More than 60 years after they were outlawed, the historical discriminatory housing practices known as redlining are still connected to heart disease and related risk factors in the affected districts, according to a study recently published in the Journal of the American College of Cardiology. Health disparities have been related to a number of socioeconomic, environmental, and social variables. This research adds to the increasing body of evidence demonstrating the long-term cardiovascular impacts disparities may have on vulnerable groups. The phrase “redlining” is used to refer to a variety of discriminatory housing practices. Its roots are in a government program from the 1930s when the homeowners’ Loan Corporation produced maps of over 200 American towns with ratings based on racial/ethnic mix, housing conditions, and local surroundings. The areas with a D-rating were referred to as “redlined” areas. Despite the fact that these housing practices were prohibited in the 1960s, throughout the course of the last century, their consequences and other forms of discrimination have persisted to shape social and environmental structures, worsening health inequities. We already know historic redlining has been linked with modern-day health inequities in major urban areas, including asthma, certain types of cancer, preterm birth, mental health, and other chronic diseases, cardiologist at University Hospitals Harrington Heart & Vascular Institute and Assistant Professor of Medicine at Case Western Reserve University in Cleveland and a senior author on the study. They excluded any census tracts with less than 20% total area of intersection.
The study defined redlined neighborhoods as D-graded census tracts and non-redlined neighborhoods as A- through C-graded census tracts. The CDC PLACES database, which reports the prevalence estimates of census tract level health indicators, as well as census-tract level exposure to particulate matter and Diesel particulate matter from the Environmental Protection Agency’s 2021 environmental justice tool, were used to calculate potential environmental confounders. Other outcome variables and assessments used included: markers of health care access, cardio metabolic risk factors, and cardio metabolic outcomes.
A previous study demonstrated that Black adults living in historically redlined areas had a lower cardiovascular health score than Black adults living in A-graded neighborhoods. The current study supports this finding and extends the demonstrated health inequality nationally, showing that redlining not only affects coronary artery disease, stroke, and chronic kidney disease but also is associated with an increased risk of comorbidities and a lack of access to appropriate medical care. According to the researchers, the association between redlining and the prevalence of cardio metabolic conditions further illustrates that historic redlining practices may impact contemporary cardiovascular outcomes by traditional and non-traditional risk factors. Residents of redlined neighborhoods, particularly minorities, are known to have lower access to public transportation, health care insurance, and healthy food choices, which increases their risk for missed prevention and adverse health outcomes. Study limitations include self-reported health outcomes in the CDC PLACES database, which may be mischaracterized. The study was also unable to measure confounders such as behavioral and genetic factors. The definition of redlining census tract boundaries has also not been standardized across studies.
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