Kids' Asthma Improves After Moving to Better-Resourced Neighborhoods

A program that helped families move to a low-poverty neighborhood was linked with a significant improvement in symptoms and exacerbations among children with persistent asthma, a cohort study out of Baltimore showed.

Prior to moving to a low-poverty area, 15.1% of participants experienced at least one asthma exacerbation per 3-month period compared with 8.5% after moving (P=0.009), reported Craig Evan Pollack, MD, MHS, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and co-authors.

Similar results were seen in maximum symptom days in the previous 2 weeks, with 5.1 days prior to the move and 2.7 days after moving (P<0.001), they noted in JAMA.

In models that adjusted for age and sex, this translated into a 54% reduced odds of asthma exacerbation (adjusted OR 0.46, 95% CI 0.28-0.76) and a 59% reduced odds of a symptom day (aOR 0.41, 95% CI 0.32-0.53) associated with moving.

"In the U.S., Black children have 2 to 3 times the prevalence of asthma as white children and, among those with asthma, have more than twice the risk for emergency department visits and hospitalizations compared with white children," Pollack and team wrote. "Multiple causes of this disproportionate burden of asthma morbidity -- many tied to living in disadvantaged urban neighborhoods -- have been identified, including indoor allergen exposures, indoor and outdoor air pollution, and neighborhood-related stress."

Before moving with assistance from the Baltimore Regional Housing Partnership mobility program, 81% of participants were living in a high-poverty census tract, defined as more than 20% of families living below the poverty line. The median household income was $32,542 on the census tract. After the move, 0.9% of children were still living in a high-poverty tract.

While addressing the impacts of racism on health may not have been the main focus of the mobility program, these findings must be considered in future programs and initiatives, Pollack's group noted.

"Housing mobility programs were designed to address historic and contemporary housing discrimination that resulted in racial and ethnic segregation, depleted segregated neighborhoods of opportunities to generate wealth, and contributed to unhealthy and stressful living conditions," they wrote. "Although housing mobility interventions result in a wholesale change in housing and neighborhood conditions and do not target specific risk factors for asthma morbidity, understanding whether home environmental exposures and stress mediate the effects of moving on asthma lends insight into optimal intervention design."

In an accompanying editorial, Neeta Thakur, MD, MPH, and Adali Martinez, MD, MPH, of the University of California San Francisco, noted that understanding the relationship between race and health is an essential part of future research.

"Researchers can best work to reduce or eliminate health disparities by taking a step beyond identifying associations between race and health outcomes," they wrote. "They can move the field forward by acknowledging the pervasiveness of racism in causing adverse health outcomes and addressing the root cause."

"More work is needed to understand other important downstream effects of structural racism that shape neighborhood quality and affect psychosocial stress and health," they added. "Such an understanding is key to enabling designing and scaling interventions to enrich oppressed communities with resources to improve their health and well-being."

This study included 123 children ages 5 to 17 with asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020, who were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores.

Median age was 8.4 years, 97.6% were Black, and 47.2% were girls.

In propensity score-matched analyses with URECA data, results remained significant. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving.

Pollack and team noted that parents may have decided to move after watching their children experience asthma exacerbations, which could have led to potential confounding. In addition, the findings may not be generalizable outside of Baltimore.

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