Abstract
We investigated historical redlining, a government-sanctioned discriminatory policy, in relation to cardiovascular health (CVH) and whether associations were modified by present-day neighborhood physical and social environments. Data included 4,779 participants (mean age 62 y; SD = 10) from the baseline sample of the Multi-Ethnic Study of Atherosclerosis (MESA; 2000 to 2002). Ideal CVH was a summary measure of ideal levels of seven CVH risk factors based on established criteria (blood pressure, fasting glucose, cholesterol, body mass index, diet, physical activity, and smoking). We assigned MESA participants' neighborhoods to one of four grades (A: best, B: still desirable, C: declining, and D: hazardous) using the 1930s federal Home Owners' Loan Corporation (HOLC) maps, which guided decisions regarding mortgage financing. Two-level hierarchical linear and logistic models, with a random intercept to account for participants nested within neighborhoods (i.e., census tracts) were used to assess associations within racial/ethnic subgroups (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Chinese). We found that Black adults who lived in historically redlined areas had a 0.82 (95% CI -1.54, -0.10) lower CVH score compared to those residing in grade A (best) neighborhoods, in a given neighborhood and adjusting for confounders. We also found that as the current neighborhood social environment improved the association between HOLC score and ideal CVH weakened (P < 0.10). There were no associations between HOLC grade and CVH measures or effect modification by current neighborhood conditions for any other racial/ethnic group. Results suggest that historical redlining has an enduring impact on cardiovascular risk among Black adults in the United States.
Highlights
We investigated historical redlining, a government-sanctioned discriminatory policy, in relation to cardiovascular health (CVH) and whether associations were modified by present-day neighborhood physical and social environments
Home Owners’ Loan Corporation (HOLC) grades varied by neighborhood physical and social environments with the highest mean physical and social environment scores among those residing in areas historically considered “A: best” neighborhoods and the lowest scores among those residing in “D: hazardous” neighborhoods
In models examining HOLC score and continuous BMI and blood pressure (BP), we found that Black participants who lived in historically redlined areas had a 2.01 higher BMI and 8.33 and 4.89 higher systolic BP (SBP) and diastolic BP (DBP), respectively, compared to Black adults residing in neighborhoods historically considered “A: best” neighborhoods, independent of confounders (SI Appendix, Table S3)
Summary
A government-sanctioned discriminatory policy, in relation to cardiovascular health (CVH) and whether associations were modified by present-day neighborhood physical and social environments. HOLC grades prevented residents in these “undesirable” neighborhoods, especially Black residents, from accessing mortgage financing and home ownership This led to the systematic disinvestment in redlined neighborhoods for decades, contributing to stark inequities in the quality of the physical and social environments in which historically marginalized populations reside in greater proportions [12]. Results suggested that living in historically redlined neighborhoods was associated with CVH only among Black participants and that within this group, living in a neighborhood with better social environment quality weakened but did not fully attenuate this association These findings suggest that, similar to the institution of slavery, redlining is one manifestation of structural racism that drives health outcomes today. This work underscores the necessity to investigate structural racism as a root cause of racial/ethnic health inequities
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