An equity-focused evaluation of a system-wide intervention to reduce mold in NYC public housing and its impact on asthma burden

项目摘要/摘要 哮喘是美国最普遍的慢性病之一，也是最常见的 完全不同。在美国和纽约市(NYC)，哮喘的患病率、发病率和 按种族/族裔和社会经济群体分列的死亡率。低收入家庭面临的不合标准的条件 居住在出租或公共住房中会增加对室内哮喘的暴露，从而在一定程度上加剧了这些哮喘差异。 触发物，如霉菌。霉菌会向空气中释放孢子、碎片和毒素，从而导致呼吸道疾病。 反应；霉菌与哮喘的发展和恶化都有因果关系。尽管 尽管已知霉菌对健康的不利影响，但业主几乎没有动力进行补救。莫尔德 补救措施，特别是针对水损害和霉菌生长的根本原因的补救措施，往往代价高昂。 需要更换管道、屋顶或通风系统。因此，霉菌问题，特别是在租户居住的房屋中， 通常不会被解决。关于(A)在气候变化的背景下， 霉菌生长加剧哮喘差异和(B)霉菌干预对以下方面的健康益处最大 那些最需要的人。纽约市住房管理局(NYCHA)的居民-最大的公共住房 在北美，居住着超过38万纽约市居民的当局-长期以来一直忍受着不成比例的 在家中暴露在潮湿和霉菌中，可能会导致哮喘的高发病率 发病率。然而，在2019年，NYCHA实施了一项旨在消除 NYCHA开发中的霉菌。《霉菌终结者》展示了一个自然的实验和丰富的数据。 利用我们的目标：了解(A)霉菌生长和气候变化所面临的双重负担 NYCHA居民(B)有利于霉菌生长的社区和建筑特征以及(C) “霉菌终结者”导致的哮喘发病率--所有这些都可以为住房机构处理霉菌的方法提供信息。 有问题。我们将把NYCHA收集的楼层纵向霉菌报告与纵向 气象和哮喘相关急诊科就诊数据。首先，我们将进行时间序列分析 量化极端天气事件之间的关系，预计随着气候变化而增加，以及 关于霉菌的报告，包括整体和考虑可能会改变这一点的社区和建筑特征 关系(目标1)。接下来，我们将使用《霉菌终结者》之前的数据来了解社区和建筑 导致霉菌生长和哮喘发病率的特征(目标2)。最后，我们将进行建设- 水平差值(DID)分析比较“灭霉剂”前后哮喘相关急症 部门访问NYCHA建筑中的非NYCHA，控制建筑，同时考虑社区， 建筑和个人特点(目标3)。如果我们成功了，这些分析将为未来提供信息 通过确定易受伤害的社区、建筑和子群体进行干预，进一步采取行动 霉菌和/或哮喘的发病率是必要的，气候变化将不成比例地影响。

PROJECT SUMMARY/ABSTRACT Asthma is one of the most prevalent chronic conditions in the United States (US); it is also one of the most disparate. Both in the US and in New York City (NYC), differences exist in asthma prevalence, morbidity, and mortality by racial/ethnic and socioeconomic groups. Substandard conditions faced by lower-income families living in rented or public housing partially drive these asthma disparities by increasing exposure to indoor asthma triggers such as mold. Mold can release spores, fragments, and toxins into the air which can lead to respiratory responses; mold has been causally implicated in both the development and exacerbation of asthma. Despite the known adverse health impacts of mold, proprietors have little incentive to perform remediations. Mold remediations, especially those targeting the root causes of water damage and mold growth, may be costly, often requiring pipe, roof, or ventilation system replacement. Thus, mold issues, especially in renter-occupied homes, often go unaddressed. There are critical knowledge gaps surrounding (a) how, in the context of climate change, mold growth exacerbates asthma disparities and (b) if mold interventions have the largest health benefits for those needing it the most. Residents of the NYC Housing Authority (NYCHA) – the largest public housing authority in North America, housing over 380,000 NYC residents – have long endured disproportionate exposures to dampness and mold in their homes, likely contributing to consistently high rates of asthma morbidity. However, in 2019, NYCHA implemented ‘Mold Busters’—a comprehensive program aimed to remove mold in NYCHA developments. ‘Mold Busters’ presents a natural experiment and a wealth of data that could be leveraged for our objectives: to understand (a) the dual burdens of mold growth and climate change faced by NYCHA residents (b) neighborhood and building characteristics conducive to mold growth and (c) changes in asthma morbidity resulting from ‘Mold Busters’—all of which could inform housing agencies’ approaches for mold problems. We will combine building-level, longitudinal mold reports collected by NYCHA with longitudinal meteorological and asthma-related emergency department visit data. First, we will conduct time series analyses to quantify the relationship between extreme weather events, expected to increase with climate change, and reports of mold, both overall and considering neighborhood and building characteristics that may modify this relationship (Aim 1). Next, we will use pre-‘Mold Busters’ data to understand the neighborhood and building characteristics that contribute to mold growth and asthma morbidity (Aim 2). Finally, we will conduct building- level difference-in-difference (DiD) analyses comparing pre/post-‘Mold Busters’ asthma-related emergency department visits in NYCHA buildings to non-NYCHA, control buildings, while considering neighborhood, building, and individual characteristics (Aim 3). If we are successful, together these analyses will inform future interventions by identifying vulnerable neighborhoods, buildings, and subgroups where further action targeting mold and/or asthma morbidity is necessary, and that climate change will disproportionately affect.