Association of Childhood Asthma With Federal Rental Assistance

Abstract

To assess the relationship between type of participation in the US Department of Housing and Urban Development (HUD) rental assistance programs with childhood asthma outcomes, such as emergency department (ED) or urgent care center (UC) use, diagnosis, and asthma exacerbations.The population studied includes 2992 children, representative of the US population, between 0 and 17 years old who were receiving rental assistance (HUD) or who had not yet applied (WLG) to receive rental assistance between January 1, 1999, and December 31, 2014. These records were linked to the National Health Interview Survey. HUD assists children through 3 programs: public housing, multifamily housing, and housing choice vouchers.This was a retrospective survey study of linked data from the National Health Interview Survey and the National Center for Health Statistics. Deidentified data were used.In the HUD and WLG groups, some asthma outcomes were higher than those seen in the general low-income population. For HUD and WLG children, 23.2 and 24.1%, had an asthma diagnosis, 43.6 and 45.6% of those had an asthma exacerbation in the past year, and 45.4 and 60.7% of those children visited the ED for asthma, respectively. In the general population with incomes <150% of the federal poverty level, without an HUD history, percentages were 12.8, 44.3, and 38.7, respectively. Participation in any rental assistance program was associated with an 18.2% (25% relative reduction) lower use of ED or UC for asthma in children who had an asthma attack in the past year. This association for ED and UC visits was significant in children participating in public or multifamily housing (decreased by 36.6%; 95% confidence interval: −54.8 to −18.4) but not housing choice vouchers (decreased by 7.2%; 95% confidence interval: −24.6 to −10.3). No significant differences were noted in asthma attack or diagnosis rates.There was an 18.2% decrease in ED use for asthma among children who received rental assistance, when compared with children waiting to enter a housing program. Differences were not explained by demographic factors, neighborhood characteristics, or primary care access.In this publication, the authors highlight important structural factors, like housing stability and affordability, that may affect health outcomes in pediatric allergic patients. In previous studies, authors have noted mixed associations between pediatric asthma outcomes and voucher assistance given to public housing residents, with some variation by sex. The underlying factors that lead to differences in health outcomes on the basis of housing access and stress are poorly understood but may be affected by housing codes and percent of income spent on rent, which vary by housing assistance subgroups. Additional studies are necessary to understand whether these differences have any impact on clinical practice. One important limitation of this study is that only 36.8% of subscribers were eligible for health and housing data linkage (did not refuse and answered demographic and rental questions relevant to linkage); this may represent a selection bias for certain characteristics.