Purpose: Communities impacted by structural racism bear a disproportionate burden of asthma due to unjust exposure to environmental hazards. Understanding relationships between environmental and social determinants of health that contribute to asthma prevalence may support the development and implementation of public health interventions to reduce asthma inequities. This study sought to examine associations between social, economic, and environmental characteristics and asthma prevalence in Detroit, MI.

Study Question: Within Detroit, MI, how is adult asthma prevalence associated with environmental, structural, and social determinants of health at the census tract level?

Methods: This ecological study in the Detroit, MI metropolitan area used 8 publicly available census tract-level datasets from 2016-2021. These included census tracts with Home Owners’ Loan Corporation (HOLC) grades (n=494), which were racialized historic mortgage risk scores assigned by the federal government to urban neighborhoods. Associations between 26 variables, consisting of social, economic, and environmental characteristics, and asthma prevalence were assessed using linear regression for bivariate and multivariable models (i.e., a full model with all variables).

Results: Bivariate regression analysis showed statistically significant associations between asthma prevalence and 24 of the 26 variables; percent of census tracts with parks and percent owner-occupied with a Hispanic homeowner were not significantly associated. In the full model, the following variables were positively associated with increased asthma prevalence: level of segregation, smoking prevalence, percent of eligible units available for government housing assistance, percent of renter-occupied units, and percent of owner-occupied units with a Black homeowner. A higher median household income was associated with decreased asthma prevalence.

Conclusions: Desegregating neighborhoods, increasing affordable housing, offering resources for smoking cessation, and providing opportunities to build wealth could potentially affect asthma prevalence in Detroit, MI. This study emphasizes the importance of understanding and addressing the complex interplay between environmental, structural, and social determinants of health.