Housing mobility to low poverty neighborhood improves asthma exacerbation and morbidity: JAMA

A new study published in JAMA Network suggests that children with asthma who were part of a program that assisted their family in relocating to less impoverished areas had a substantial reduction in asthma symptom days and exacerbations.

Children who reside in underprivileged urban districts have disproportionately high asthma morbidity, which has been linked to structural racism. The effectiveness of current strategies to lessen asthma triggers is limited. This study was carried out by Craig Evan Pollack and colleagues to determine if participation in a housing mobility program that offered housing vouchers and assistance moving to low-poverty neighborhoods was associated with decreased asthma morbidity in children and to explore potential mediating factors.

Cohort study of 123 children with recurrent asthma, aged 5 to 17 years, whose families took part in the housing mobility program of the Baltimore Regional Housing Partnership from 2016 to 2020. Using propensity scores, children were matched to 115 kids included in the Urban Environment and Childhood Asthma (URECA) birth cohort. For this study, moving to a community with less poverty served as the exposure. The primary outcomes were symptoms and asthma exacerbations as reported by caregivers.

The key points of this study were:

1. The program served 123 kids, with a median age of 8.4 years, 58 (47.2%) females, and 120 (97.6%) Black kids.

2. Only 1 of the 106 children having post-move data (0.9%) still resided in a high-poverty census tract after the transfer, compared to the 89 of 110 children (81%) who did so before the move.

3. Prior to moving, 15.1% (SD, 35.8) of this group experienced at least one exacerbation per three months, compared to 8.5% (SD, 28.0) after moving, an adjusted difference of 6.8 percentage points.

4. The highest number of symptom days in the previous two weeks were 5.1 (SD, 5.0) before relocating and 2.7 (SD, 3.8) after moving, which is an adjusted difference of 2.37 days.

5. In studies using URECA data and propensity score matching, the results were still significant.

6. Moving was shown to increase stress measures including social cohesiveness, neighborhood safety, and urban stress, which were all predicted to mediate between 29% and 35% of the relationship between moving and asthma exacerbations.

Reference:

Pollack, C. E., Roberts, L. C., Peng, R. D., Cimbolic, P., Judy, D., Balcer-Whaley, S., Grant, T., Rule, A., Deluca, S., Davis, M. F., Wright, R. J., Keet, C. A., & Matsui, E. C. (2023). Association of a Housing Mobility Program With Childhood Asthma Symptoms and Exacerbations. In JAMA (Vol. 329, Issue 19, p. 1671). American Medical Association (AMA). https://doi.org/10.1001/jama.2023.6488