This Majority-Black City Is the Asthma Capital of America

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As asthma sufferers brace for the onset of fall allergy season, a nonprofit has ranked the 20 worst cities for the disease. And Detroit — one of a half-dozen cities with significant or majority-Black populations — tops the list. 

On Tuesday, the Asthma and Allergy Foundation of America ranked the Motor City first on its annual list of “asthma capitals” across the country. The organization found that Detroit had the largest number of asthma cases that resulted in complications, including treatment in an emergency room. 

Motown finished just ahead of other Rust Belt cities like Rochester, New York, Cleveland, and Milwaukee, as well as former industrial hubs such as Baltimore and Allentown, Pennsylvania. Asthma is a disproportionate problem in the Black community: according to the federal Office of Minority Health, Black adults were 30% more likely to have asthma than white adults in 2023.

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 “As someone who lives with asthma and has dedicated my career to helping others manage this condition, [the AAFA report] is both eye-opening and heartbreaking,” says Dr. Renee Matthews, a physician and author. “Seeing my hometown of Detroit top the list underscores how deeply the environment, health care access, and socioeconomic factors affect people’s ability to breathe.”

Kenneth Mendez, president and CEO of AAFA, said in a statement that asthma and its symptoms “can lead to missed days of work and school, emergency room visits, and hospitalizations.” That can be costly, he said, resulting in an economic burden of $115 billion annually.

The disease can also be fatal. Mendez noted that asthma kills as many as 11 people per day, or roughly 4,000 people every year.

Social Determinants of Asthma 

Each year, AAFA analyzes the number of asthma cases among the top 100 most populous cities, suburbs, and rural areas in the nation’s 48 contiguous states. Using asthma rates, the number of asthma-related emergency department visits, and the number of asthma-related deaths, the nonprofit identifies the worst places in the country to live with the disease.

September can be one of the hardest months for asthma sufferers. As summer ends, ragweed pollen season begins, along with the annual surge in the number of respiratory illnesses like colds, flu, and COVID-19, which are often spread among children returning to school. 

But studies show socioeconomic factors also play a role. Asthma prevalence and severe outcomes are strongly associated with living in areas with poor air quality and greater exposure to air pollutants. While Black asthma patients are more likely to experience asthma symptoms requiring urgent care, they are less likely than whites to have access to quality healthcare.

Data shows that asthma patients living in Detroit and other predominantly Black cities were 1.6 times more likely to visit the emergency department for asthma-related illness in 2020 than people living in predominantly white cities.

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“Asthma is not just about using an inhaler. It is about having clean air, affordable medications, supportive policies, and equitable health care,” Matthews says. “The report reminds us that addressing asthma means tackling more than just symptoms. It means addressing the systems and environments that keep so many of us at risk.”

The AAFA’s 2025 report found that the area with the highest overall percentages of residents being treated for asthma is Rochester, with Detroit a close second. But the two regions switched places when ranked by the percentage of residents who reported severe asthma-related complications–such as emergency room visits. 

In 2019, the most recent data available, Detroit had approximately 524,900 Black residents, and 16.2% — around 85,000 of them — had asthma. A previous study found that 15% of Black high school–age Michiganders had been diagnosed with the illness. Nationally, just over 11% of Black adults and 11% of Black children have asthma. 

Have a Plan for You And Your Family

Medical experts say asthma patients should write an Asthma Action Plan that lists their medications, helps track symptoms, helps identify an oncoming asthma attack, and outlines steps to take during an emergency. 

Asthma patients are also advised to keep up with immunizations for flu, COVID-19, RSV, and pneumococcal vaccines to reduce their risk of getting a respiratory illness. 

In April, deep staffing cuts at the Centers for Disease Control and Prevention wiped out the agency’s National Asthma Control Program. The NACP worked to reduce asthma hospitalizations, morbidity, and mortality. 

The program intended to improve asthma care, control, and treatment, and it funded state-level asthma control programs. The Trump administration’s “One Big, Beautiful Bill” slashed healthcare programs, including Medicaid. 

At the same time, the administration rolled back Environmental Protection Agency clean-air policies, a move that is expected to undermine asthma prevention and care. Experts say the move, coupled with healthcare cuts, will result in worsening air quality in some areas while reducing access to healthcare. 

Matthews says asthma patients and their families should not wait for symptoms to go from bad to worse. And lawmakers should take action to protect the public’s health.

“Stay proactive. Review your Asthma Action Plan, stay on top of your medications, and protect yourself from indoor and outdoor triggers,” she says. “To policymakers: the time for action is now. Lives depend on it.”

Here are the areas AAFA finds are the worst for asthma sufferers: