PROVIDENCE, R.I. (WPRI) — Ahead of one of the country’s worst weeks for fall allergies – the third week in September is known as Asthma Peak Week – a newly released report ranked 100 cities in the continental U.S. from most to least challenging to live with asthma.
The Asthma and Allergy Foundation of America’s (AAFA) 2022 Asthma Capitals report looks at how location may influence asthma in different cities. In each city, asthma prevalence, emergency department visits for asthma, and deaths due to asthma were all examined.
Providence was ranked 58th worst out of 100, or in other words, 42nd best in the cities included in the report. Boston, however, was ranked much more favorably at 91st worst out of 100, or ninth best.
Estimated Asthma Prevalence
The AAFA says about 25 million Americans suffer from asthma, and factors like sex, race, ethnicity and socioeconomic status can all be associated with the disease.
The most recent data from the U.S. Centers for Disease Control and Prevention (CDC) shows more than 103,000 Rhode Island adults have asthma, or 12% of the population. The data revealed more than 592,000 Massachusetts adults had asthma in 2020, or about 10% of the population.
Prevalence rates differ significantly by race and ethnicity, according to AAFA. For example, Puerto Ricans have the highest rate of asthma prevalence compared to any other racial or ethnic group in the United States, while Black Americans are also disproportionally diagnosed with asthma compared to white Americans.
According to Sanaz Eftekhari, the AAFA’s vice president of research, in 2022, Providence had the 18th highest prevalence rate of all 100 cities analyzed, an improvement from having the third-highest prevalence in 2021.
The report noted for this ranking, Providence’s asthma prevalence was worse than average, while Boston’s ranked better than average.
The AAFA separately disclosed the worst-ranked cities for asthma prevalence, and Poughkeepsie, New York, was first.
Emergency Department Visits
Since asthma can trigger severe enough symptoms that would require an emergency room visit, the AAFA also looked at emergency department data from each of the 100 cities.
In 2019, for example, federal health data shows asthma accounted for 169,330 discharges from hospital inpatient care and 1.8 million emergency department visits.
Both Providence and Boston were ranked better than average for asthma-related emergency department visits.
“Ideally, the asthmatics are getting treated in the community by the primary care [doctors], by the specialists, and you’re preventing ER visits,” Dr. Robert Settipane of the Allergy & Asthma Center in East Providence explained. “So if we have low number of ER visits, we’re ahead of the class.”
The AAFA ranked the worst cities for ED visits, and Wichita, Kansas, was first.
According to Eftekhari, Providence actually had the lowest rate of ED visits per 10,000 asthma patients. In 2021, under different methodology, Providence was ranked 47th for ED visits, Eftekhari said.
The AAFA says increased ED visits are “a sign of poor asthma control,” and in order to improve it, people with asthma should reduce their exposure to triggers, have access to their medications, and also have an asthma action plan.
However, the report notes race and age can significantly impact emergency room visits. For example, federal health data shows asthma-related ED visits are more than five times as high for non-Hispanic Black patients compared to non-Hispanic white patients.
Separately, data shows children are much more likely than adults to have asthma-related ED visits, with children ages 5 to 17 having the highest rate.
More than 4,000 asthma-related deaths occurred in 2020, according to data from the CDC. That same year, data shows deaths due to asthma rose for the first time in 20 years.
The agency notes in 2020, 84 asthma-related deaths were recorded in Massachusetts, while 11 were recorded in Rhode Island.
The AAFA’s report shows Providence has average asthma-related death rates, and despite Boston’s more favorable ranking, the city had a worse than average death rate.
Asthma Risk Factors
Additionally, the report also examined risk factors that contribute to the above health outcomes, including poverty, air quality, access to specialist medical care, pollen counts, medicine use, tobacco policies, and the rate of uninsured residents.
According to this year’s State of the Air report, more than 40% of the U.S. population lives in areas with unhealthy levels of ozone or particle pollution.
In Suffolk County, where Boston is located, the county received a B for its number of high ozone days, and like Providence County, was also given an A for its particle pollution.
In that report, Providence County was given an F for its number of high ozone days, but an A for its particle pollution.
Providence has poorer air quality than Boston, according to Eftekhari, but similar to Boston, Providence has public smoking laws to support cleaner air, along with a low rate of uninsured patients.
Eftekhari says Providence also has fewer asthma specialists available per 10,000 patients. Settipane believes there are a few reasons to support that.
“In Rhode Island, we’re having a retirement and attrition of a lot of pulmonologists, as well as the allergists,” Settipane said.
“I think there been, recently, a dramatic drop in the number of pulmonologists, so that may be affecting us,” he added. “We’re not attracting the new pulmonologists, and the older ones are retiring.”
In August, the Rhode Island Public Transit Authority (RIPTA) unveiled the first bus in its new electric fleet. RIPTA CEO Scott Avedisian said 14 “New Flyer Xcelsior CHARGE NG” 40-foot battery-electric buses will replace the current diesel fleet on the R-Line, becoming the state’s first fully electric route.
The R-Line serves multiple areas of persistent poverty and high asthma rates Providence and Pawtucket.
“Switching diesel buses to electric buses will certainly make a difference in the coming years. Diesel exhaust exposure is linked to serious health effects, including asthma attacks,” Eftekhari told 12 News in an email.
Eftekhari said the new initiative could lead to immediate benefits for those who live along the route, and for those who regularly take the buses.
In the short term, she said the switch “will reduce local particle pollution and ground-level ozone that diminish lung function and can exacerbate asthma.”
“As noted in AAFA’s report, air pollution is a significant risk factor for asthma, so any efforts to improve local air quality are going to provide health benefits to the community,” Eftekhari said.