20 New York New York

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

19. Hartford, Connecticut

One of the oldest cities in America is also one of the most challenging places to live with asthma, as seen by its high asthma death rate and medicine use. Hartford’s residents with asthma face high pollen. Pollen can trigger asthma symptoms in people with allergic asthma. Even though Hartford is #19 overall on our Asthma Capitals report, it sits at #6 in the nation for high pollen (spring and fall combined).

18. Akron, Onio

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.

17. Winston-Salem, North Carolina

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.

16. Detroit, Michigan

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. 

15. Cleveland, Ohio

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.

14. Milwaukee, Wisconsin

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.

12. Worcester, Massachusetts

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.

(tie) 12. Omaha, Nebraska

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.

11. Boston, Massachusetts

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. 

10. Toledo, Ohio

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.

9. Greensboro, North Carolina

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.

8. Birmingham, Alabama

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.

7. Youngstown, Ohio

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.

6. Cincinnati, Ohio

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.

5. Louisville, Kentucky

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.

4. Philadelphia, Pennsylvania

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.

3. Dayton, Ohio

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.

2. Richmond, Virginia

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.

1. Springfield, Massachusetts

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.