Parcel-Level Housing Conditions and Pediatric Asthma Hospital Utilization

Pediatric hospital encounters related to asthma have been linked to failed housing inspections, but evidence at the individual- and parcel-level is absent. Our objective was to examine the impact of housing code violations on pediatric asthma exacerbations.

We conducted a retrospective cohort study based on electronic health records at Cincinnati Children's Hospital Medical Center in Hamilton County, Ohio, between July 2016 and July 2022. We followed 13 404 patients with asthma living at 22 762 unique addresses for 11 million cumulative patient-days. Study participants were exposed to poor housing conditions if they resided at a parcel within 1 year of the enforcement of a housing code infraction. Our outcome was defined as the time to asthma exacerbation (or censoring event) in days.

Overall, 66% of patients with asthma were publicly insured and lived in homes with a median market total value of $104 000 with a parcel type of mostly single-family homes (67%) but also apartments (13%) and 2- or 3-family homes (9%). A total of 1327 study participants (9.9%) experienced an asthma exacerbation during the follow-up period, and 1651 (12%) were exposed to poor housing conditions as defined by infractions of local housing codes. In proportional hazards models adjusted for public insurance and total market value by housing type, living at a parcel with a housing infraction during the previous year was associated with a 34% increased individual-level hazard for an asthma exacerbation (hazard ratio, 1.34; 95% CI, 1.08-1.67).

The impact of improving housing conditions merits further study.