Asthma is greatly influenced by where someone lives. People who have affordable and accessible health care, clean air, and economic stability have a greater chance of managing and controlling their asthma. AAFA’s Asthma Capitals™ report ranks the largest 100 cities in the continental U.S. by how challenging they are to live in when you have asthma. AAFA publishes this report to show the nationwide burden of asthma. It is a call to action to help the more than 27 million people in the U.S. with asthma.
2023 Asthma Capitals: Full Report
The Asthma Capitals report ranking is based on three health outcomes: asthma prevalence, emergency department visits for asthma, and deaths due to asthma.
The report also discusses risk factors that contribute to these outcomes: poverty, air quality, access to specialist medical care, pollen allergy, medicine use, tobacco policies, and the rate of uninsured residents.
Asthma Peak Month
This year’s report has been released during September to raise awareness of the spike in asthma-related attacks and hospital stays that happen each September. It is known as Asthma Peak Month, or the September Asthma Epidemic. The third week of the month – known as Asthma Peak Week – is often the worst.
People with asthma are exposed to several triggers at once during September, such as:
- Higher ragweed pollen
- Higher mold counts
- The beginning of respiratory illness season
- Poor indoor air quality in schools
- Wildfire-related air pollution
- Extreme weather events and natural disasters, such as hurricanes, heat waves, and extreme thunderstorms
The top 10 most challenging places to live with asthma are:
The Most Challenging Places to Live With Asthma
Our report looks at how challenging it is to live with asthma in the top 100 most-populated U.S. cities. Download our full report to see where each city ranks for asthma outcomes (prevalence, emergency room visits, and deaths). The report also reviews factors that impact asthma.
10. Rochester, New York
Rochester is #10 for 2023. It has higher-than-average asthma prevalence but an average number of asthma-related deaths and emergency department visits.
9. Fresno, California
8. Philadelphia, Pennsylvania
7. Richmond, Virginia
Richmond is #7 for 2023. It has a higher-than-average number of asthma-related deaths and emergency department visits but average asthma prevalence. Richmond has the second-highest asthma mortality score of all 100 cities analyzed for this report.
6. Poughkeepsie, New York
Poughkeepsie is #6 for 2023. It has higher-than-average asthma prevalence but an average number of asthma-related deaths and a lower-than-average number of emergency department visits.
5. Detroit, Michigan
Detroit is #5 for 2023. It has higher-than-average asthma prevalence and number of asthma-related deaths but an average number of emergency department visits. Detroit has the second-highest asthma prevalence rate of all 100 cities analyzed for this report. It also has among the highest poverty rates and among the worst air quality score – two risk factors for asthma.
4. Cleveland, Ohio
Cleveland is #4 for 2023. It has higher-than-average asthma prevalence, number of emergency department visits, and number of asthma-related deaths.
3. Charleston, South Carolina
Charleston is #3 for 2023. It has higher-than-average asthma prevalence and emergency department visits but an average number of asthma-related deaths.
2. Lakeland, Florida
Lakeland is #2 for 2023. It has higher-than-average asthma prevalence and emergency department visits but an average number of asthma-related deaths. Lakeland also has a very high number of residents who do not have health insurance.
1. Allentown, Pennsylvania
Allentown is #1 for 2023. It has higher-than-average asthma prevalence and emergency department visits but an average number of asthma-related deaths. Allentown has the highest emergency department visit score of all 100 cities analyzed for 2023.
It is AAFA’s goal that the 2023 Asthma Capitals report inspires action. Reduced asthma rates and deaths are possible. And this report highlights where we can focus our efforts for healthier environments and communities. This year’s report focuses on three topics related to asthma prevalence and outcomes:
- Reducing health disparities in communities that bear the heaviest burden of asthma
- Taking steps to improve asthma outcomes
- Taking action through advocacy and policy
Reducing Health Disparities in Communities that Bear the Heaviest Burden of Asthma
This report acknowledges that where a person lives can greatly impact their health. Social, economic, and environmental factors play a role in asthma outcomes. Many of the top Asthma Capitals are also facing major challenges and inequities that lead to health disparities.
AAFA’s Health Equity Advancement and Leadership (HEAL) program reinforces AAFA’s commitment to drastically reduce health disparities in communities that bear the heaviest burden of asthma. Through the HEAL program, AAFA provides funding and resources to local pilot programs tailored to at-risk populations most impacted by asthma.
Learn more about health equity and the HEAL program in our report.
Taking Steps to Improve Asthma Outcomes
AAFA is committing our resources to programs and policies with the aim to drastically reduce asthma rates, deaths, and disparities, as well as their impact on people and communities. We urge multiple stakeholders to join us to work together to improve and save lives.
This section outlines ideas for the following stakeholders:
- Federal, state, and local health officials
- Policymakers, legislators, and regulatory agencies
- Health care providers
- People with asthma and caregivers of children with asthma
- Health insurance companies
- Drug (pharmaceutical) companies
Our report outlines ways these stakeholders can improve asthma outcomes. See our report to learn more.
Taking Action Through Advocacy and Policy
Advocacy is a critical part of AAFA’s mission to save lives and reduce the burden of disease for people with asthma, allergies, and related diseases. This year, AAFA is calling on our community to join us in these advocacy efforts – including at the state and local levels.
This report outlines major risk factors that impact asthma outcomes, as well as racial and ethnic disparities in those outcomes. There is no single policy solution to address the issues the asthma community faces. Because of this, AAFA supports a “health in all policies” approach that recognizes that policy decisions in all sectors – including health, education, environment, labor, housing, social services, and city planning – affect health.
Your voice is critical to help build awareness in your community and to educate your elected officials who can lead change. In this report, we’ve included:
- Tips for identifying and contacting your state legislators
- Tips for requesting a meeting with your legislators
- Tips for communicating and advocating effectively
- A sample letter to send to your legislator
Learn more about how you can advocate for people with asthma and allergies in our report.
Products to Help You Reduce Your Exposure to Asthma Triggers
CERTIFIED asthma & allergy friendly® products can also help you manage your contact with asthma triggers inside your home and have better indoor air quality. Through the asthma & allergy friendly® Certification Program, we have tested and certified products to help you reduce asthma triggers and allergens in your home. When you are shopping for products for your home, look for the CERTIFIED asthma & allergy friendly® mark.
Visit aafa.org/certified to search for CERTIFIED products and learn more about our program.
The 2023 Asthma Capitals report is an independent research project of AAFA and is made possible by a grant from Sanofi and Regeneron.
Asthma and Allergy Foundation of America, (2023). 2023 Asthma Capitals. Retrieved from asthmacapitals.com.
For media and related inquiries, contact gro.afaa@aidem.