Abstract 11250: Historical Neighborhood Redlining and Cardiovascular Risk in Patients With Chronic Kidney Disease: Results From Chronic Renal Insufficiency Cohort

Abstract

Background: Neighborhood redlining was established by the government-sanctioned Home Owners' Loan Corporation (HOLC) in the 1930s aimed to develop neighborhood risk assessment for mortgage applications in the United States. Redlining has resulted in residential segregation and has contributed to persistent systemic racism. Objectives: We sought to investigate the association between redlining and prevalent and incidence cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Methods: We linked participants from the Chronic Renal Insufficiency Cohort (patients with mild to moderate CKD enrolled 2003-2008 and followed prospectively) with historical redlining risk groups using participant residential address at enrollment. HOLC groups neighborhoods into risk groups (A-D, with A being lowest risk and D being highest risk). We examined the association between redlining groups with prevalent and incident cardiovascular events Results: A total of 1720 participants were included: 109 (6.3%) in group A, 305 (18%) in group B, 753 (44%) in group C, and 553 (32.2%) in group D. Overall, increasing neighborhood HOLC risk was associated with increased proportion of Black and Hispanic residents, younger age, proteinuria, higher systolic BP, and high sensitivity troponin levels (all P<0.01). In multivariable models, group B (Odds Ratio [OR] 2.34 (95% CI: 1.32-4.15), P=0.003), group C (OR 2.31 (1.34-3.98), P=0.003) and group D (OR 2.10 (1.21-3.65), P=0.009) were associated with increased CVD at baseline (vs group A). Among 1118 participants without baseline CVD, group D was associated with increased risk for HF or all-cause death (adjusted HR 2.63 (1.31-5.28), P=0.006) which remained unchanged after further adjustment for BNP and high-sensitivity troponins (D vs A: HR 2.55 (1.27-5.13), P=0.008). Conclusions: Historical neighborhood redlining is associated with prevalent CVD and incident heart failure/death in a contemporary cohort of patients with CKD, enrolled more than 6 decades after the redlining practices were abolished. Future studies should focus on investigating the mechanisms of this relationship and the impact of residential segregation on cardiovascular health.