma was found among Puerto Ricans (11.2%), followed by blacks (9.1%), Cubans (8.8%), Mexican-Americans (4.5%), and whites (3.3%). Increasingly, it is recognized that Hispanics are not a single homogeneous group. Economic, social, and clinical factors play an important role in the noted differences among Puerto Ricans, Mexican-Americans, and Cu-ban-Americans in their health status, illness behavior, and use of medical care services. For example, Puerto Rican women of reproductive age are more likely to smoke (33.5%) than Mexican-American women (23.2%), and children of mothers who smoke have a higher incidence of wheezing illness, especially in the first few years of life. Compared with Mexican-Americans and Cubans, Puerto Ricans are more likely to be near or below the poverty line, insured by Medicaid, have a greater number of disability days, and have the highest annual healthcare expenses. canadian health&care mall

In addition to the racial/ethnic differences in asthma hospitalization rates, particularly among Hispanics, differences between the east and west coast reported in this study may also be due to variations in access to health-care sendees, level of poverty (considered to be a surrogate measure of health-care access and use), as well as medical treatment practice patterns.’’ Regional differences in the reporting of a specific illness as a primary diagnosis may also contribute to the underreporting of asthma in California. Finally, the indoor and outdoor environmental agents that east and west coast residents are exposed to may differ substantially.