Asthma-Related Emergency Department Visits Can Indicate Poor Housing Conditions

Study results published in The Lancet Public Health suggest that emergency department (ED) visits for asthma can identify poor housing conditions and can predict a failed housing inspection about a year in advance.

Researchers aimed to investigate whether ED visits can be used to generate a geospatial signal that identifies poor housing conditions. They also aimed to determine if this data can identify poor housing conditions earlier than the currently used means. Poor housing quality is associated with higher asthma prevalence and severity. Efficient identification of poor housing may help to better develop interventions to improve these conditions and aid patients with asthma.

This retrospective cohort study was conducted in New Haven, Connecticut, as the greater New Haven metropolitan area has one of the highest asthma prevalence rates in the United States because of older housing, poverty, rented housing, and poor air quality. The study included children and adults seen for asthma in the EDs of Yale New Haven Hospital from March 1, 2013, to August 31, 2017. Included in the study were data from 11,429 asthma-related ED visits by 6366 patients. The mean age of patients was 32 years, 3836 (60%) were female, 3461 (54%) were insured with Medicaid, 2651 (41%) were Black.

Researchers geocoded patient addresses at the time of their ED visit and linked them to tax assessor parcels. ED visits were assigned to a parcel to estimate the incidence of asthma-related ED visits for each parcel. There were 10,560 parcels with at least 1 asthma-related ED visit in each.

Researchers then collected public housing complex inspection scores from standardized home inspections that are conducted every 1 to 3 years. Regression analyses adjusting for neighborhood and individual factors that may have contributed to an ED visit was used to determine if parcel-level asthma-related ED visits were linked with Real Estate Assessment Center (REAC) public housing inspection scores. To estimate how far in advance documentation of poor housing condition could identify elevated asthma-related ED visits, researchers used a sliding-window approach.

REAC inspection scores were available for 62 public and subsidized housing complexes. Researchers noted increased ED visits from patients living in low-income areas with mostly Black and Latinx residents.

For all the complexes, REAC scores were significantly negatively correlated with asthma burden. Incidence of asthma-related ED visits was strongly correlated with lower REAC scores. Asthma-related ED visits and lower REAC scores remained correlated after researchers adjusted for patient and neighborhood demographics. This geospatial analysis of ED asthma visits was able to identify poor housing conditions about a year before a housing complex failed their housing inspection.

This study is limited in that the geospatial model developed may not be effective for places with a lower population density or lower asthma prevalence. As the model is based off of data from New Haven, it may not be as effective at identifying poor housing quality based on data from places with multiple EDs. Other limitations include that poor housing is sometimes giving passing scores and that the study did not have access to data on private housing. In addition, other individual factors, such as housing instability, houselessness, and socioeconomic status, that may exacerbate asthma were not considered.

The model developed in this study demonstrates the potential for using asthma-related ED visits as an indicator for poor housing and public health interventions. “Emergency care use data for asthma are a leading ex-ante indicator of poor housing conditions, and emergency department visits are elevated approximately 1 year before a concerning housing inspection score. This approach represents a novel method of early identification of dangerous housing conditions, which could aid in the prevention of asthma-related morbidity and mortality,” the researchers concluded.

Reference

Samuels EA, Taylor RA, Pendyal A, et al. Mapping emergency department asthma visits to identify poor-quality housing in New Haven, CT, USA: a retrospective cohort study. Lancet Public Health. 2022;7(8):E694-E704. doi:10.1016/S2468-2667(22)00143-8