Top 10 Cities With the Most Asthma-Related Deaths (2025)

Asthma, a chronic respiratory condition impacting millions globally, presents unique challenges depending on where you live.

In the United States, the prevalence and severity of asthma can differ greatly from city to city, shaped by a complex mix of environmental conditions, socioeconomic disparities, and healthcare accessibility.

This article takes an in-depth look at the U.S. cities with the highest asthma-related death rates. We’ll explore the specific hurdles these cities face, the factors driving their high mortality rates, and the ongoing efforts to improve asthma management and patient outcomes in these regions.

Cities with the Highest Asthma-Related Deaths

Each year, the Asthma and Allergy Foundation of America (AAFA) releases a comprehensive report on the “Asthma Capitals,” highlighting cities with the highest rates of asthma-related deaths.

These cities face a range of challenges, from environmental issues to socioeconomic factors, which contribute to their elevated mortality rates from asthma.

Here are some of the cities with the most asthma-related deaths:

1. St. Louis, MO

Famous for its Gateway Arch, St. Louis also struggles with a significant asthma burden. Contributing factors include high poverty levels, limited access to health insurance, and elevated pollen counts. The city experiences a high rate of emergency room visits related to asthma, compounding its public health challenges.

2. Baltimore, MD

Known for its historic seaport and diverse neighborhoods, Baltimore also ranks high in asthma-related deaths. Poverty, lack of healthcare access, and seasonal spikes in pollen levels are key contributors to its asthma crisis. These factors combine to make asthma a serious issue for many residents.

3. Jackson, MS

As the capital of Mississippi, Jackson is renowned for its role in civil rights history and southern charm. However, it also contends with high asthma prevalence. Socioeconomic disparities, such as poverty and insufficient health coverage, along with high pollen counts, are major contributors to asthma-related deaths in the city.

4. Richmond, VA

Richmond, Virginia’s capital, is celebrated for its rich history and vibrant arts culture. Unfortunately, it also faces a high prevalence of asthma, with poverty, limited access to healthcare, and high pollen levels driving up asthma-related mortality rates.

5. Fresno, CA

Nestled in California’s agriculturally rich San Joaquin Valley, Fresno is not only known for its crop production but also faces a high rate of asthma-related issues. Factors such as widespread poverty, limited access to healthcare, and elevated pollen levels contribute to the city’s significant asthma mortality rate.

6. New York, NY

New York City, “The Big Apple,” may be famous for its skyscrapers and bustling lifestyle, but it also grapples with high asthma prevalence. Socioeconomic disparities, limited health insurance coverage, and seasonal surges in allergens like pollen exacerbate asthma-related deaths in this densely populated urban area.

7. Tucson, AZ

Located in Arizona’s sunny Sonoran Desert, Tucson is renowned for its outdoor lifestyle. However, it also ranks high for asthma prevalence. The city’s poverty rate, lack of adequate health insurance, and frequent exposure to high pollen levels are key factors driving asthma-related mortality.

8. Detroit, MI

Known as the “Motor City” due to its automotive heritage, Detroit also struggles with significant asthma-related health challenges. High poverty levels, limited healthcare access, and elevated pollen counts all contribute to the city’s high rates of asthma-related emergency room visits and deaths.

9. Chattanooga, TN

While Chattanooga is famous for its scenic beauty and outdoor recreational opportunities, it also faces a growing asthma crisis. Contributing factors include economic challenges, poor healthcare access, and high pollen levels, all of which drive up asthma-related mortality rates in the region.

10. Cleveland, OH

Cleveland’s vibrant arts scene and sports culture make it a lively city, but it also contends with a high prevalence of asthma. Like many other cities on this list, poverty, inadequate health insurance, and allergen-heavy environments are leading contributors to asthma-related deaths.

Note: These descriptions highlight the common factors contributing to high asthma mortality rates in each city, though specific contributing elements may vary slightly from one location to another.

Factors That Influence Asthma-Related Death Rates

Several key factors contribute to asthma-related deaths, highlighting the complex interplay between health, environment, and social determinants.

These include:

• Poverty: Financial hardship can severely limit access to asthma care, from emergency room visits and medications to routine management. The costs associated with asthma, both direct (like hospital stays) and indirect (such as lost income from missed work), often prevent individuals from receiving the care they need—even for those with insurance.
• Lack of Health Insurance: Without health insurance, many people are unable to afford necessary treatments and medications, which can lead to poorly managed asthma. Uncontrolled asthma significantly raises the risk of severe, life-threatening asthma attacks.
• Race and Ethnicity: Racial and ethnic disparities in healthcare access and quality are significant contributors to asthma-related death rates. Black and Hispanic individuals, for instance, often experience higher medical costs and poorer outcomes due to systemic healthcare inequities compared to their White counterparts.
• Air Pollution: Exposure to pollutants like smog, particulate matter, and industrial emissions can worsen asthma symptoms and trigger severe attacks. Urban areas with higher pollution levels often see higher asthma-related mortality rates.
• Pollen: High pollen counts can be a major trigger for individuals with asthma, especially those with pollen allergies. This can lead to sudden, severe asthma attacks, increasing the risk of fatal outcomes during high pollen seasons.
• Smoking (Cigarettes, Cigars, Vapes): Smoking or exposure to secondhand smoke significantly worsens asthma symptoms. It irritates the airways, making asthma more difficult to control and increasing the likelihood of severe, potentially deadly attacks.
• Asthma Medication Mismanagement: Incorrect or inconsistent use of asthma control medications can result in poorly managed asthma. Without proper use of these medicines, individuals are more prone to severe flare-ups, which can become fatal if not promptly addressed.
• Limited Access to Specialists: Access to asthma specialists is crucial for effective management of the condition. When patients cannot regularly consult specialists, their asthma may be inadequately managed, raising the risk of severe, uncontrolled attacks that could lead to death.

These factors emphasize the need for comprehensive asthma management that goes beyond medical treatment alone.

Addressing the social, economic, and environmental barriers is essential to improving asthma outcomes and reducing preventable deaths.

Final Thoughts

Asthma-related deaths are not evenly spread across the United States; cities like St. Louis, Baltimore, and Jackson experience a disproportionate share of this burden. The root causes—poverty, lack of health insurance, air pollution, and limited access to specialized care—drive these stark disparities.

However, acknowledging these challenges is the first step toward creating meaningful change. It’s essential for policymakers, healthcare providers, and community leaders in these cities to collaborate in improving asthma management, reducing exposure to triggers, and addressing the underlying social determinants of health.

While the task may be daunting, the opportunity to save lives and enhance the quality of life for thousands of individuals makes it a vital and urgent effort.