Structural Racism, Historical Redlining, and Incidence of Kidney Failure in US Cities, 2012-2019.

SIGNIFICANCE STATEMENT: Residing in neighborhoods designated as grade D (hazardous) by the Home Owners' Loan Corporation (HOLC) under historical redlining-a discriminatory housing policy beginning in the 1930s-has been associated with present-day adverse health outcomes such as diabetes mortality. Historical redlining might underlie conditions in present-day neighborhoods that contribute to inequitable rates of kidney failure incidence, particularly for Black individuals, but its association with kidney disease is unknown. The authors found that among adults with incident kidney failure living in 141 metropolitan areas, residence in a historically redlined neighborhood rated grade D was associated with significantly higher kidney failure incidence rates compared with residence in a redlined grade A (best) neighborhood. These findings suggest that historical racist policies continue to affect current-day racial inequities in kidney health. BACKGROUND: Historical redlining was a 1930s federally sponsored housing policy that permitted the Home Owners' Loan Corporation (HOLC) to develop color-coded maps and grade neighborhoods' mortgage lending risk on the basis of characteristics that included racial makeup. This practice has been associated with present-day health disparities. Racial inequities in kidney disease-particularly for Black individuals-have been linked to residential segregation and other structural inequities. METHODS: Using a registry of people with incident kidney failure and digitized HOLC maps, we examined the association between residence in a historically redlined US census tract (CT) with a historical HOLC grade of D or hazardous) and present-day annual CT-level incidence of kidney failure incidence among adults in 141 US metropolitan areas, in 2012 through 2019. RESULTS: Age-adjusted and sex-adjusted kidney failure incidence rates were significantly higher in CTs with a historical HOLC grade D compared with CTs with a historical HOLC grade of A or best (mean, 740.7 per million versus 326.5 per million, respectively, a difference of 414.1 per million). Compared with national averages of all adults in our sample, rates of kidney failure incidence were higher for Black adults in our study sample, irrespective of CT HOLC grade. Age-adjusted and sex-adjusted incidence rates for Black persons in CTs with a HOLC grade D were significantly higher than for Black persons residing in HOLC grade A CTs (mean, 1227.1 per million versus 1030.5 per million, respectively [a difference of 196.6 per million]). CONCLUSIONS: Historical redlining is associated with present-day disparities in kidney failure incidence, demonstrating the legacy of historical racist policies on contemporary racial inequities in kidney health. PODCAST: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2023_08_24_JASN0000000000000165.mp3.

Shifting neighborhoods, shifting health: A longitudinal analysis of gentrification and health in Los Angeles County.

Gentrification is characterized by an influx of capital, built environment upgrades, and physical and social displacement of residents and institutions. The numerous, relatively rapid transitions that occur during gentrification make accounting for duration of exposure to gentrification particularly important when exploring its relationship to health. Though a large literature explores how timing and duration of exposure to relatively stable neighborhood conditions are linked to health, little is known about how exposure to gentrification is linked to the health of longtime residents. Using restricted, longitudinal data from the Los Angeles Family and Neighborhood Survey, I ask (1) how is duration of exposure to gentrification linked to the self-reported health of those who remain in the neighborhood? (2) How does this relationship vary for members of different racial and ethnic groups? Results indicate that the longer an individual lives in a gentrifying neighborhood, the better their self-reported health. The results do not vary by race or ethnicity. The results of this study are not an endorsement of the use of gentrification as a public health intervention, as previous work finds that gentrification can also be associated with social, physical, and institutional displacement. Instead, findings reiterate the importance of neighborhood investments for the health and well-being of their residents over time.