Around 25 million Americans have asthma. Tragically, 10 people die from it every day. Most of these deaths can be prevented with access to medical care, education on how to properly manage the disease, healthy housing and clean air. But asthma is still one of the most chronic diseases in our nation. It also costs our society $82 billion a year.
AAFA's Asthma Capitals™ 2018 Report ranks the top 100 metropolitan cities that are the most challenging to live in with asthma. We publish this report to help people who live in Asthma Capitals advocate for better care and policies. The report also shows how communities can best direct their focus to reduce the impact of asthma.
With such a large and diverse population, it's no surprise to see New York City in the top 20 on our list. America’s largest city has a higher-than-average asthma death rate. Poverty and not enough asthma specialists for the population are risk factors for poor asthma outcomes in this city. Thankfully, New York City recently took action to help renters with asthma by passing the Asthma-Free Housing Act
Akron is #18 on our Asthma Capitals list due to higher-than-average emergency room visits for asthma. Asthma long-term control and quick-relief medicine use is high in Akron, partly due to high pollen counts. Six Ohio cities made the top 20 of our report, revealing that asthma is a widespread issue in the entire state from a damaging mix of poverty, pollen and poor air quality.
This traditional Southern town made the top 20 for its high rate of asthma-related emergency room visits. Poverty and uninsured residents, as well as asthma controller medicine use, are behind Winston-Salem’s placement on our list. It is known for having a young population due to a large number of college students – a group that usually has a lower income and is less likely to have insurance.
Motor City is #16 on our list for a high rate of asthma fatalities. Like too many cities in our top 20, poverty is a primary player in Detroit's asthma rates, with a 22.9% rate compared to the nation's average of 14%. Detroit also has fewer asthma specialists to choose from, which can make it harder for people with asthma to get the care they need.
With a worse-than-average rate of asthma-related emergency room visits, Cleveland lands at #15. Its poverty rate sits at 18.3%, above the nation's 14% average. Combined with the city's poor air quality1, it's no wonder 9% of Cleveland's residents have asthma. Cleveland ranks #7 in the U.S. for a high rate of quick-relief asthma medicine use, showing that many residents may have uncontrolled asthma.
This Midwestern city on the shore of Lake Michigan made our list for a high number of asthma-related emergency room visits. This is likely related to its 19.8% poverty rate. Many residents also have high rates of controller and quick-relief medicine use. And even though it's not one of the city's top three risk factors, the air quality in Milwaukee is an issue for many with asthma.
The second most populated city in New England is high on our list for asthma prevalence. Asthma rates in Worcester tend to be higher among children, compared to national averages. According to the city of Worcester, the main asthma triggers affecting Worcester are air pollution and indoor asthma triggers. People in low-income, urban areas deal with symptoms caused by pests, mold, tobacco smoke, gas and dust mites.
The furthest west location of our top 20 Asthma Capitals, Omaha made the list for its high number of emergency room visits and death rate. Our report found a high number of asthma medicine prescriptions. In the area, rates of asthma are highest among black and Hispanic children in low-income households – groups that traditionally see a higher occurrence of asthma across the U.S.
Boston's asthma-related rates for emergency room visits and deaths are average, yet it is still one of the highest on our list for asthma prevalence. Like other cities on our report, poverty is a risk factor for Boston. And residents with allergic asthma may feel the effects of the city's high pollen rate. These are combined with a lower number of specialists in the area to affect Boston's asthma outcomes.
At #10, Toledo sits on the list with above-average emergency room visits and asthma deaths. Risk factors such as poverty and high asthma medicine use helped it place on our list. Childhood asthma is higher than average in Toledo. About 12% of children ages 0-11 have been diagnosed with asthma2, compared to 8.4% in the U.S. overall.
Many people in Greensboro frequent the emergency room for their asthma, placing this Southern city in the #9 spot. Poverty rate, a high number of uninsured and fewer asthma specialists have dealt the area a triple blow. These factors all reveal that many of the people with asthma in the area aren't getting the proper treatment to keep their asthma under control.
Asthma prevalence is high in Birmingham, likely due to poor air quality and a large number of uninsured residents. Birmingham has been working to improve its air quality over the years. But without insurance, people with asthma might not be able to afford necessary medicines and doctor's visits, leaving a lot of residents with uncontrolled asthma.
Youngstown comes in seventh on the list with above-average asthma-related emergency room visits. Almost 19% of the area's residents live in poverty, a high risk factor for asthma. Youngstown has one of the highest shares of low-income housing in the U.S., which can expose people with asthma to common triggers like mold, dust mites and cockroaches.
High ozone and particle pollution affect the quality of Cincinnati's air, driving up asthma rates. This city on the bank of the Ohio River was ranked the #6 Asthma Capital due to above-average asthma-related emergency room visits and deaths. According to our findings, Cincinnati also has a high number of asthma medicine prescriptions in the area.
Our #5 Asthma Capital has the highest asthma prevalence in the country. High pollen and air quality play into Louisville's ranking. The city has some of the worst air quality in the country. But officials are well aware of its high asthma rate, so they are taking action. Through a program run by AIR Louisville, they use GPS health sensors attached to inhalers to track medicine use and find ways to improve air quality.
The sixth largest city in the U.S. is our #4 Asthma Capital because of high asthma prevalence and number of asthma fatalities. Considered one of the nation's poorest cities, poverty is no doubt the top risk factor in Philadelphia's asthma rates. Poor air quality also makes managing asthma in Philadelphia a challenge, due to the area's high ozone and amount of airborne particle pollution.
Dayton is the sixth largest city in Ohio, but it ranks the highest of the Ohio cities on our list coming in as the #3 Asthma Capital in the nation. The “Birthplace of Aviation” has a high rate of asthma among its residents, as seen by the high number of asthma controller medicine prescribed in the area. Emergency room visits are also high, likely due to high pollen counts and poverty.
Richmond is #2 on our Asthma Capital list, but it's top in the nation for the number of asthma fatalities. The city's high poverty rate of 26.2% is a factor. Low-income families may face poorly maintained rental housing, urban locations with high pollution and lack of resources to pay for proper care. With a high pollen count and higher-than-average emergency room visits, it's no surprise Richmond is near the top of the list.
Known as “The City of Firsts” for being the birthplace of many innovations, Springfield is also first on our list as the top Asthma Capital for 2018. The area has the highest number of asthma-related emergency room visits in the U.S., as well as a high rate of asthma prevalence overall. High pollen counts are also a big factor for Springfield’s residents with asthma, especially those with allergic asthma.
Our report looks at the 100 most challenging places to live with asthma. Download our full report to see where each city ranks for asthma outcomes and eight primary risk factors impact asthma rates.
This comprehensive report identifies critical asthma outcomes in the 100 most populated metropolitan areas in the U.S. The ranking is based on weighted outcomes: asthma prevalence, asthma-related emergency department visits and asthma-related deaths. The report also analyzes eight risk factors that can affect asthma outcomes. They are poverty, number of uninsured, air quality, pollen count, long-term control medicine use, quick-relief medicine use, smoke-free laws and access to specialists. Our report also uncovered two “Asthma Belts” in the Ohio-Lake Erie area and Northeast Mid-Atlantic states. To show the impact of asthma in some of the top cities on our report, we profile patients who share their experiences of living with asthma in various cities across the U.S.
Our report ranked these asthma outcomes (not weighted equally):
Asthma prevalence is the number of people who have asthma. About 7.8% of Americans have asthma. Asthma rates are higher in low-income areas and among minorities. Our report looked at the number of people with asthma in each metropolitan area.Asthma-Related Emergency Department Visits
Asthma is one of the top reasons for emergency department (ED) visits. An ED visit is one outcome of poorly controlled asthma. The number of asthma-related ED visits affected the overall rank of each city on our Asthma Capitals report.Asthma-Related Mortality
Ten people die each day from asthma in the United States. Older adults and African-Americans have the highest number of fatalities due to asthma. The number of fatal outcomes due to asthma influenced the overall rank of each city in our Asthma Capitals report.
A risk factor is something that can increase your chances of getting asthma or can make your asthma worse. We analyzed the following risk factors and their potential impact on asthma outcomes in each of the 100 largest U.S. metropolitan cities (the risk factors did not weigh into the ranking):
Poverty can play a major role in developing asthma and the ability to manage it. This can be because of poor rental housing, location near highways, not being able to pay for treatment and more. Many cities on our report have poverty as a top risk factor.Lack of Health Insurance
Asthma treatment can be expensive. People without insurance may not be able to pay for medicines and health care, causing them to have uncontrolled asthma.Poor Air Quality
Harmful gases, like ozone, and small particles in the air, like smoke, can make asthma worse. Cities with poor air quality tend to have higher asthma rates.Pollen
People with allergic asthma may have more symptoms during high pollen seasons. We looked at pollen counts in each city and how it affects asthma rates.Asthma Long-Term Control Medicine Use
Controller medicines are used daily to prevent and control asthma symptoms. The number of controller prescriptions can mean a high amount of the city’s residents may have persistent asthma.Asthma Quick-Relief Medicine Use
Quick-relief medicines act fast to relax asthma symptoms while they are happening. Several cities on our report have a high number of quick-relief prescriptions, meaning these cities may have a large number of residents with uncontrolled asthma.Smoking Laws
Tobacco smoke is a common asthma trigger. Secondhand and thirdhand smoke can also make asthma worse in children and affect lung development. Increasing the number of smoke-free places is one way cities can help reduce asthma rates.Access to Specialists
People with asthma need access to proper and affordable health care. But some cities have a lower number of asthma specialists per patient. This can mean longer wait times for appointments and a longer drive to see a doctor.
The 2018 Asthma Capitals™ report is an independent research project of the Asthma and Allergy Foundation of America made possible by Sanofi Genzyme and Regeneron.