Energy burden and asthma prevalence in U.S. cities: An emerging social determinant of health.

Background: Energy burden, defined as the inability to afford residential energy consumption, is a pressing public health issue globally and in the U.S. However, its impact on asthma remains largely unknown.

Objectives: This study aims to examine the association between energy burden and asthma prevalence in U.S. areas and to evaluate whether the association differs by climate zone.

Methods: We merged the energy burden variables at census tract from Low-Income Energy Affordability Data (LEAD) and asthma prevalence from CDC PLACES data. Using the data from five nationally representative datasets including LEAD and CDC, we employed multilevel random intercept model to estimate the association between energy burden and asthma prevalence, controlling for the socioeconomic status and housing characteristics of census tracts across the largest 500 US cities. Further, we conducted a stratification analysis to examine whether this association varies by climate region in the U.S.

Main Results: Energy burden at the census tract level is significantly and independently associated with asthma prevalence across U.S. census tracts. Census tracts with high energy burdens exhibited a 0.803 % higher asthma prevalence [95 % Confidence Interval (CI): 0.763, 0.834] compared to those with low energy burdens. The significant and positive association between high energy burden and asthma prevalence remains in all climate regions, respectively, after adjusting for socioeconomic and housing characteristics.

Conclusion: The findings suggest that high energy burden is an emerging environmental determinant of respiratory health in the U.S.