More than 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 common chronic diseases in our nation. Asthma is one of the most common chronic diseases and costs our society $82 billion a year.
AAFA's Asthma Capitals™ Report ranks the top 100 metropolitan cities that are 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.
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 (prevalence, asthma-related ER visits and mortality). The report also reviews eight risk factors that impact asthma
This traditional Southern town made the top 20 for its higher-than-average rate of asthma-related emergency room visits. Poverty and uninsured residents, as well as long-term 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.
The birthplace of “The Star-Spangled Banner” is also home to high asthma-related emergency rooms visits. The city’s high poverty rate is the leading contributing risk factor. According to the Centers for Disease Control and Prevention (CDC), people living below the poverty level are more likely to have asthma than those above it.
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 is an Asthma Capital due to above-average asthma-related emergency room visits. According to our findings, Cincinnati also has a high number of asthma medicine prescriptions in the area.
High pollen counts and poor air quality contribute to the high rate of asthma deaths among St. Louis residents. One study has even narrowed down the highest childhood asthma rates to five zip codes in St. Louis. These zip codes are home mostly to low-income and black residents – two groups with high asthma rates overall.
Columbus joins four other Ohio cities in the top 20 and is part of the Ohio Valley “Asthma Belt.” It’s high on the list for higher-than-average emergency room visits. It is high in four asthma risk factors: poverty, pollen, quick-relief medicine use and long-term controller medicine use.
The most populated city in Mississippi is also one of the highest in the nation for asthma mortality. Almost all the asthma risk factors are working against Jackson’s residents: poverty, lack of health insurance, high pollen, high quick-relief medicine use and high long-term controller medicine use. Jackson also came in at #2 on our 2019 Allergy Capitals report.
Akron is #14 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. Five 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.
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 prevalence and asthma-related emergency department visits. Hartford’s residents with asthma face high pollen. Pollen can trigger asthma symptoms in people with allergic asthma. Even though Hartford is #13 overall on our Asthma Capitals report, it ties with New Haven, Connecticut and Springfield, Massachusetts for high estimates of people affected by pollen.
Richmond is #12 on our Asthma Capitals list for high asthma-related death and emergency room visits. The city’s high poverty rate 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.
This coastal city in Connecticut comes in at #11 because of its high asthma prevalence. New Haven’s residents have high usage of both long-term control and quick-relief asthma medicines. This is connected to very high pollen counts and poor air quality. New Haven tied with Springfield, Massachusetts, and Hartford, Connecticut, for having the highest estimates of people affected by pollen.
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 19.1% poverty rate. Many residents also have high rates of controller and quick-relief medicine use.
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 see a higher occurrence of asthma across the U.S.
Boston’s asthma-related rates for emergency room visits are average, yet it is still one of the highest on our list for asthma prevalence and deaths. 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 count.
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 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.
High asthma prevalence and higher-than-average emergency room visits puts Allentown at #6 on Asthma Capitals. Risk factors affecting these asthma outcomes include a high estimate of people affected by pollen, access to fewer asthma specialists and few smoking laws. Poor air quality also plays a role. Lehigh County, where Allentown is located, scored a D for ozone pollution on the American Lung Association’s 2019 “State of the Air” report.
With a worse-than-average rate of asthma-related emergency room visits, Cleveland lands at #5. With a high poverty rate of 11.8% combined with poor air quality, it’s no surprising 9% of Cleveland’s residents have asthma. Cleveland ranks #6 in the U.S. for a high rate of quick-relief asthma medicine use, showing that many residents may have uncontrolled asthma.
The sixth largest city in the U.S. is our #4 Asthma Capital because of high asthma prevalence, a high number of emergency room visits and a high 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.
Many people in Greensboro frequent the emergency room for their asthma, placing this Southern city in the #3 spot. A high number of uninsured and fewer asthma specialists have dealt the area a double 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.
Dayton is the sixth largest city in Ohio, but it ranks the highest of the Ohio cities on our list coming in as the #2 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 quick-relief and long-term controller medicine prescribed in the area.
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 the second year in a row. The area has the second 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.
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 influence asthma outcomes: poverty, lack of health insurance, air quality, pollen count, long-term control medicine use, quick-relief medicine use, smoke-free laws and access to asthma specialists. Our report reveals two “Asthma Belts” in the U.S: one in the Ohio Valley area and one in the Northeast Mid-Atlantic region. To show the impact of asthma in some of the top cities on our report, we profile patients, doctors and legislators who share their experiences of living with asthma in various cities across the U.S.
Our report ranked the following asthma outcomes (not weighted equally). Within each outcome, we report the cities that ranked the highest.
Asthma prevalence is the number of people who have asthma. About 8.3% 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 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, inability 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 they affect 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 2019 Asthma Capitals™ report is an independent research project of the Asthma and Allergy Foundation of America made possible by Sanofi Genzyme and Regeneron.