Tax Credits and Health Equity: An Observational Study of Tax Credits and Asthma Outcomes

Abstract Federal tax credits are an evidenced-based strategy to promote health equity. Our objectives were to describe families’ knowledge and use of tax credits, to analyze the association between receipt of tax credits and asthma health outcomes, and to offer referrals for free tax preparation to families. We hypothesized that tax credit receipt would be associated with improved asthma outcomes. We surveyed the parents of children aged 2–18 years old with high-risk asthma living in low-income neighborhoods about tax credits. We then conducted a retrospective observational study using a convenience sample of 102 parents of children enrolled in the Community Asthma Initiative from March 2017-January 2020. We analyzed the association of report of tax credits with reductions in ED visits, inpatient stays, PCP visits, steroid courses, missed school days, days of inactivity, and missed parental workdays using a paired t-test. We enrolled 102 parents in this study. Nearly one third of the parents (29%) did not report any tax credits. Housing costs (34%) and paying bills and debts (34%) were the most common use of tax credits. Among the 55 with 6-month follow-up information, significant reductions were seen in inpatient stays (0.46, p-value < 0.01), steroid courses (0.73, p-value < 0.01), missed school days (4.19, p-value < 0.01), and days of inactivity (2.81, p-value < 0.01) compared to no significant reductions among non-tax credit recipients. Expansion of tax credits may be an important way for pediatricians to promote health equity in asthma outcomes.