Whether you have asthma – and how serious your asthma is – has a lot to do with the community where you live, experts say.
“It is not who someone is, but where they live, that is the major determining factor for their asthma,” says Elizabeth C. Matsui, MD, a professor of population health and pediatrics at the University of Texas at Austin.
Disparities in Asthma Outcomes
Asthma is one of the most common diseases In the U.S., affecting about 28 million people. But it doesn’t affect all communities equally.
Things known to trigger or worsen asthma include:
- Air pollution
- High pollen levels
- Poor indoor air quality, including smoking and secondhand smoke
- Lack of accessible medical care
- Poverty and lack of health insurance
“Communities facing challenges like limited access to health care, higher pollution levels, and economic disparities often see higher rates of asthma-related complications,” says Sharon Stokes-Williamson, DrPH, program director of health at the National Environmental Education Foundation in Washington, D.C.
Each year, the Asthma and Allergy Foundation of America ranks 100 cities in the lower 48 states of the U.S. based on how difficult it is to live there with asthma. Its 2024 report ranked these as the top 10 most challenging cities:
- Allentown, Pennsylvania
- Rochester, New York
- Detroit
- Springfield, Massachusetts
- Philadelphia
- Cleveland
- Lakeland, Florida
- Baltimore
- Charleston, South Carolina
- Providence, Rhode Island
“Poor indoor or outdoor air quality, often from pollution, and access to treatment play the greatest role in location-based asthma outcomes,” says Kenneth Mendez, president and CEO of the Asthma and Allergy Foundation of America.
Outdoor Air Quality
One reason why people who grew up or live in urban areas are at higher risk of having asthma is because they’re exposed to more smog.
For a variety of reasons, ranging from discriminatory zoning policies to land prices, pollution sources such as factories and highways tend to be in low-income areas. According to the Environmental Protection Agency, neighborhoods with higher poverty rates have higher levels of exposure to harmful particulate matter and ozone.
“The environment around the home can be significant, such as living near a highway where exhaust particulate levels are high or in damp environments where mold levels are high,” says Geoffrey Chupp, MD, director of the Yale Center for Asthma and Airways Disease in New Haven, Connecticut.
Living in places prone to wildfires, high pollen counts, or in farming areas with pesticides can also mean more frequent flare-ups, says Maryum Merchant, MD, a pulmonologist at UCLA Health.
Indoor Air Quality
Poor housing conditions can also raise your risk of asthma and make your symptoms worse. That’s because asthma triggers like mold, dust mites, and pests are more common in homes that need repair.
Carpet and bedding can hold allergens that increase the risk of asthma attacks. Pets, housemates who smoke, and propane stoves can do the same, Chupp says
Even bad indoor air quality in aging neighborhood school buildings increases the risk that children will have serious asthma attacks.
When kids with asthma living in disadvantaged areas in Baltimore moved with their families to low-poverty neighborhoods, their symptoms improved, one study found.
Access to Health Care
About 80 million Americans live in what the federal Health Resources and Services Administration calls Health Professional Shortage Areas (HPSAs). That means there are too few health care providers to serve the population.
Low-income communities often have a hard time getting health care providers who are willing and trained to serve them, especially when many residents lack insurance or have Medicaid. And this isn’t just an issue in inner-city areas.
“Rural areas come with their own challenges, too – limited access to health care can delay diagnosis and treatment, making asthma harder to manage,” says Merchant, lead doctor of the Adult Asthma program at UCLA Health Thousand Oaks Hampshire Primary & Specialty Care in Thousand Oaks, California.
Experts recommend that an allergist, immunologist, or pulmonologist treat severe asthma. But one report found that only 4 in 10 Americans who had severe asthma saw a specialist. The study authors found that living near a specialist affects whether a person will get care from one. Telehealth may help more people gain access to specialists, the researchers noted.
Reduce the Risks You Can Control
Relocating may be an option if you live in a high-risk area, but it’s not on the table for everyone. Still, there are ways to improve your outcomes.
“If you live in an area where these exposures are prevalent, it is important to reduce the risks you can control,” says Scott Bickel, MD, a pulmonologist and medical director of respiratory therapy at Norton Children's Hospital in Louisville, Kentucky.
Experts recommend a few ways to ease symptoms and improve care:
- Reduce your exposure to allergens and triggers. Properly vent your stove. Wash your bedding regularly in hot water and use pillow and mattress covers if you're sensitive to dust mites. Get a hypoallergenic mattress and pillow covers if possible.
- Avoid smoking and vaping.
- Use a portable air cleaner.
- Find an asthma specialist who does telehealth appointments if there’s not one near where you live.
- Monitor outdoor air quality and limit outdoor activities on days when the air quality is poor. Wear a mask outside for extra protection.
- Explore a professional home evaluation, and ask your landlord if they can repair issues that may trigger your asthma.
Show Sources
Photo Credit: The Image Bank/Getty Images
SOURCES:
Sharon Stokes-Williamson, DrPH, program director of health, National Environmental Education Foundation.
Kenneth Mendez, president and CEO, Asthma and Allergy Foundation of America.
Maryum Merchant, MD, pulmonologist, UCLA Health; lead doctor, Adult Asthma program, UCLA Health Thousand Oaks Hampshire Primary & Specialty Care.
Elizabeth C. Matsui, MD, professor of population health and pediatrics, University of Texas at Austin.
Geoffrey Chupp, MD, professor of pulmonology, Yale School of Medicine; director, Yale Center for Asthma and Airways Disease, New Haven, Connecticut.
Scott Bickel, MD, pulmonologist; medical director of respiratory therapy, Norton Children's Hospital.
Asthma and Allergy Foundation of America: “Asthma Facts,” “Asthma Capitals 2024,” “Indoor Air Quality,” “Health Disparities.”
Annals of Asthma, Allergy & Immunology: “Geographic variation in disease burden among patients with severe persistent asthma in the United States.”
Academic Pediatrics: “Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey.”
American College of Allergy, Asthma & Immunology: “Non-Allergic Asthma,” “Air Filters.”
Cureus: “Geographic Disparity in Asthma Hospitalizations: The Role of Race/Ethnicity, Socioeconomic Status, and Other Factors.”
Current Opinion in Allergy and Immunology: “Asthma and Ethnic Minorities: Socioeconomic Status and Beyond.”
Journal of Community Health: “Traveling Towards Disease: Transportation Barriers to Health Care Access.”
Clinical Communications: “Racial and ethnic disparities in biologic prescriptions for asthma in the United States.”
The Journal of Allergy and Clinical Immunology: “Real-World Assessment of Asthma Specialist Visits Among U.S. Patients with Severe Asthma.”
The Journal of the American Medical Association: “Association of a Housing Mobility Program With Childhood Asthma Symptoms and Exacerbations.”
National Committee for Quality Assurance: “Moving Toward Better Asthma Care and Outcomes: What Will It Take?”
Current Allergy and Asthma Reports: “Using Telemedicine to Care for the Asthma Patient.”
Yale Journal of Biology and Medicine: “An Overview of Health Disparities in Asthma.”
Allergy & Asthma Network: “How Telehealth Helps Asthma and Allergy Patients.”
American Lung Association: “Disparities in the Impact of Air Pollution.”
