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Impacts of residential indoor air quality and environmental risk factors on adult asthma-related health outcomes in Chicago, IL

Journal of Exposure Science & Environmental Epidemiology volume 33, pages 358–367 (2023)Cite this article

Abstract

Background

Residential environments are known to contribute to asthma.

Objective

To examine the joint impacts of exposures to residential indoor and outdoor air pollutants and housing risk factors on adult asthma-related health outcomes.

Methods

We analyzed >1-year of data from 53 participants from 41 homes in the pre-intervention period of the Breathe Easy Project prior to ventilation and filtration retrofits. Health outcomes included surveys of asthma control, health-related quality of life, stress, and healthcare utilizations. Environmental assessments included quarterly measurements of indoor and outdoor pollutants (e.g., HCHO, CO, CO2, NO2, O3, and PM), home walk-throughs, and surveys of environmental risk factors. Indoor pollutant concentrations were also matched with surveys of time spent at home to estimate indoor pollutant exposures.

Results

Cross-sectional analyses using mixed-effects models indicated that lower annual average asthma control test (ACT) scores were associated (p < 0.05) with higher indoor NO2 (concentration/exposure: β = −2.42/−1.57), indoor temperature (β = −1.03 to −0.94), and mold/dampness (β = −3.09 to −2.41). In longitudinal analysis, lower ACT scores were also associated (p < 0.05) with higher indoor NO2 concentrations (β = −0.29), PM1 (concentration/exposure: β = −0.12/−0.24), PM2.5 (concentration/exposure: β = −0.12/−0.26), and PM10 (concentration/exposure: β = 10.14/-0.28). Emergency department visits were associated with poorer asthma control [incidence rate ratio (IRR) = 0.84; p < 0.001], physical health (IRR = 0.95; p < 0.05), mental health (IRR = 0.95; p < 0.05), higher I/O NO2 ratios (IRR = 1.30; p < 0.05), and higher indoor temperatures (IRR = 1.41; p < 0.05).

Significance

Findings suggest that residential risk factors, including indoor air pollution (especially NO2 and particulate matter), higher indoor temperature, and mold/dampness, may contribute to poorer asthma control.

Impact

This study highlights the importance of residential indoor air quality and environmental risk factors for asthma control, health-related quality of life, and emergency department visits for asthma. Two timescales of mixed models suggest that exposure to indoor NO2 and particulate matter, higher indoor temperature, and mold/dampness was associated with poorer asthma control. Additionally, emergency department visits were associated with poorer asthma control and health-related quality of life, as well as higher I/O NO2 ratios and indoor temperatures. These findings deepen our understanding of the interrelationships between housing, air quality, and health, and have important implications for programs and policy.

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Fig. 1: Overall cross-sectional associations between the level of asthma control and indoor exposures, indoor concentrations, and indoor-to-outdoor (I/O) ratios of air pollutants.
Fig. 2: Incidence rate ratios (IRRs) of emergency department (ED) visits associated with health outcomes and indoor-to-outdoor (I/O) ratios of air pollutants.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its Supplementary Information.

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Acknowledgements

This study was funded by the U.S. Department of Housing and Urban Development (HUD) (Grant no. ILHHU0031-16). Additional funding was provided by ComEd through their Energy Efficiency Program’s Emerging Technologies initiative (Project No. P-0136). The authors are deeply appreciative of their colleagues at the Built Environment Research Group at Illinois Institute of Technology, team members at Elevate Energy, the Chicago Bungalow Association, and our study participants for their contributions to this work. This study was funded by the U.S. Department of Housing and Urban Development (HUD) (Grant no. ILHHU0031-16). Additional funding was provided by ComEd through their Energy Efficiency Program’s Emerging Technologies initiative (Project No. P-0136).

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Authors and Affiliations

  1. Department of Civil, Architectural, and Environmental Engineering, Illinois Institute of Technology, Chicago, IL, USA

    Insung Kang & Brent Stephens

  2. Elevate, Chicago, IL, USA

    Anna McCreery, Amanda Gramigna, Griselda Baca, Whitney Hayes, Timothy Crowder, Rachel Scheu & Anne Evens

  3. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Parham Azimi

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Contributions

Conceptualization, funding acquisition, and project administration: BS, AM, AG, AE, RS. Participant management: GB, AG. Survey implementation and administration: AM, GB, AG. Field measurements and assessments: IK, PA, TC, BS. Data curation and processing: IK, PA, AM. Statistical analysis: IK, WH. Writing—original draft: IK. Writing–review, and editing: All authors.

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Correspondence to Brent Stephens.

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Kang, I., McCreery, A., Azimi, P. et al. Impacts of residential indoor air quality and environmental risk factors on adult asthma-related health outcomes in Chicago, IL. J Expo Sci Environ Epidemiol 33, 358–367 (2023). https://doi.org/10.1038/s41370-022-00503-z

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