The Best and Worst Cities for Asthma Sufferers

April 15, 2014 Health, Medical Costs
The Best and Worst Cities for Asthma Sufferers

With the arrival of spring, many Americans will experience a spike in their asthma symptoms—tightness in the chest, wheezing, shortness of breath or early morning or nighttime coughing. Asthma is one of the most common chronic diseases in the United States. According to the Centers for Disease Control and Prevention, asthma affects about 1 in 12 adults and nearly 1 in 10 children. It also accounts for more than $56 billion in annual costs, 14.2 million physician office visits and 439,000 inpatient discharges. Location can play a big role in the quality of life, affordability of treatment and management of asthma. To help asthma sufferers identify the best and worst cities to live in the U.S., NerdWallet analyzed available data on asthma prevalence, air quality, cost and access to asthma care in the 50 largest U.S. cities.

The rankings were based on the following factors:

  1. How common is asthma in the largest U.S. cities? We obtained data on the prevalence of both childhood and adult asthma.
  2. How many relevant health care providers are in these cities? We gathered data on the number of active primary care physicians and specialists such as allergists, immunologists and pulmonologists per 100,000 residents.
  3. How good is the air? We studied data on ozone (smog) and particle air pollution in each city.
  4. How costly is asthma care? We analyzed data on average hospitalization charges and average total payments for asthma in each city. We also obtained data on the one-time, out-of-pocket cash price of some of the most commonly used asthma medications—Albuterol, Advair diskus, Flovent diskus and Singulair.


Best cities for asthma sufferers

Rank City % of children with asthma % of adults with asthma Hospital charges Actual Medicare payments Primary care physicians (per 100,000 residents) Specialists (per 100,000 residents) Smog grade Particle air pollution grade Drug cost Aggregate score
1 Omaha 1.6 5.5 $22,434 $5,433 84 25 A C $523 65.4
2 Nashville 2.1 5.5 $16,703 $6,202 85 66 C A $564 60.6
3 Arlington 2.2 5.4 $25,917 $5,378 70 322 F A $561 59.3
4 Tucson 1.9 7.4 $25,313 $5,424 79 66 C A $544 57.8
5 Seattle 1.5 7.7 $30,853 $6,239 99 66 C A $553 57.8
6 Colorado Springs 2.4 5.2 $17,413 $5,766 95 94 C A $639 56.7
7 Denver 1.9 6.5 $28,223 $6,700 95 65 B A $635 55.5
8 Raleigh 2.2 6.6 $18,844 $5,242 83 123 D B $554 54.9
9 Fort Worth 2.2 5.4 $25,696 $5,984 70 159 F A $561 54.8
10 Virginia Beach 2.0 6.7 $20,064 $7,358 90 112 C B $563 54.4
Average 2.0 6.1 $23,146 $5,973 85 110 $570


Worst cities for asthma sufferers

Rank City % of children with asthma % of adults with asthma Hospital charges Actual Medicare payments Primary care physicians (per 100,000 residents) Specialists (per 100,000 residents) Smog grade Particle air pollution grade Drug cost Aggregate score
1 Los Angeles 1.7 6.4 $50,228 $8,452 91 55 F F $652 29.0
2 Philadelphia 2.3 7.3 $48,174 $7,665 99 61 F D $646 29.6
3 San Jose 1.7 6.4 $77,829 $8,417 91 217 F D $661 30.1
4 Chicago 1.7 6.2 $25,795 $8,319 96 28 F F $655 33.4
5 Milwaukee 1.9 7.0 $19,418 $6,833 95 53 F D $695 34.8
6 New York 2.0 7.7 $24,402 $10,234 109 20 D B $646 37.7
7 Sacramento 1.8 6.3 $45,219 $8,319 91 444 F F $648 38.5
8 Phoenix 2.2 7.1 $23,361 $6,029 79 23 F F $544 38.9
9 Washington 3.1 8.3 $19,383 $7,181 246 14 F C $648 39.1
10 Indianapolis 2.4 7.2 $16,028 $7,202 78 34 D F $554 39.4
Average 2.1 7.0 $34,984 $7,865 107 95 $635


Key findings

Significant regional differences exist in asthma prevalence, air quality and access to care.

  • Omaha takes the #1 spot: A combination of low asthma prevalence, outstanding air quality, relatively low hospitalization charges and payments as well as affordable medications helped this Midwestern city secure the first place. The Nebraska Medical Center has relatively affordable asthma treatment—not surprising considering it was ranked as one of the best hospitals in Nebraska.
  • Colorado has a strong showing with two of its cities, Colorado Springs and Denver, making the top 10. Though their medication costs are higher than average, these cities score well in the number of primary care physicians, specialists and air quality. Penrose-St. Francis Health Services and Sky Ridge Medical Center were two of the best hospitals for patients with asthma, according to our analysis.
  • Don’t mess with Texas: Arlington and Fort Worth powered their way to the top 10 with high numbers of asthma specialists and favorable ratings with respect to particle air pollution (ash, vehicle exhaust, soil dust, pollen and other pollution). Medication costs in these cities were also lower than average. Baylor All Saints Medical Center at Fort Worth and Baylor University Medical Center account for much of the success in asthma care management and affordability in these two cities.
  • Bigger cities tend to fare worse than smaller cities: Los Angeles ranks as the worst city for asthma sufferers. A combination of high child and adult asthma prevalence rates, exorbitant hospitalization charges and drug costs as well as deplorable air quality ensured that the second-largest city in the U.S. ranked so low. Los Angeles is joined by other large cities such as New York City, Philadelphia, Chicago and San Jose. In fact, the average population (2,113,831) of the worst cities for asthma sufferers is four times higher than the average population (513,060) of best cities.

Prices drastically vary between cities—asthma sufferers can pay more for hospital care or prescription drugs in certain cities

  • The cost of care varies widely across cities: Asthma sufferers should keep in mind that the average hospitalization charge ($34,984) for asthma in the worst cities is 51% higher than the average hospitalization charge ($23,146) in the best cities.
  • Medicare pays more in some cities: In the best cities, patients and payers can save an average of 32% on their hospital bills as compared to the worst cities. Average total payments ($7,864) for asthma hospitalization in the worst cities is 32% higher than the average total payments ($5,972) in the best cities.
  • Medication prices vary widely across cities: In the best cities, patients may be able to save an average of 11% on their drug costs as compared to the worst cities. Average one-time costs of some of the most commonly used asthma medications in the worst cities ($635) is 11% higher than those in the best cities ($570).

The Best and Worst Cities for Asthma Sufferers

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To our knowledge, this is one of the first studies of its kind to consider financial factors such as hospitalization charges, average total payout and drug costs in the ranking of the best and worst cities for asthma sufferers. “For many American families, asthma represents both a health and financial strain. People need to know that the cost of asthma treatments and medication can vary widely by city,” says Dr. Fisayo Ositelu, Head of Consumer Insights at NerdWallet Health and the author of the study. Regarding Omaha’s top ranking, Dr. William Ingram, an otolaryngologist at the Nebraska Medical Center, says, “Here in Omaha, there’s not a lot of pollution as compared to Chicago and Los Angeles. People also have good access because there is not a lot of waiting around to see doctors.” Asthma drugs are particularly important because they account for high recurrent costs and are central to breathing. “It’s tough,” Dr. Ingram says. “Four different companies send me discount pharmaceutical cards. I try to give them to patients that come in. Costs of drugs are really rising, and with the increase in high-deductible health plans, it might be getting worse.”

As spring allergies peak, those with asthma should be particularly aware of the connections between asthma and allergies. Managing asthma includes minimizing triggers, controlling symptoms by taking the right medications and dosage, as well as seeing your doctor regularly. Asthma management should also be balanced with healthy habits such as eating well and learning to control exercise-induced asthma as one engages in physical activity. To learn more about living with asthma, visit our asthma resource page.

More Asthma Resources:

Visit our asthma resources page here.


The 50 largest U.S. cities were included in this analysis. All variables were normalized to range from 0 to 100, with 100 being the best and 0 being the worst. The overall score was calculated by taking the average of the normalized variables by city. Each variable was weighted equally. We then ranked cities on the 0-to-100 scale. Find the detailed rankings for all 50 cities here.

Prevalence: Obtained on a county-by-county basis. Source: American Lung Association, Epidemiology and Statistics Unit, Research and Health Education 2013.

Hospitalization charges and average total payments: Obtained on a citywide basis for the “asthma with complication” diagnosis-related group. Hospitalization charges and payments are for Medicare patients only, which is a limitation of this study. Source: Medicare Provider Utilization and Payment Data (Inpatient).

Drug costs: Drugs include Albuterol, Advair diskus, Flovent diskus and Singulair. They comprise the one-time, out-of-pocket cash price of the major classes of asthma medications. Obtained from (retrieved 3/26/2014 at 6:30 p.m. PT) on a zip code level.

Number of primary care physicians: Data were obtained from the American Association of Medical Colleges 2013 State Physician Workforce Data Book. It reports the number of physicians per 100,000 residents in the state.

Number of specialists: Specialists include allergists, immunologists, pediatric pulmonologists and pulmonary disease specialists. Source was the American Board of Medical Specialties.

Air quality: Ozone level and 24-hour particle pollution were used to assess air quality. Ozone means smog, and particle pollution comprises tiny particles from ash, vehicle exhaust, soil dust, pollen and other pollution. Air quality is graded from “A” to “F,” with the former being the best and the latter the worst. Data were obtained on a zip code basis from

Woman with inhaler image via Shutterstock.

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