Neighborhood Variation in Childhood Asthma Emergency Department Visit Rates in Austin, Texas, Is Associated with Tenant-Reported Housing Conditions

Abstract Housing conditions are a significant contributor to the individual-level childhood asthma burden. However, there is limited evidence that housing exposures are associated with population-level asthma outcomes and disparities. In this study, we examined the association between neighborhood rates of tenant-reported poor housing conditions and childhood asthma emergency department (ED) visits in Austin, Texas. Incidence rates (IR) of poor housing conditions reported to Austin’s housing code enforcement agency (tenant reports per tenant-year) and estimated population-based incidence rates (PBIR) of childhood asthma ED visits (ED visits per child-year) were computed for residents of Austin from February 1, 2021, to October 31, 2023, at the block group level. We tested for associations using generalized linear mixed models, adjusting for neighborhood characteristics, median household income, and traffic density. We linked 1500 childhood asthma-related ED visits and 16,939 tenant reports of poor housing conditions to 513 residential census block groups. The median (interquartile range, IQR) IR of poor housing conditions and PBIR of childhood ED visits were 13.87 (19.86) per 1000 tenant-year and 3.46 (9.57) per 1000 person-year, respectively. Each IQR increase in the IR of poor housing conditions was associated with a 15.9% (95% credible interval 4.5%, 29.3%) increase in the PBIR of childhood ED visits. These findings show that substantial association between the neighborhood incidence of tenant-reported poor housing conditions and childhood asthma ED visit burden exists, underscoring the utility of tenant reporting data to assess exposure, and the pressing need to improve access to healthy housing.