Association of Childhood Asthma With Federal Rental Assistance

To examine whether participation in the US Department of Housing (HUD) rental assistance program was associated with pediatric asthma outcomes and whether those associations varied by program type.

Data were linked between the National Health Interview Survey (NHIS) to administrative housing assistance records for 2992 children (0–17 years old) from 1999–2001 and 2004–2012.

The main exposure is whether children’s families were participating in the HUD rental assistance programs (treatment group). Authors were concerned that rental program participation is voluntary, and there would be unobserved factors leading to selection bias, so a comparator group included children whose families were not participating but would enter the HUD program in two years (ie, the quasi-wait-list group). In their subgroup analyses examining program type, children in multifamily and public housing, grouped together to enhance statistical power and to represent a non-portable, placed-based benefit, were compared with children in housing choice vouchers. Unadjusted and adjusted logistic regressions were used to study the association between the HUD program and ever diagnosis of asthma, asthma attack in the last 12 months, and asthma-related emergency department (ED) visits in the last 12 months.

Unadjusted and adjusted analyses showed not significant difference in asthma diagnoses or asthma attacks in the last 12 months between current HUD participants and “quasi-wait-list” participants. ED visits were 15.3% points lower (95% CI: −29% to −1.6% points) among current HUD participants than wait-list participants. After adjusting the model for demographic factors, ED use was 18.9% points less among HUD participants than wait-list participants. Subgroup analyses found that current participants in multifamily or public housing had 36.6% points (95% CI: −54.8% to −18.4% points, P = .02) less ED use than their quasi-waitlist counterparts. Findings were not significant for ED use among children in housing voucher programs.

The findings suggest that asthma-related ED use was less among children receiving HUD rental assistance than children waiting to enter a program; however, participation in the HUD rental assistance program was not significant for reduced asthma diagnoses or asthma attacks.

The study highlights how rental assistance programs may be associated with reduced ED use, which is an important outcome for value-based agreements between pediatric health providers, health systems, and insurers. The findings give pediatricians preliminary evidence for considering housing support programs in their health care systems, but more in-depth study of the relationship between the program and health care use is needed.