Historic redlining in Columbus, Ohio associated with stroke prevalence.

BACKGROUND: Racial disparities exist in stroke and stroke outcomes. In an ecologic study, using the Home Owners' Loan Corporation (HOLC) "redlining" scores, as indicator of historic racialized lending practices, we hypothesized that census tracts with high historic redlining are associated with higher stroke prevalence. METHODS: Weighted historic redlining scores (HRS) were calculated using the proportion of 1930s HOLC residential security grades contained within 2010 census tract boundaries of Columbus, Ohio. Stroke prevalence (adults >=18) was obtained at the census tract-level from the CDC's 500 Cities Project. Sociodemographic census tract level data (American Community Survey 2014-2018) were considered mediators in the causal association between historic redlining and stroke prevalence and were not controlled for in regression analysis. HRS and stroke prevalence associations were evaluated with and without adjustment for proportion of census tract 65 years and older. RESULTS: Census tracts in the highest quartile of HRS (greater redlining) had 1.73% higher stroke prevalence compared to those in the lowest quartile (95% CI:0.41,3.05) adjusting for proportion 65 years and older. No other interquartile differences were observed. CONCLUSIONS: Historic redlining practices are a form of structural racism that established geographic systems of disadvantage and consequently, poor health outcomes. Our findings demonstrate disparate stroke prevalence by degree of historic redlining in census tracts across Columbus, Ohio.

The legacy of structural racism: Associations between historic redlining, current mortgage lending, and health.

Structural racism, which is embedded in past and present operations of the U.S. housing market, is a fundamental cause of racial health inequities. We conducted an ecologic study to 1) examine historic redlining in relation to current neighborhood lending discrimination and three key indicators of societal health (mental health, physical health, and infant mortality rate (IMR)) and 2) investigate sustained lending disinvestment as a determinant of current neighborhood health in one of the most hypersegregated metropolitan areas in the United States, Milwaukee, Wisconsin. We calculated weighted historic redlining scores from the proportion of 1930s Home Owners' Loan Corporation residential security grades contained within 2010 census tract boundaries. We combined two lending indicators from 2018 Home Mortgage Disclosure Act data to capture current neighborhood lending discrimination: low lending occurrence and high cost loans (measured via loan rate spread). Using historic redlining score and current lending discrimination, we created a 4-level hierarchical measure of lending trajectory. In Milwaukee neighborhoods, greater historic redlining was associated with current lending discrimination (OR = 1.73, 95%CI: 1.16, 2.58) and increased prevalence of poor physical health (ß = 1.34, 95%CI: 0.40, 2.28) and poor mental health (ß = 1.26, 95%CI: 0.51, 2.01). Historic redlining was not associated with neighborhood IMR (ß = -0.48, 95%CI: -2.12, 1.15). A graded association was observed between lending trajectory and health: neighborhoods with high sustained disinvestment had worse physical and mental health than neighborhoods with high investment (poor physical health: ß = 5.33, 95%CI: 3.05, 7.61; poor mental health: ß = 4.32, 95%CI: 2.44, 6.20). IMR was highest in 'disinvested' neighborhoods (ß = 5.87, 95%CI: 0.52, 11.22). Our findings illustrate ongoing legacies of government sponsored historic redlining. Structural racism, as manifested in historic and current forms of lending disinvestment, predicts poor health in Milwaukee's hypersegregated neighborhoods. We endorse equity focused policies that dismantle and repair the ways racism is entrenched in America's social fabric.

The intersectional effect of poverty, home ownership, and racial/ethnic composition on mean childhood blood lead levels in Milwaukee County neighborhoods.

Environmental conditions that contribute to childhood lead exposure are spatially patterned. Socioeconomic and racial inequities in childhood lead exposure have been well documented, however childhood lead exposure in Milwaukee is understudied. As a segregated rustbelt metropolitan area with childhood lead exposure concerns, Milwaukee is uniquely positioned to evaluate the synergistic effects of racial and economic drivers of childhood lead exposure. Using surveillance data from the Wisconsin Department of Health Services, Division of Public Health and the US Census Bureau, this cross-sectional study determined the intersectional effect of poverty, home ownership, and racial/ethnic composition on childhood lead exposure in Milwaukee County neighborhoods using linear regression adjusting for average census tract housing age and number of children. The final analytical sample consisted of 48,393 individual childhood blood lead levels aggregated to 215 Milwaukee County census tracts. Census tracts with mean childhood blood lead levels greater than or equal to 5 µg/dL were predominantly low home ownership, high poverty, and majority non-White census tracts. The effects of low home ownership, high poverty, and majority non-White census tracts were synergistic, producing 1.78 (95% CI: 1.44, 2.11) µg/dL higher mean childhood blood lead level than high home ownership, low poverty, and majority White census tracts (referent). This research reveals that social determinants at the neighborhood level co-occur and interact to produce inequities in childhood lead exposure. Lead prevention efforts should align with equity-focused housing and economic policies that target primary prevention in neighborhoods disproportionately burdened by childhood lead exposure.