The historical discriminatory housing policies known as “redlining” may be associated with cardiovascular disease and related risk factors today in impacted neighborhoods, more than 60 years after they were banned, according to a study published July 4 in the Journal of the American College of Cardiology.

Issam Motairek, MD, et al., used original Home Owners’ Loan Corporation (HOLC) graded data and calculated the percentage of intersection between each graded neighborhood boundaries and the 2020 U.S. Census tract boundaries. The researchers used the graded intersections to generate a scale using their corresponding HOLC numeric scores (1-4 corresponding to A-D) and created a score that was transformed back into one of four categories: A (1), B (2), C (3) and D (4). The study defined redlined neighborhoods as D-graded census tracts and non-redlined neighborhoods as A- through C-graded census tracts. The researchers also linked HOLC graded census tracts with the prevalence of cardiometabolic indicators and calculated the average of each indicator across census tracts in each HOLC grade.

More than 11,000 HOLC-graded census tracts were included, comprising over 38.5 million inhabitants. The A-graded areas covered 7.1%, B-graded areas covered 19.4%, C-graded areas covered 42% and D-graded areas covered 31.5% of census tracts. The percentage of Black and Hispanic residents increased across HOLC grades (A-D, respectively). Across HOLC grades A through D, the researchers found statistically significant increases in the prevalence of coronary artery disease, stroke and chronic kidney disease.

“We found neighborhoods with so-called better HOLC grades had higher cholesterol screening and routine health visits when compared to neighborhoods with worse HOLC grades. And the prevalence of adults 18 to 64 years old without health insurance nearly doubled from A through D-graded areas,” said Motairek. “In each stepwise increase across the HOLC grading spectrum, from A to D, we also observed an overall increase in rates of diabetes, obesity, hypertension and smoking.”

According to the researchers, the association between redlining and the prevalence of cardiometabolic 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.

Disparities in environmental exposures and in socioeconomic attributes may help explain the poor health outcomes in redlined neighborhoods, which are often situated next to major sources of pollution and make residents more likely to experience the detrimental health effects from disproportionately higher exposure to air pollution, less green space and other environmental toxins. Residents of redlined neighborhoods also experience financial strain, dismantled communities and racial discrimination which may lead to increased stress and associated adverse health events.

“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 disease,” said Sadeer Al-Kindi, MD, FACC, a senior author of the study. “While ours is the first study to examine the national relationship between redlined neighborhoods and cardiovascular diseases, it’s logical that many of the socioeconomic, environmental and social impacts of redlining on other areas of residents’ health outcomes would also be seen in heart disease.”

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Prevention, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Hypertension, Smoking

Keywords: Stroke, Smoking, Obesity, Asthma, Diabetes Mellitus, Delivery of Health Care, Cholesterol, Risk Factors, Hypertension, Air Pollution, Outcome Assessment, Health Care, Chronic Disease, Insurance, Health, Environmental Exposure, Renal Insufficiency, Chronic, Neoplasms, Mental Health, Coronary Artery Disease, Premature Birth, Cardiovascular Diseases, Racism

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