Public health officials say it’s ‘not clear’ why the disparity is growing
Detroiters get asthma at higher rates than the rest of the state, a disparity that has risen sharply in recent years, according to a new report. In February, the Michigan Department of Health and Human Services (MDHHS) released its analysis of health and hospital data to follow up on previous asthma data published in 2016. Findings illustrate that Detroit’s disproportionally high asthma burden has only gotten worse, a trend that has left public health experts searching for answers.
From 2017 to 2019, 16.2% of Detroit adults and 11.1% of Michigan adults had asthma. That means asthma rates in Detroit residents were 46% higher than those for Michigan residents as a whole between 2017 and 2019 – up from 29% higher between 2012-2014. The data also show a significant difference between the prevalence of asthma among children in Detroit (14.6%) compared to Michigan (8.4%). In the earlier period, asthma rates for kids in Detroit and the state as a whole were about the same.
“Unfortunately, the reasons for the increasing prevalence are really unclear,” John Dowling, a program manager with the MDHHS’ asthma program, told Planet Detroit. “Generally, it’s usually a combination of environmental factors, genetic factors. Secondhand smoke is a big issue.”
The analysis is part of a federal grant from the Centers for Disease Control and Prevention (CDC) through its National Asthma Control Program. Comparing asthma hospitalizations between the two time periods was not possible due to medical coding changes. Still, the analysis found that Detroiters were hospitalized for asthma at least four times as often as Michigan residents as a whole between 2017 and 2019. It also found that the rate of asthma hospitalizations for Black residents in Detroit was more than three times that of white residents in 2019.
“We know that this is an important region in Michigan that does have a higher asthma burden, so we wanted to update it to see how Detroit has been doing in the past five or so years,” Beth Anderson, manager of the state’s Chronic Disease Epidemiology Section, told Planet Detroit. “And unfortunately, it is not good. Overall, the rates have really increased.”
That pattern is consistent with national statistics. Black and Indigenous communities have the highest rates of asthma in the United States, according to data published by the American Lung Association. The MDHHS analysis is part of a wider effort to identify areas with a high asthma burden to help steer interventions like home health care delivery to communities most in need across the state. The agency will publish a similar analysis for Saginaw County later this summer and, dependent on CDC funding, aims to update the report for Detroit every five years.
The new study also found:
- Detroit has more asthma hospitalizations. In Detroit, asthma hospitalizations rates were at least two times higher among Detroit children than Michigan children and three times higher for adults.
- Black asthma sufferers are more likely to be hospitalized than whites, even within the city. Asthma hospitalization among Black Detroiters was over three times that of white Detroiters. Black Michiganders had over five times the asthma hospitalization rate of white Michiganders.
- And Black Detroiters were disproportionately affected compared to Black Michiganders. In 2019, Detroit Blacks had about two times the asthma hospitalization rate of Black Michiganders.
Rates of Asthma Hospitalization by ZIP Code of Residence for Children (<18 Years), Detroit, 2016-2019. Click on the map to see the data. The highest zip codes for asthma hospitalization for children 18 years or younger included 48235, 48221, 48202, 48201, 48207, 48214, 48205, and 48224.
Experts struggle to pinpoint causes
Dowling said that poor indoor air quality is likely a factor driving high asthma rates in the city. Experts note the negative health impacts of living in older, poor quality housing stock that is common in Detroit and a concern for environmental justice activists. Common asthma triggers found in such housing include mold, pollen and dust. In Detroit, 80% of the housing stock is at least 60 years old.
Outdoor air quality is likely another factor. Studies show an association between air pollutants like particulate matter and ground-level ozone and asthma, and that proximity to major roads and highways is a driver of asthma in small children.
And a recent study showed how air pollution across the United States today reflects patterns of redlining dating back to the 1930s when discriminatory housing practices concentrated minority communities into areas closer to industry, major roads, and highways.
Detroiters continue to fight against air pollution caused by the trucking industry and industrial air pollution. New tailpipe emissions standards proposed by the Biden administration may help to address these issues. However, advocates say the best solution lies in total electrification of vehicles, which would eliminate pollutants.
Air pollution from vehicles and industry is a detriment to public health, according to Donele Wilkins, founder, and CEO of advocacy group The Green Door Initiative.
“The concentration of pollutants and the type of pollutants like particulate matter PM2.5 and PM10, sulfur dioxide, ozone, and NOx is especially harmful to human health,” Wilkins said. “For far too long, there has been an overemphasis placed on individuals’ behavior like smoking and allergies, and little attention to policies that grant permits to industry without regard for the exposure placed in an already overburdened community like Detroit.”
Wilkins wants to see regulators stop granting new air permits to industrial polluters in the Detroit area to protect public health. She also believes regulators should pay greater attention to how the additive impact of multiple sources of air pollution impacts human health.
“Agencies like EGLE’s air division must place a moratorium on new permits with considerable attention placed on the cumulative exposures concentrated in Detroit,” she said. “Data derived from the multiple air monitoring activities in the city must be reviewed with an effort towards mitigation that will improve Detroit’s air quality.”
Solutions are complicated
“Asthma is an endemic problem in the city of Detroit. It will take a holistic approach to improve conditions for those affected by asthma,” Kathleen Slonager, executive director of the Asthma & Allergy Foundation of America – Michigan Chapter, told Planet Detroit. “This also means recognizing that guidelines and policies must address long-standing health inequities.”
Slonager said Detroiters suffering from asthma need quality healthcare, including appropriate medications, evidence-based care and education, and frequent follow-up.
One problem is that Detroiters have poor access to specialists, despite more than a dozen standalone asthma practices in the surrounding suburbs. Detroiters can only access specialized asthma care at the city’s hospitals, Slonager said, where time on the waitlist to see a specialist can stretch for months.
Dowling pointed to an array of programs underway to improve asthma in Detroit. That includes the Detroit Alliance for Asthma Awareness, which coordinates outreach and education efforts around asthma care in the city, and the local nonprofit agency Kids Health Connections, which offers in-home health care delivery for asthma treatment.
Other newer programs include the Michigan Environmental Council’s anti-idling workgroup, which received funding last year to lobby schools to adopt anti-idling policies for buses to reduce air pollution around children. Another is the Green Door Air Quality Management Project, a new program led by Wilkins’ organization to improve the ambient and indoor air quality surrounding childcare and early childhood education facilities. They help school leaders implement best practices to support kids with asthma, like maintenance standards or avoiding particular cleaning products.
But these programs are not making enough of a dent in the problem, according to Slonager.
She hopes that the latest state report, and its stark evidence of increasing disparity despite existing community and public programs to address asthma in Detroit, will motivate change.
“In Detroit, there’s not a concerted effort on the part of all parties that need to be involved to make a difference, and it’s frustrating,” she said. “Because we know evidence-based medicine works when it’s applied. But it’s not being applied systematically.”
Planet Detroit’s Solving Lead & Asthma in Detroit series is underwritten, in part, by the Erb Family Foundation.