Hundreds of thousands of New Jersey residents live with asthma, a long-term lung disease that affects breathing. Asthma can have serious health repercussions for those with the condition if they do not receive the proper care during asthma attacks, medical events when the airways into the lungs become smaller and more difficult for air to pass through. Though people in all parts of New Jersey have asthma, studies have repeatedly found the rates and risks of asthma to be higher in urban centers. Data from the New Jersey Department of Health reveals that the state’s capital city, Trenton, is no exception.

The New Jersey Department of Health published “asthma profiles” on the various counties in the state in 2014. Of note in Mercer County’s profile was the information about the city of Trenton. Trenton residents visited the emergency room for their asthma 3.8 times more than the average New Jersey resident. And despite only making up 23% of Mercer County’s population, 73% of asthma-related emergency room visits in the county occurred in Trenton.

“In general, respiratory disease risk is a complicated picture in urban environments. There are a lot of variables at play,” said Dr. Samir Kelada, a professor at the University of North Carolina at Chapel Hill.

Kelada conducts research that investigates the potential links between gene expression and the environment. He specifically focuses on the links between the development of asthma and exposure to a variety of types of air pollution that are common in cities. Some of the risk factors for developing asthma that Kelada investigates are also a health concern to those who have already developed the disease, because they can bring on asthma attacks.

“One major risk would be particulate matter air pollution, typically associated with roadways and the exhaust from vehicles,”said Kelada.

The vehicular traffic traveling through the streets of Trenton, and the fact that Interstate 295 and New Jersey Route 29 partially encircle the city, are potentially contributing factors to the high rate of emergency room visits in Trenton.

Isles Inc., a local organization that aims to foster self-reliant families and healthy, sustainable communities, numbers asthma and respiratory health among their concerns for the citizens of Trenton. Isles approaches the subject largely from an indoor perspective, as opposed to Kelada’s work, which addressed risk factors that come from outside the home.

“The important thing to know is that asthma continues to be disproportionately present in older urban areas compared to suburban, and what we know is that there are very well-known triggers for asthma in old housing that has not been well-maintained,” said Elyse Pivnick, the senior director of Isles’s Environmental Health Initiative.

Some of said triggers, like mold, cockroaches, and the waste left behind by other pests are regularly encountered by Andre Thomas, a building inspector and the training manager for Isles’ Center for Energy and Environmental Training. He indicated that the asthma risks he encounters the most in Trenton are typically mold and cockroaches. Thomas also discussed the implications of frequent asthma attacks beyond the risks to health.

“We also like to identify how asthma also causes the family to miss work, or cause the child to miss school,” said Thomas. 

Missing work can have a negative impact on a family’s ability to support itself and continue paying for medical treatments, and missing school can leave asthmatic children at an academic disadvantage to their peers.

The makeup of those who bear the brunt of the impact of urban asthma is not always uniform. The asthma profile for Mercer County provided a breakdown of the race and ethnicity of individuals visiting the emergency room for asthma in the county. The profile found that black and hispanic residents of Mercer County made up a significantly higher percentage of those going to the emergency room for asthma related reasons than white non-hispanic residents, and that this data was consistent with state data. Across the board in New Jersey, far more Black and hispanic residents than white non-hispanic residents were visiting the emergency room out of concern for their asthma.

“Asthma is an environmental justice issue, I don’t think there’s any doubt about it,” said Kelada. “I’m not the kind of scientist that knows how to solve that complex societal problem, but through my research I have gained enough awareness to appreciate that that is the reality.”