Worst Cities for People With Asthma

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Richmond and Other Southern Cities Rise to Top on 'Worst Asthma' List

By Bill Hendrick
WebMD Health News

Reviewed By Laura J. Martin, MD

March 5, 2010 -- Richmond, Va., is the "most challenging" place to live for Americans with asthma, according to a ranking by the Asthma and Allergy Foundation of America (AAFA).

It is joined in the Top 25 by 12 other Southern cities. The AAFA says the poor ranking for cities in the South is due in large part to slow adoption of "100% smoke-free" laws.

The worst five cities in 2010 for people with asthma are:

1. Richmond, Va.
2. St. Louis, Mo.
3. Chattanooga, Tenn.
4. Knoxville, Tenn.
5. Milwaukee, Wis.

Of the 100 cities examined, the bottom five on the list - the metro areas best for asthma sufferers - are Minneapolis at No. 100, San Francisco at 99, Daytona Beach, Fla., at 98, Portland, Ore., at 97, and Des Moines, Iowa, at 96.

Researchers looked at a number of factors, analyzing data on prevalence of the disease and risk and medical factors for the 100 most populated metropolitan statistical areas in the nation. These included annual pollen scores, pollution levels, public smoking laws, poverty rates, the percentage of people without health insurance, and state laws ensuring student access to emergency inhalers to use in asthma episodes. The researchers also looked at the number of states that have the most antismoking laws, forbidding smoking in bars, restaurants, workplaces, and in some states, cars in which minors are riding.

Stan Fineman, MD, of the Atlanta Asthma and Allergy Clinic says cities known for traffic congestion, ozone problems, and high pollen counts are difficult for people with asthma.

"We see very high pollen counts in the South," Fineman tells WebMD. "And smog in many cities on the list is a problem for people with asthma."

Sandra Fryhofer, MD, an internist and a past president of the American College of Physicians, tells WebMD that smog-induced asthma is on the rise, and that it's no surprise that cities like Richmond that don't have enough allergy and asthma specialists rank high on the list.

The AAFA says in a news release that cities were ranked from the highest total score -- Richmond's was 100 -- to the lowest. By comparison, Minneapolis' score, calculated as a composite of all factors that contribute to higher asthma prevalence, was 61.3.

AAFA experts say every city in the country has a variety of risk factors and that people need to work with specialists to control asthma, regardless of where they live. It says more than 20 million U.S. children and adults live with asthma, making it one of the most common and costly diseases.

Here's the AAFA's list of the worst 100 cities for people with asthma, along with scores bases on morbidity and mortality statistics; risk factors such as air quality, pollen, 100% smoke-free laws, and poverty; and medical factors, including medication usage and access to specialists:

RANK METRO AREA SCORE

1. Richmond, Va. 100
2. St. Louis, Mo. 97.35
3. Chattanooga, Tenn. 96.60
4. Knoxville, Tenn. 96.27
5. Milwaukee, Wis. 95.51
6. Memphis, Tenn. 95.31
7. Tulsa, Okla. 94.50
8. Philadelphia, Pa. 93.97
9. Augusta, Ga. 92.15
10. Atlanta, Ga. 92.14
11. Little Rock, Ark. 91.92
12. Springfield, Mass. 91.32
13. Dayton, Ohio 91.23
14. Allentown, Pa. 89.88
15. Scranton, Pa. 89.71
16. Birmingham, Ala. 89.29
17. Madison, Wis. 89.00
18. Detroit, Mich. 88.91
19. Pittsburgh, Pa. 88.82
20. Nashville, Tenn. 88.74
21. San Antonio, Texas 88.45
22. McAllen, Texas 88.44
23. Hartford, Conn. 87.93
24. Indianapolis, Ind. 87.63
25. Grand Rapids, Mich. 86.94
26. Jacksonville, Fla. 86.92
27. Wichita, Kan. 86.81
28. Louisville, Ky. 86.69
29. New Haven, Conn. 86.59
30. Oklahoma City, Okla. 86.10
31. Bakersfield, Calif. 85.38
32. New York, N.Y. 85.08
33. Harrisburg, Pa. 84.86
34. Columbus, Ohio 84.85
35. Buffalo, N.Y. 84.76
36. Toledo, Ohio 84.75
37. Providence, R.I. 84.68
38. Tampa, Fla. 84.07
39. El Paso, Texas 83.76
40. Youngstown, Ohio 83.49
41. Washington, D.C. 83.29
42. Cincinnati, Ohio 83.23
43. Greensboro, N.C. 83.12
44. Cleveland, Ohio 82.94
45. Virginia Beach, Va. 82.58
46. Bridgeport, Conn. 82.55
47. Charlotte, N.C. 82.50
48. Akron, Ohio 82.39
49. Poughkeepsie, N.Y. 82.33
50. Baltimore, Md. 82.07
51. Fresno, Calif. 82.05
52. Tuscon, Ariz. 81.98
53. Columbia, S.C. 81.67
54. Chicago, Ill. 81.43
55. Charleston, S.C. 81.41
56. Lancaster, Pa. 81.31
57. Boston, Mass. 80.99
58. Riverside, Calif. 80.61
59. Greenville, S.C. 80.49
60. Los Angeles, Calif. 79.62
61. Houston, Texas 79.52
62. Phoenix, Ariz. 79.20
63. Modesto, Calif. 79.08
64. Albany, N.Y. 78.84
65. Orlando, Fla. 78.81
66. Rochester, N.Y. 78.64
67. San Diego, Calif. 78.27
68. Denver, Colo. 77.81
69. Worchester, Mass. 77.10
70. Salt Lake City, Utah 76.93
71. Stockton, Calif. 76.41
72. Jackson, Miss. 76.37
73. Palm Bay, Fla. 76.23
74. Raleigh, N.C. 75.42
75. New Orleans, La. 75.19
76. Ogden, Utah 74.90
77. Colorado Springs, Colo. 74.42
78. Syracuse, N.Y. 74.38
79. Baton Rouge, La. 74.15
80. Dallas, Texas 73.95
81. Sacramento, Calif. 73.50
82. Oxnard, Calif. 72.39
83. Lakeland, Fla. 72.06
84. San Jose, Calif. 71.96
85. Miami, Fla. 71.51
86. Las Vegas, Nev. 71.44
87. Albuquerque, N.M. 70.68
88. Boise City, Idaho 70.45
89. Kansas City, Mo. 68.74
90. Portland, Maine 68.32
91. Sarasota, Fla. 68.29
92. Seattle, Wash. 67.60
93. Cape Coral, Fla. 65.72
94. Austin, Texas 65.61
95. Omaha, Neb. 64.90
96. Des Moines, Iowa 64.64
97. Portland, Ore. 64.00
98. Daytona Beach, Fla. 63.20
99. San Francisco, Calif. 62.05
100. Minneapolis, Minn. 61.30

SOURCES: Asthma and Allergy Foundation: "Asthma Capitals."

News release, Asthma and Allergy Foundation of America.

Stan Fineman, MD, Atlanta Asthma and Allergy Clinics.

Sandra Fryhofer, MD, internist and past president, American College of Physicians.

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