iIn the 1930s, the US government introduced the practice of redlining — Categorize neighborhoods based on the ethnic and racial background of the people who lived there, with areas primarily inhabited by people of color identified as high-risk to mortgage lenders. The policy led to further housing segregation and decades of disinvestment in health care, schools and other basic services and infrastructure, taking a disproportionate toll on black communities.
Although redlining was officially discontinued in the 1940s, its legacy continues to harm marginalized people, according to a new study published Tuesday in JAMA Network Open.
Among veterans living with cardiovascular disease, those who lived in historically defined neighborhoods (rating “D”) had a 13% higher risk of dying from any cause and a 14% higher risk of having a serious adverse cardiovascular event. experience the event compared to those living in historically white, wealthy areas, the study said. It is the first major national study to look at the link between redlining and overall cardiovascular risk, and provides the latest evidence of how historical structural racism can impact health across generations.
“Redlining happened … almost a century ago, and we’re showing that it still has implications, and it should give us pause,” said Sadeer Al-Kindi, one of the study’s lead authors and a Harrington Heart and Heart Disease researcher. Vascular Institute at University Hospitals and Case Western Reserve University. “Because now, when we put in place policies — especially policies related to segregation, gentrification, things like that where it talks about re-mapping — it can have a long, lasting legacy of health impacts, particularly on cardiovascular disease. [health].”
The analysis builds on similar studies of the impact of redlining on smaller geographies, such as an April 2023 study of how redlining contributes to stroke risk in New York Cityas well as one national study with a greater risk of adverse cardiovascular outcomes at the neighborhood level than at the individual level.
In this retrospective cohort study, researchers looked at data from about 80,000 U.S. veterans who received care for coronary heart disease, peripheral vascular disease, or stroke between 2016 and 2019, and who lived in areas previously categorized by the Home Owners’ Loan in the 1930s. Corporation (HOLC) established under the New Deal.
The researchers followed up these veterans for an average of four years to see if they had experienced an adverse cardiovascular event. Their statistical models adjusted for factors such as age, gender, race and baseline health, and removed important traditional variables such as diabetes, high blood pressure and high cholesterol. They also adjusted for factors such as pollution and neighborhood deprivation — what Salil V. Deo of the Louis Stokes Veteran Affairs Hospital, one of the study’s co-authors, calls “unseen” risks.
According to environmental epidemiologist Joan Casey, an adjunct assistant professor at Columbia University Mailman School of Public Health, who was not involved in the study, other studies have shown that historically realigned communities continue to experience poorer health outcomes and lower environmental quality.
In the 1930s, “Class D neighborhoods were poorer, had more industry and pollution, lower quality housing, and immigrants and black individuals,” Casey said via email. “Redlining helped consolidate structural racism and prevented wealth accumulation (via home ownership) in specific communities. That can still have health consequences today.”
The study is also notable because black Americans already have a disproportionate amount of cardiovascular problems, according to Mahasin Mujahid, chief of epidemiology at the UC Berkeley School of Public Health. “To truly understand the long-term effects of slavery and its aftermath, including discriminatory policies like redlining, we need to delve into the intergenerational effects,” she said via email.
While the study authors note that their findings may not be generalizable to non-veterans, it was important that they used the large national dataset of veterans available at the census level, as opposed to the larger zip code areas covered by Medicare. data was recorded. Focusing on veterans also reduced the bias that comes from using health care data from the general population, excluding people who don’t have insurance. In contrast, all veterans generally have access to health care through their Veterans Affairs insurance, regardless of their income or current employment status.
To counteract the lingering effects of redlining, Al-Kindi says, you need to get creative with both policies and local initiatives. Connecting patients to better access to food and planting trees in deprived areas are simple actions that can help, but much larger solutions are also needed.
“This paper is so exciting because it tries to pin down structural barriers, long-term historical factors that we have to take into account or we might make things worse than they already are,” said Hayden Bosworth, a professor of public health sciences at Duke. University. School of Medicine who co-authored a commentary on the study. “If you think about it, generation after generation, we know that wealth accumulates. The equivalent is that if generation after generation continues to lack resources, they will continue to build and build, making it much harder to get out of the hole.