Association of a Housing Mobility Program With Childhood Asthma Symptoms and Exacerbations

Abstract

ImportanceStructural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact.ObjectiveTo examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors.Design, Setting, and ParticipantsCohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores.ExposureMoving to a low-poverty neighborhood.Main OutcomesCaregiver-reported asthma exacerbations and symptoms.ResultsAmong 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of −6.8 percentage points (95% CI, −11.9% to −1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of −2.37 days (95% CI, −3.14 to −1.59; P < .001). Results remained significant in propensity score–matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations.Conclusions and RelevanceChildren with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.

Housing Mobility Intervention for Childhood Asthma—Reply

“…Second, Ko and Hsu suggest that outdoor air quality or time spent outdoors could be reasons for the improvements in asthma in our study . Outdoor air quality can be an important determinant of child respiratory health, and increases in neighborhood safety and other factors associated with moving can affect the amount of time that children spend outdoors.…”

“…In Reply Drs Ko and Hsu raise 3 concerns about our study describing asthma outcomes among participants in the MAP cohort. First, they suggest that genetics or other confounders including geography could have affected our comparison with asthma outcomes among children in the URECA cohort.…”

Housing Mobility Intervention for Childhood Asthma

“…Second, previous research has implicated increased concentrations of particulate matter 2.5 μm or less in diameter and ozone as substantial contributors to asthma exacerbations in children . However, this study only considered indoor pollution and indoor allergens and did not measure outdoor pollutants or assess exposure to outdoor allergens such as pollen. Moreover, moving to a low-poverty neighborhood may increase the risk of exposure to traffic-related air pollution, which could explain why some participants experienced worse exacerbations and symptom days following their move.…”

“…To the Editor We have several concerns about a recent study that investigated the effect of a housing mobility intervention on asthma in children.…”

“…However, receipt of a voucher during childhood was significantly associated with lower rates of hospitalization during long-term follow-up. Given concerns about the robustness of subgroup analyses in that trial and the case-control design used in this study, we look forward to further research using a randomized design to elucidate this issue.…”