Asthma Control: Where You Live Can Make a Difference
Did you know that where you live can greatly affect your ability to achieve asthma control? It's true. Every year, the Asthma and Allergy Foundation of America (AAFA, for short), ranks 100 of our largest cities in their "Asthma Capitals" report. Being selected as an Asthma Capital in the U.S. is no honor. The 100 cities included in this list are rated as the "most challenging" cities to live in if you have asthma.
Some alarming statistics
Did you know that, according to the AAFA:
- Asthma is one of the most common chronic illnesses in the U.S. (25 million of us have it)?
- 10 people die every day from asthma? Asthma is one of our most costly diseases ($82 billion/year)?
- The sad thing is that most asthma deaths and much of the poor control that asthmatics deal with could be preventable with:
- More stringent asthma management (this should be a bullet, not a subhead)
- Better access to medical care
- Improvements in housing conditions
- Cleaner air quality
The annual report from AAFA is intended to alert both asthma sufferers and healthcare professionals in the so-called Asthma capitals as to the challenges they need to address.
How a city becomes an asthma capital
The AAFA rated cities for this report based on both risk factors for asthma, as well as health outcomes. Risk factors they included were as follows:
- Air quality
- Access to asthma specialists
- Average pollen counts
- Medicine use
- Anti-smoking laws
- Number of people who have no or inadequate health insurance
Health outcomes that they measured included:
- Prevalence of asthma
- Number of emergency room visits for asthma
- Number of asthma deaths
By focusing efforts on the cities that rank low in these 10 areas, hopefully, as a nation, we can improve asthma health outcomes over time.
Two regions in the U.S. had especially high number of cities in the top 20 Asthma Capitals this year:
- The state of Ohio, which had 6 of the top 20 capitals
- The northeast & mid-atlantic regions of the U.S., which had 8 of the top 20 capitals
The other 6 of the top 20 capitals were located either in the midwest or in the south. Surprisingly, none of the top 20 capitals were located in the western U.S., not even in the large Pacific coast metropolises. However, it should be noted that many of the cities in California, Arizona, and Texas were included in the top 100 asthma capitals ranking.
The most challenging of all the cities is Springfield, Massachusetts and the least challenging of the top 100 is McAllen, Texas. In a moment, we'll take a closer look at the data. Here are the top 10 overall:
- Springfield, MA
- Richmond, VA
- Dayton, OH
- Philadelphia, PA
- Louisville, KY
- Cincinnati, OH
- Youngstown, OH
- Birmingham, AL
- Greensboro, NC
- Toledo, OH
Taking a closer look at health outcomes
Let's delve into some of the detail on these cities, shall we? As you will see below, the overall ranking sometimes differs markedly from a city's ranking in a particular area.
First let's look at asthma prevalence
In the U.S., 7.8% of people have asthma. It's more common in children, and also in certain ethnic groups, genders, and socioeconomic classes. The top 5 cities with the highest prevalence of asthma are:
- Louisville, KY (ranked 5 overall)
- Portland, OR (ranked 39 overall)
- Providence, RI (ranked 35 overall)
- Boston, MA (ranked 11 overall)
- Bridgeport, CT (ranked 49 overall)
Second, let's discuss emergency room visits
Typically, people with asthma seek emergency care when an asthma flare-up becomes so severe, it does not respond adequately to home treatment. According to a recent national survey, asthma accounts for more than 2 million visits to the emergency department yearly, making it one of the top 20 reasons for ED visits.
It is important to seek medical care right away for severe asthma attacks. However, unnecessary visits to the ER can be costly. There may be a correlation between inadequate health insurance and excess visits to the ER as well.
The top 5 cities in terms of emergency room visits are:
- Springfield, MA (ranked 1 overall)
- Virginia Beach, VA (ranked 22 overall)
- Omaha, NE (ranked 13 overall)
- Dayton, OH (ranked 3 overall)
- Greensboro, NC (ranked 9 overall)
Asthma-related deaths are a critical factor
As stated earlier, 10 people a day, or over 3000 per year, die of asthma. Older adults are at the greatest risk, but African-Americans are also at a considerably higher risk than other races.
The top 5 cities in terms of asthma-related deaths in the 2018 report are:
- Richmond, VA (ranked 2 overall)
- Chicago, IL (ranked 43 overall)
- New York, NY (ranked 20 overall)
- New Orleans, LA (ranked 25 overall)
- Detroit, MI (ranked 16 overall)
Risk factors affect asthma rates
Let's look at a couple of the risk factors explored in the AAFA report.
For those who live at or below the poverty level, managing asthma can be extremely challenging.
Having to choose between basic needs such as housing, clothing, and food versus medical care or medication can be a tough choice. And asthma care and medication can be extremely expensive, especially when there are multiple family members who have asthma, which is common.
It's easy to see how living in poverty can also impact on several of the other risk factors for asthma that were listed earlier in this article.
The top 5 cities in terms of poverty level include:
- McAllen, TX (ranked 100 overall)
- Richmond, VA (ranked 2 overall)
- Augusta, GA (ranked 31 overall)
- Fresno, CA (ranked 75 overall)
- Philadelphia, PA (ranked 4 overall)
Air quality is also a big influencer of asthma rates
Air pollution can be due to both natural and man-made substances, and poor air quality can be both outdoors and indoors. Cities with the worst air quality include:
- Phoenix, AZ (ranked 47 overall)
- Bakersfield, CA (ranked 85 overall)
- Fresno, CA (ranked 75 overall)
- Los Angeles, CA (ranked 92 overall)
- Riverside, CA (ranked 86 overall)
Clearly, although California didn't have any cities in the top 20 overall, air quality is a huge concern for the cities in that state.
Tobacco smoke, from both firsthand use and secondhand exposure, is also a big factor in air quality in a community. These cities do the least to protect their citizens from smoke:
- August, GA
- Chattanooga, TN
- Knoxville, TN
- Memphis, TN
- Nashville, TN
Looks like Tennessee is not the state to live in if you are sensitive to tobacco smoke! (And most of us asthmatics are.)
Living with asthma can be challenging no matter where you live. But for people who live in the 100 "asthma capitals" in the U.S., it can be even harder to maintain asthma control. I'm not recommending people move as a result of this report, but knowledge is power. Knowing the risks you face in your particular area can help you take actions that may enhance your degree of asthma control.
For more detailed analysis of the health outcomes and risk factors, you may want to download and read the AAFA report for yourself.
Have you ever gotten "moon face" as a side effect of prednisone?