Diabetes prevalence higher among people living in historically redlined areas
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Neighborhoods that were historically redlined on Home Owners’ Loan Corporation maps in the 1930s are associated with higher diabetes prevalence than non-redlined areas after adjusting for 2010 population figures, according to study data.
According to study background, historical redlining was initiated in 1934 by the Federal Housing Administration to systematically deny residents living in economically disadvantaged areas access to credit and insurance by grading neighborhoods on a color-coded scale, with green indicating the best neighborhoods and red indicating hazardous neighborhoods. Redlined neighborhoods were more often inhabited by racial-ethnic minority groups, according to the study.
Using a conceptual model, researchers found residents living in previously redlined neighborhoods not only have a higher diabetes prevalence, but are also more likely to be exposed to adverse social factors including discrimination, poverty, decreased food access and unemployment.
“This is a growing body of literature on the direct pathways between structural racism and population health,” Leonard Egede, MD, MS, professor of medicine and inaugural Milwaukee community chair in health equity research at the Medical College of Wisconsin, told Healio | Endocrine Today. “This study provides additional information regarding possible indirect pathways for targeting interventions. The possible targets for intervention to mitigate the impact of structural racism on diabetes include incarceration, poverty, discrimination, substance use, housing, education, unemployment and food access.”
Egede and colleagues developed a conceptual model based on a review of literature on structural racism and known pathways as well as data from people’s lived experiences gathered during more than 30 focal group and 350 stakeholder interviews. The model was assessed using census-tract level data. Diabetes prevalence was obtained from the CDC’s 2019 PLACES database. Historical Home Owners’ Loan Corporation (HOLC) maps were gathered from the Mapping Inequality project. Census tracts were assigned a grade based on their overlap with historical HOLC maps, with a grade of 1 representing the best neighborhoods and a grade of 4 representing hazardous or redlined neighborhoods. Diabetes prevalence was measured within each census tract level. Data on social factors were collected from the Opportunity Insights database.
There were 11,375 U.S. Census tracts included in the study. The mean diabetes prevalence within those tracts was 11.8%.
After adjusting for 2010 population, redlined neighborhoods were correlated with a higher crude prevalence of diabetes (r = 0.01; P = .008). In a final model incorporating social factors, redlined neighborhoods were associated with a higher diabetes prevalence through incarceration (r = 0.06; P < .001), poverty (r = –0.1; P < .001), discrimination (r = 0.14; P < .001), substance use measured by binge drinking (r = –0.65; P < .001) and smoking (r = 0.35; P < .001), housing instability (r = 0.06; P < .001), education (r = –0.17; P < .001), unemployment (r = –0.17; P < .001) and food access (r = 0.14; P < .001).
Of the social factors in the study, Egede said poverty was one that stood out the most.
“Poverty remains a critical component in the pathway between structural racism and diabetes prevalence,” Egede said. “While it may not be the strongest driver, addressing poverty should be incorporated into multifaceted approaches to address structural racism.”
Egede said all of the associations found in the study identify potential intervention targets that may reduce the impact of structural racism on diabetes prevalence.
“More work is needed to identify additional pathways between structural racism and present-day population health, and in developing and testing interventions that target pathways,” Egede said.
For more information:
Leonard E. Egede, MD, MS, can be reached at legede@mcw.edu.
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