Historical redlining affects heart failure risk among Black residents today
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Key takeaways:
- Historical redlining was associated with incident heart failure risk among Black residents living in areas with socioeconomic distress.
- In contrast, redlining was tied to reduced HF risk among white residents.
Black residents living in historically redlined neighborhoods at the time of Medicare enrollment experienced increased risk for incident HF compared with those living in non-redlined areas and white residents, researchers reported.
Redlining proportion — defined as the proportion of a ZIP code exposed to historical redlining practices — was only associated with increased risk for incident HF in areas with the highest Social Deprivation Index (SDI), according to data published in Circulation.
Historical redlining practices
Redlining is defined as the practice denying a mortgage to an otherwise creditworthy and eligible applicant trying to buy a home in a certain neighborhood, according to the Federal Reserve’s Consumer Compliance Handbook.
The Fair Housing Act — Title VIII of the Civil Right Act of 1968 — made it illegal for lenders to deny such loans based on race, color, religion, national origin, sex, handicap or familial status, according to the handbook.
“Although discriminatory housing policies were effectively outlawed nearly a half-century ago, the relationship between historic redlining practices and people’s health today gives us unique insight into how historical policies may still be exerting their effects on the health of many communities,” Shreya Rao, MD, MPH, cardiologist and assistant professor in the department of internal medicine at the University of Texas Health Science Center at San Antonio and University Hospital, said in a press release.
Rao and colleagues identified more than 2.3 million self-reported white and Black beneficiaries from the Medicare Beneficiary Summary Files from 2014 to 2019 (mean age, 71 years; 45% men) and linked patient data with 2,922 ZIP codes with available information on redlining using the Mapping Inequality Project.
After stratifying patients into quartiles of historical redlining proportion, the researchers compared risk for incident HF among Black and white Medicare beneficiaries.
“Ultimately, we were most interested in assessing the difference in risk of heart failure between individuals from communities with the highest level of exposure to redlining and individuals from other communities,” Amgad Mentias, MD, MS, interventional cardiology fellow at Cleveland Clinic, said in the release.
Redlining and risk for incident HF
After adjusting for age, sex and comorbidities, the researchers reported that Black residents living in ZIP codes with the highest quartile of redlining proportion at Medicare enrollment experienced an 8% increased risk for incident HF compared with Black residents living in the lowest quartile of redlining (RR = 1.08; 95% CI, 1.04-1.12; P < .001).
This association was slightly attenuated after adjustment for area-level SDI, but redlining remained associated with incident HF (RR = 1.04; 95% CI, 1.002-1.08; P = .04), according to the study.
In contrast, redlining was associated with a lower risk for incident HF among white residents, even after similar adjustment (RR = 0.9; 95% CI, 0.85-0.95; P < .001).
Moreover, the researchers observed a significant interaction between redlining proportion and SDI in that higher redlining proportion was only associated with increased risk for incident HF in areas with significant socioeconomic distress (P for interaction < .01).
“These findings show us the harm that discriminatory and racist housing policies have had on generations of Black adults and suggest the long-term impact of such policies on cardiovascular health disparities,” Ambarish Pandey, MD, MS, cardiologist and assistant professor in the department of internal medicine at the University of Texas Southwestern Medical Center, said in the release. “A reparative approach may be needed on the part of federal, state and local governments to intervene and drive investment in redlined communities.”
References:
- Consumer Compliance Handbook: Division of Consumer and Community Affairs. www.federalreserve.gov/boarddocs/supmanual/cch/cch.pdf. Updated December 2016. Accessed July 13, 2023.
- Redlining linked to higher heart failure risk among Black adults in U.S. newsroom.heart.org/news/redlining-linked-to-higher-heart-failure-risk-among-black-adults-in-u-s. Published July 17, 2023. Accessed July 17, 2023.
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