Asthma among Adults in Boston Varies with Housing Assistance

Indoor housing quality problems, which are commonly found in public housing, are associated with asthma. Prior research has found that adults living in assisted housing (either public housing or rental assistance) in Boston are more likely to report health problems, including asthma, than other Boston residents, even after controlling for socioeconomic factors. This study aimed to expand this evidence to assess the presence of current asthma or a history of asthma among socioeconomically similar adults across more residential statuses, specifically public housing, other rental assistance, unassisted renters, and those with other living arrangements as compared with homeowners in the city. Researchers analyzed results by age (18 to 34 years old, 35 years or older), smoking status (ever, never), obesity status (obese, not obese), household income, and educational attainment. To account for differences between homeowners and assisted renters by age, racial or ethnic identity, educational attainment, household income, and behavioral health history, the researchers repeated the analysis using low-income unassisted renters as the comparison group. The study did not consider the impact of contemporaneous policy changes in public housing, including efforts to control pests, prioritize environmental standards during redevelopment, and convert to smoke-free buildings.

The sample consisted of 9,554 adult residents of Boston who responded to the Boston Behavioral Risk Factor Surveillance System (BRFSS) survey in 2010, 2013, or 2015 and had complete information on variables of interest. The BRFSS uses random-digit dialing, and households with more phone numbers or adult members have a higher likelihood of selection. Housing assistance status and asthma status were self-reported. By the 2015 survey, more than one-third of the sample were from cell phone–only households.

Key findings

• The prevalence of ever having asthma was 1.55 times higher among public housing residents (23.2 percent) and 1.89 times higher among other subsidized renters (28.3 percent) than among homeowners (15 percent).
• For current asthma, the prevalence was two times higher among public housing residents (17.8 percent) and other subsidized renters (21.7 percent) than among homeowners (9.1 percent).
• When restricted to people who had ever smoked, public housing residents and other subsidized renters had even higher odds of current asthma than a comparison group of homeowners (2.6 times higher and 3.3 times higher, respectively).
• Compared with unassisted renters, the odds of current asthma were two times higher among public housing residents and other subsidized renters. The association between housing assistance—whether through public housing or other rental assistance programs—continued after restricting the analysis to adults with household incomes under $35,000, household incomes under $20,000, and a high school education or less.
• Renters receiving a subsidy from programs other than public housing consistently fared the worst for asthma, suggesting the presence of additional vulnerabilities and the need for targeted health supports and additional research.

Photo by Image Point Fr/Shutterstock