Asthma is generally perceived to be an inner city health concern, but in 2004, the four highest youth asthma hospitalization rates in Cook County were found in suburban municipalities like west suburban Stickney, south suburban Calumet City and Harvey and northwest suburban Barrington.

Note: The map denotes asthma hospitalization rates for individuals younger than 15 in comparison to the national youth asthma hospitalization rate of 274 per 100,000. Within Chicago, the map displays ZIP codes. Outside Chicago, the map displays suburban municipalities.

Source: Cook County Department of Public Health, Chicago Department of Public Health; analyzed by The Chicago Reporter.

A couple of months after filling out a questionnaire about her son’s health when he was in kindergarten four years ago, Santa Hernandez got a notice from the boy’s school saying he might have asthma.

About a year later, with her husband laid off and having no health insurance, Hernandez made appointments for both of her children at a free mobile outpatient clinic at the children’s new school. That’s when she found out that both children had asthma.

For many, such an announcement might mean nightly nebulizer treatments and handheld inhalers. But for some the consequences might be more severe. Although asthma deaths are rare–”in 2005 there were 86 in Chicago–”the city holds the distinction of having one of the highest asthma death rates in the country, according to Dr. Edward Naureckas of the Respiratory Health Association of Chicago. Data from the National Center for Health Statistics and the Chicago Department of Public Health shows that the city’s asthma death rate is more than twice the national rate.

Some studies show that indoor air quality is to blame, and that blacks and youths are disproportionately affected–”particularly in Chicago. But they’re not the only ones who should be concerned about asthma.

The numbers are troubling for Cook County where youth asthma hospitalization rates are higher in some suburban municipalities than in the city.

An investigation by The Chicago Reporter found that:

* Youth asthma hospitalization rates were higher in 15 suburban Cook County municipalities than in any ZIP code in Chicago. West suburban Stickney had the highest suburban rate at 1,820 hospitalized for every 100,000 youth, more than two times greater than any ZIP code in the city.

* Of the 10 Chicago ZIP codes with the highest youth asthma hospitalization rates, nine are located in ZIP codes where blacks represent the largest racial group.

* Youth asthma hospitalization rates in many parts of the region are greater than the national average. In 2004, the rates of four Chicago ZIP codes–”60637, 60649, 60644, and 60610–”and nearly 30 suburban Cook County municipalities were more than double the national rate of 274 hospitalizations for every 100,000 youth. Locally youth are defined as children under 15, while nationally youth are all children under 18.

A March 2008 study in the Journal of Allergy and Clinical Immunology found that a person’s neighborhood was a strong predictor of asthma prevalence–”even more so than race, gender or age.

One of the most beleaguered neighborhoods is Englewood. The ZIP code serving the community has the fifth highest youth asthma hospitalization rate in Chicago. Dr. Stephanie Whyte of Chicago’s Mobile C.A.R.E. Foundation said Englewood is bordered by a highway and railroad tracks and acts as a “catch main” for air pollution and poor air quality, a contributing factor to the community’s higher asthma rates. But Chicago’s need for asthma healthcare is certainly not limited to Englewood. More than one-third of the 62 Chicago city ZIP codes included in the data have youth asthma hospitalization rates higher than the national average.

One of the factors likely contributing to these numbers is the quality of indoor air, said Naureckas. Cockroaches, mold, pet allergens and second-hand smoke have all been identified as asthma irritants, he said.

Indoor air quality is harder to monitor than outdoor air quality, Naureckas said. It’s not like outdoor air quality, which the Environmental Protection Agency has developed standards for and now monitors. He said indoor air quality varies from building to building, and testing and monitoring the air quality of a building is the responsibility of the individual property owner. Sheila Batka, a scientist in the EPA’s air program, said individuals interested in assessing indoor environment can rely on many tools including carbon monoxide detectors, lead inspection kits and radon assessments. She said people can also seek help from qualified professionals.

The EPA Web site provides information on monitoring a home’s indoor air quality at and the agency has been working with schools to monitor indoor air quality for several years. About half of all U.S. schools have some sort of indoor air quality management system in place. The EPA’s “Tools for Schools” program, a free, self-assessing system of evaluating indoor air quality, has been instrumental in creating indoor air quality awareness in schools across the U.S., she said. The kit provides information about how schools can improve their indoor air quality and how to better understand their quality of air.

But the Tools program would require finances that the Chicago Public School system doesn’t have, said managing engineer Joseph Clair of the district’s department of operations. However, the district’s renovation and maintenance programs incorporate EPA concepts, Clair said, by monitoring energy usage, air system functions and building systems.

Even so, asthma remains a major problem in Chicago. “The need [for treatment] is everywhere,” Whyte said.