Document Type
Article
Publication Date
11-2-2026
Abstract
Puerto Ricans experience among the highest asthma morbidity in the United States, and ambient fungal spores are abundant tropical aeroallergens. This ecological time-series study asked whether associations between ambient fungal spores and recorded asthma healthcare utilization in the San Juan Metropolitan Area, Puerto Rico (2018–2021), were stable across two contextual eras (post-Hurricane María recovery, 2018–2019; the COVID-19 pandemic, 2020–2021) and across age groups. Daily Burkard spore counts were linked to 168,578 asthma encounters. Encounter volume (negative binomial rate ratios, RR) and the ED/inpatient encounter fraction (logistic odds ratios, OR) were modeled per 10,000 spores·m−3 using weekly means and 3- and 7-day moving averages, with age adjustment or stratification, period × age interaction tests, false discovery rate (FDR) control, and a time-stratified case-crossover analysis of ED/inpatient events. Age-adjusted annual estimates were close to the null (volume RR 0.990–1.011; fraction OR 0.975–0.999). Associations with the ED/inpatient fraction differed by age and period (interaction p < 0.001), whereas heterogeneity in encounter volume was weak (p = 0.05–0.28). Of 48 period × age estimates, eight were nominally significant, and one survived FDR control (2020, ages 75–84, fraction OR 1.28, 95% CI 1.12–1.47). The 2020 case-crossover estimate for 3-day average exposure was inverse (OR 0.946, 95% CI 0.910–0.984), the 7-day estimate was null, and directions varied across years. These small, heterogeneous associations describe population-level co-occurrence in this region, not individual-level risk.
Publication
Aerobiology
Publisher
MDPI
Volume
4
Issue
4
Pages
24
Department
College of Arts and Sciences
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Peer Reviewed
1
Publication History
Received: 24 September 2026 | Revised: 20 October 2026 | Accepted: 29 October 2026 | Published: 2 November 2026
Recommended Citation
Bolaños-Rosero, B., Pereira Moreira, C. I., Robles-Rivera, C. S., & Rivera-Mariani, F. E. (2026). Age- and period-stratified associations between ambient fungal spore exposure and asthma healthcare utilization in the San Juan metropolitan area, Puerto Rico, 2018–2021. Aerobiology, 4(4), 24. https://doi.org/10.3390/aerobiology4040024
Comments
This article belongs to the Topic Impacts of Air Quality on Environment and Human Health, 2nd Edition