Moving more effective than cleaning up distressed properties for children with asthma

Big part of asthma burden not about who you are, but where you live… research shows

Children whose families participated in a program that helped them move from distressed neighborhoods to areas with lower rates of poverty and better public resources like schools and parks experienced significant improvements in severe asthma episodes, according to a new study led by a researcher at Dell Medical School at The University of Texas at Austin.

The study, published today in the Journal of the American Medical Association, involved 123 children, ages 5 to 17, with persistent asthma whose families took part in a six-year housing mobility program in Baltimore.

Before moving, for every 100 children, there were approximately 88 severe asthma attacks per year. After moving, there were approximately 40 severe attacks per year, a reduction of more than 50%.

“These findings confirm what we’ve long suspected: A big part of the asthma burden is not about who you are. It’s about where you live.” – Elizabeth Matsui, M.D.

“That degree of improvement is larger than the effect we see with asthma medications,” said epidemiologist Elizabeth Matsui, M.D., senior author of the study and a professor of population health and pediatrics at Dell Med. “We were also surprised to find that improvements in neighborhood stressors, including feeling safer in their new community and experiencing better social cohesion with neighbors, seemed to be major factors in the improvements in asthma.”

In fact, researchers found that the reduction in neighborhood-related stress was responsible for between 20% and 35% of the improvement in asthma exacerbations and symptoms. The number of symptom days also declined with moving, from five days to just under three days in a two-week period.

Previous efforts to improve asthma by addressing household-level exposures such as mouse and cockroach allergens have had only modest success in improving asthma.

Programs that support families that want to move to better resourced neighborhoods provide an alternative approach that appears to be more effective, according to Matsui.

“These findings confirm what we’ve long suspected: A big part of the asthma burden is not about who you are. It’s about where you live,” said Matsui. “This study demonstrates that programs designed to counter housing discrimination can have significant positive health effects for the children who move.”

Matsui said she thinks the outcomes of this study are scalable to other cities that offer similar housing mobility programs.  

The findings could also explain persistent racial and ethnic disparities in childhood asthma, Matsui said, since Black and Latinx/Hispanic children are more likely to live in distressed, urban areas because of historical and current-day housing discrimination.

“For example, we know kids in the poorest neighborhoods in Austin and Travis County have the highest burden of asthma emergency department visits and that these kids tend to be Black and Hispanic,” said Matsui. “The results of our study suggest that if those children lived in better-resourced neighborhoods, their emergency hospital visits would be greatly reduced.”

Other contributors to the JAMA article include Roger Peng, Ph.D., a professor in the Department of Statistics and Data Sciences at UT, as well as researchers from Johns Hopkins University and the University of North Carolina at Chapel Hill.