Asthma-related ER visits may indicate poor housing conditions

According to the results of a study in New Haven, Connecticut, visits to asthma emergency rooms may be an indicator of poor housing conditions.

The results of the study published in Lancet Public Health suggest that emergency room visits for asthma can identify poor housing conditions and can predict failure of a housing inspection about a year in advance.

The researchers aimed to determine if ER visits could be used to generate a geospatial signal that identifies poor housing conditions. They also aimed to determine whether these data can identify poor housing conditions earlier than the means currently used. Poor quality housing is associated with higher asthma prevalence and severity. Effective identification of substandard housing can help better develop interventions to improve these conditions and help asthma patients.

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

The researchers geocoded the addresses of the patients at the time of their emergency room visit and linked them to the tax assessors’ packages. ED visits were assigned to a plot to estimate the incidence of asthma-related ED visits for each plot. There were 10,560 packages with at least 1 asthma-related emergency room visit in each.

The researchers then collected inspection scores for public housing complexes from standardized home inspections that are conducted every 1 to 3 years. Regression analyzes adjusting for neighborhood and individual factors that may have contributed to an ED visit were used to determine whether plot-level asthma-related ED visits were related to inspection scores. public housing from the Real Estate Assessment Center (REAC). To estimate how far in advance documentation of poor housing condition could identify a high number of asthma-related emergency room visits, the researchers used a sliding window approach.

REAC inspection scores were available for 62 public and subsidized housing complexes. The researchers noted an increase in emergency room visits from patients living in low-income areas with predominantly black and Latino residents.

For all complexes, REAC scores were significantly negatively correlated with asthma burden. The incidence of asthma-related emergency department visits was strongly correlated with lower REAC scores. Asthma-related emergency department visits and lower REAC scores remained correlated after the researchers adjusted for patient and neighborhood demographics. This geospatial analysis of asthma ER visits identified poor housing conditions about a year before a housing complex failed a housing inspection.

This study is limited in that the geospatial model developed may not be effective for locations with low population density or low asthma prevalence. Because the model is based on data from New Haven, it may not be as effective at identifying poor housing quality based on data from locations with multiple EDs. Other limitations include that substandard housing sometimes gives passing grades and that the study did not have access to private housing data. Additionally, other individual factors, such as housing instability, homelessness, and socioeconomic status, which may exacerbate asthma, were not considered.

The model developed in this study demonstrates the potential for using asthma-related emergency room visits as an indicator of poor housing conditions and public health interventions. “Data on asthma emergency care utilization is an ex-ante indicator of poor housing conditions, and emergency department visits are high about 1 year before a concerning housing inspection score This approach represents a novel method for early identification of unsafe housing conditions, which could help prevent asthma-related morbidity and mortality,” the researchers concluded.

Reference

Samuels EA, Taylor RA, Pendyal A, et al. Mapping emergency room 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

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