Housing Mobility Program Transforms Asthma Management in Children

Craig Evan Pollack, MD, MPH

Credit: Johns Hopkins Bloomberg School of Public Health

Substantial improvements in asthma morbidity were seen among children whose families relocated through a housing mobility program. The study explored potential mediating factors and found that measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with the move.¹

Structural racism has long been recognized as a significant factor contributing to health disparities among marginalized communities. In particular, children living in disadvantaged, urban neighborhoods experience a disproportionately high burden of asthma morbidity.²

A team of investigators led by Craig Evan Pollack, MD, MPH, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, conducted a cohort study to evaluate whether participation in a housing mobility program could be associated with a reduction in asthma morbidity among children.¹

The housing mobility program provided housing vouchers and assistance for moving families from underserved neighborhoods to low-poverty neighborhoods. This investigation also aimed to explore potential mediating factors that could contribute to these improvements.

Evaluating the Environments of Asthma

The study included 123 children aged 5-17 years with persistent asthma who were part of families that participated in the Baltimore Regional Housing Partnership housing mobility program between 2016-2020.

To establish a comparison group, these children were matched with 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores.

The primary exposure was moving to a low-poverty neighborhood. The primary outcomes assessed were caregiver-reported asthma exacerbations and symptoms.

Prior to participating in the housing mobility program, 81% of the children lived in high-poverty census tracts (>20% of families below the poverty line). However, after moving, only 0.9% of the children lived in high-poverty tracts.

Among the cohort enrolled in the program, the researchers observed that 15.1% (SD, 35.8) of the children had at least 1 asthma exacerbation per 3-month period before moving, compared with 8.5% (SD, 28.0) after moving.

Investigators reported this difference represented an adjusted reduction of -6.8 percentage points (95% CI, -11.9% to -1.7%; P = .009).

Results also revealed the maximum number of symptom days in the past 2 weeks was 5.1 (SD, 5.0) before moving, which decreased to 2.7 (SD, 3.8) after moving. The adjusted difference of -2.37 days (95% CI, -3.14 to -1.59; P < .001) indicated a significant reduction in asthma symptoms following relocation to low-poverty neighborhoods.

According to the data, these results remained significant even after propensity score matching analyses with URECA data.

The potential mediating factors assessed in the investigation were estimated to mediate approximately 29%-35% of the relationship between moving to low-poverty neighborhoods and the occurrence of asthma exacerbations.

"The magnitude of reduction of exacerbations associated with moving was greater than that observed for individual- and household-level interventions for asthma in racialized populations, larger than the effect of inhaled corticosteroids (43% reduction in exacerbation rate in the Childhood Asthma Management Program), and similar to that observed for the effect of biologic agents (≥50%)," investigators wrote.

References:

1. Pollack CE, Roberts LC, Peng RD, et al. Association of a Housing Mobility Program With Childhood Asthma Symptoms and Exacerbations. JAMA. 2023;329(19):1671–1681. doi:10.1001/jama.2023.6488
2. Akinbami LJ, Moorman JE, Simon AE, Schoendorf KC. Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010. Journal of Allergy and Clinical Immunology. 2014;134(3):547-553.e5.