Housing conditions are a key driver of asthma incidence and severity. Recognizing that previous studies revealed an increase in emergency department (ED) visits for asthma among residents living in poor-quality housing, in 2018, fellows in the Yale National Clinical Scholars program, launched a cohort study to evaluate whether ED visits for asthma can be used to identify poor-quality housing to support proactive and early intervention.
Elizabeth Samuels, MD, MPH, MHS and Adam L Haber, PhD, led the study with guidance from mentors from the Yale Department of Emergency Medicine (DEM), Arjun Venkatesh, MD, MBA, MHS, Richard Andrew Taylor, MD, MHS, and Steven Bernstein, MD. The team was joined by Akshay Pendyal, MD, MHS, Anne S. Mainardi, MD and Abbas Shojaee, MD, who were also at Yale at the time.
Results of the study were recently published in an article in The Lancet Public Healthhttps://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2822%2900143-8/fulltext “Mapping emergency department asthma visits to identify poor-quality housing in New Haven, CT, USA: a retrospective cohort study.” In this study, investigators mapped emergency department visits for asthma and found that emergency department visits for asthma were not only higher at public housing facilities that had failed a Department of Housing and Urban Development (HUD) inspection, but emergency department asthma visits from these building were elevated approximately a year before a housing complex fails a housing inspection. This means that mapping of emergency department asthma visits could be used for earlier identification and remediation of poor housing conditions to improve residents’ health and well-being. Currently, identification of unsafe housing conditions is often delayed, and many residents are hesitant to report unsafe conditions as due to fear of retaliation and loss of housing. Using ED asthma visits to identify potentially poor housing conditions represents one strategy to identify poor housing conditions early and remove reporting burden from residents.
Increasingly, health care organizations are taking social determinants into account in the delivery of medical care, as these are key drivers of health outcomes. This study demonstrates that health outcomes can also be measurable outcomes for social services. “We see and treat health problems due to health inequities and social conditions, like poor housing, in the emergency department every day,” according to Samuels, now an Assistant Professor of Emergency Medicine at the Alpert Medical School of Brown University. “There is great potential to use data collected at time of ED visit to inform interventions to address social conditions, direct resources where they are needed most, and improve population health without placing additional burden on already strained health systems and, most importantly, people most impacted by health inequities.”
Dr. Haber, Assistant Professor of Computational Biology and Environmental Health at Harvard T.H. School of Public Health, senior author on this study, led study analysis. “Dilapidated housing continues to cause disproportionate respiratory disease burden among working-class people, particularly communities of color, and current code enforcement measures are insufficient. Our study defines a new approach to detect dangerous exposures before they have caused tremendous harm and provides a new opportunity for municipal governments to prevent them.”
We see and treat health problems due to health inequities and social conditions, like poor housing, in the emergency department every day.
Elizabeth Samuels, MD, MPH, MHS
Future goals include procuring funding to test the model in larger urban centers and developing and implementing partnerships with community partners to use emergency department data in real time to identify and address poor housing conditions.
The study was funded by the Harvard-National Institute of Environmental Health Sciences (NIEHS) Center for Environmental Health.