Q&A: Air pollution, poverty, pollen influence 2024 list of worst cities for asthma

Key takeaways:

• The report highlights asthma inequities and climate change impacts.
• Springfield, Massachusetts, returned to the top 20 after 2 years.
• Allentown, Pennsylvania, remained No. 1 for the second year in a row.

The Asthma and Allergy Foundation of America, also known as AAFA, released its yearly list of the most difficult cities for people with asthma to live in within the United States.

According to an AAFA press release, the data for the 2024 Asthma Capitals report are taken from the 100 most populous cities in the contiguous U.S. These data are then examined based on three criteria: asthma prevalence, asthma-related ED visits and deaths due to asthma.

Notably, Allentown, Pennsylvania, was named No. 1 on the list for the second year in a row. The top 10 also included Rochester, New York; Detroit; Springfield, Massachusetts; Philadelphia; Cleveland; Lakeland, Florida; Baltimore; Charleston, South Carolina; and Providence, Rhode Island.

Rochester had the greatest prevalence of asthma and Allentown had the highest number of asthma-related ED visits. Although St. Louis, Missouri, ranked 17th overall, the city came out on top for the most asthma-related deaths.

Healio spoke with Hannah Jaffee, MS, research manager at AAFA, about this year’s results as well as the factors that impact them.

Healio: What is the importance of compiling a ranking list of Asthma Capitals in the U.S.?

Jaffee: Our annual Asthma Capitals rankings highlight the burden of living with asthma and the factors that make living with asthma more challenging. Nearly 28 million people in the United States have asthma. Ten people die each day from this chronic disease.

Our report not only highlights the factors that impact asthma symptoms, but also offers tips for asthma management and policy recommendations to improve health outcomes for people with asthma.

Healio: Were there any surprising results this year?

Jaffee: Noteworthy findings this year include Springfield, Massachusetts, returning to the top 20 after 2 years due to increases in all three factors (asthma prevalence, asthma-related ED visits and deaths due to asthma). Providence, Rhode Island, and Memphis, Tennessee, are also new to the top 20 from No. 62 and No. 55, respectively, due to increased prevalence and mortality in Providence and increased prevalence and ED visits in Memphis.

Healio: Tell us about the highest-ranking cities and the factors that contribute to their place on the list.

Jaffee: Nearly all cities in the top 10 Asthma Capitals have worse-than-average scores for at least two out of the three ranking factors.

Some common threads in the cities ranking high on the list are concentrated poverty, high levels of air pollution that impact air quality and, in some cases, high pollen counts that contribute to allergic asthma.

Detroit, this year’s third ranking city, is an example of a perfect storm of factors — areas of concentrated poverty, relatively high levels of air pollution and a significant population living near interstate highways (where vehicle emissions contribute to air pollution that can trigger asthma symptoms). Detroit is consistently among the top five cities in our report.

Healio: How does the list showcase the inequity that exists in asthma care today?

Jaffee: The report itself calls out factors that contribute to inequity in asthma health outcomes. Access to physicians is a key factor. Living in an area where there are fewer asthma specialists can mean traveling long distances for care, which adds extra burden on personal finances and time, especially in areas that are also burdened by high poverty rates. Access to affordable asthma treatment also impacts asthma outcomes. People without health insurance or with inadequate coverage often cannot access the medicines they need to effectively treat their asthma.

Healio: How does climate change impact the cities with highest cases of asthma?

Jaffee: The report highlights the urgency of the climate crisis. Warmer temperatures intensify the impact of air pollution, for example. In addition, longer growing seasons for trees, grass and weeds such as ragweed mean pollen allergens are in the air more of the year. These allergens can trigger asthma symptoms.

Healio: What factors contribute to a city being lower in the ranking?

Jaffee: The rankings are relative — so, if one city is particularly high in a category, that impacts where other cities will fall on the list. Cities in the lower half of the rankings tend to score in the average-to-low range in two out of three or all three ranking factors.

This may be in part due to access to specialists/treatment options that help make living with asthma more manageable.

Healio: What can be done in terms of public policy to mitigate the results?

Jaffee: Our report includes a list of policy recommendations that can help improve health outcomes for people with asthma. Policies that improve access to treatments (by expanding insurance or lowering costs) can help people get the resources they need to manage their asthma. Following are some of our policy recommendations.

First, fund and support public programs for people with asthma:

• Provide free asthma screenings.
• Encourage flu, COVID-19 and pneumonia vaccines for people with asthma.
• Build and implement asthma education and intervention programs.
• Include people with asthma in all levels of planning for asthma-related interventions and programs.
• Offer smoking cessation programs and fund tobacco-free youth campaigns that also teach about the dangers of vaping

Next, advance policies that support:

• carpools, public transportation and cycle- and pedestrian-friendly roads;
• electrifying buses and other public transportation;
• traffic reduction measures to reduce idling;
• rebates for electric cars and green energy solutions such as solar panels;
• reduction of food waste;
• increased consumption of plant-based meals (reduction of meat intake);
• reduction of industrial air pollution from methane, nitrogen oxides, carbon dioxide and ozone;
• creation and protection of urban green spaces;
• burn ban enforcements and other fire prevention policies;
• transitions to cleaner heating (reduce fireplace and wood stoves);
• composting and recycling; and
• smoke-free zones (such as public parks).

Finally, improve access to health care and coverage of asthma guidelines-based care and treatments. Adopt policies that prioritize Medicaid and Medicare expansion, affordable drugs and copayments, and coverage for people with preexisting conditions.

Also, remove prior authorization barriers and oppose step therapy for drug coverage that does not have adequate patient protections, which may force patients to take a drug that is not designed to treat their specific health circumstances, negatively impacting care.

References:

• 2024 Asthma Capitals: The most challenging places to live with asthma. https://aafa.org/wp-content/uploads/2024/09/aafa-2024-asthma-capitals-report.pdf. Published Sept. 10, 2024. Accessed Sept. 30, 2024.
• Report names most challenging U.S. cities for living with asthma in 2024. https://aafa.org/report-names-most-challenging-u-s-cities-for-living-with-asthma-in-2024/. Published Sept. 10, 2024. Accessed Sept. 27, 2024.

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