Asthma in Texas

ChildAsthma(This post was written by Grace Tee Lewis, EDF’s Kravis Postdoctoral Science Fellow)

August in Texas is not for the weak of heart or lung.

As temperatures rise, so do levels of air pollutants such as ground-level ozone – better known as smog. For those with asthma, being outside on high ozone days can lead to asthma attacks. Children, older adults and people who work outside are the most susceptible.

In Texas, asthma affects roughly 1 in 13 adults and 1 in 11 children. In 2014, this represented 1.4 million Texans aged 18 years or older and 617,000 children according to the Texas Department of State Health Services.

In the Lone Star State, asthma prevalence differs by race and socio-economic position. (Scientists define asthma prevalence as the proportion of people who have asthma in a population at a given time such as 2015. It includes those living with asthma and newly diagnosed cases. Prevalence is usually expressed as a percentage of the total number of people in a population.) Blacks have the highest prevalence of asthma in both adults and children. Based on the 2014 Texas Asthma Burden Report, 11.8 percent of black adults suffered from asthma compared to 8.2 percent of whites. A lower percentage of Hispanics (4.2 percent) were asthmatics but because the Hispanic population in Texas is so large, that still means that more than 300,000 adults have the disease.  Among Texas children in 2013, prevalence of asthma among blacks was 19.2 percent — which is more than the percentages for whites (8.5 percent) and Hispanics (7.5 percent) combined.

Poverty may also play a role in asthma prevalence. Among Texans earning under $15,000 a year, 9.6 percent had asthma, while only 5.8 percent of Texans making $75,000 or more a year had asthma.  And air pollution increases the risk of children developing asthma in low income communities.

A 2014 study of Medicaid-enrolled children in Harris County showed an increase in the odds of new asthma cases associated with increasing levels of ozone, nitrogen dioxide, and fine particulate matter (PM2.5) levels in the air.  Among low-income urban children in this study, the odds of newly diagnosed asthma cases increased nine percent  among black children and four percent among Hispanics in the months of May to October for every 10 parts per billion  increase in mean ground-level ozone levels. Consider this — one part per billion is equal to a single drop of gasoline in a gasoline tanker truck.

The HGB area (made of Harris county and seven adjacent counties) where the 2014 study of Medicaid-enrolled children was conducted is home to a large number of industrial complexes and consistently ranks among cities with the worst air pollution nationally.  It has not met federal ozone air quality standards for more than a decade, and efforts to curb pollution have been ineffective to the point that the Environmental Protection Agency (EPA) changed its classification to severe non-attainment in 2008.  Sadly, Dallas/Fort Worth, Beaumont/Port Arthur and more recently San Antonio have also struggled with meeting government air quality standards.

The cost of more asthma attacks in minority and economically disadvantaged communities is shared by all Texas residents. Of the 15,083 adults hospitalized with asthma in 2012, average cost per person was $36,000.  In the same year, 10,075 Texas children were hospitalized due to asthma and more than half (54.2 percent) were Medicaid beneficiaries.  In total, more than $97 million dollars were spent on asthma-related care for children on Medicaid in 2012.  Reducing air pollution – and thus reducing asthma attacks – offers a great opportunity to improve the health of our families while reducing burden on tax payers, hospitals and state resources.

Lowering ambient air concentrations of ground-level ozone, nitrogen dioxide, and fine particulate matter is critical to improving air quality and reducing asthma attacks. One way to achieve this is to clean up the air around ports and terminals such as the Houston Ship Channel located in the HGB area. The Clean Air Guide for Ports & Terminals: Technologies and Strategies to Reduce Emissions and Save Energy details how we can reduce air emissions in port areas which typically fail to meet federal air quality standards. Implementing new truck engine technology, not allowing commercial trucks to idle in residential neighborhoods near ports, and legislative changes in federal truck engine efficiency standards can substantially improve air quality. Putting these strategies and technologies into action may also help Texas comply with the Environmental Protection Agency’s ozone standards, which are also designed to protect public health.

We should work to reduce air pollution and ease the burden of asthma. Let’s make summer a happier – and healthier – time for all for all Texans.

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