Historical redlining in California linked to worse COVID-19 outcomes
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SAN FRANCISCO — Residents affected by historical redlining in California communities had worse COVID-19 outcomes, according to new data presented at the American Thoracic Society International Conference.
Residential redlining began as a mortgage-lending policy instituted by the federal Home Owners’ Loan Corporation (HOLC) that would discriminate against races and deny financial relief to home owners who were at risk for losing their homes during the Great Depression, according to the study background.
“Prior research has already shown that redlining is associated with worse outcomes for asthma, birth rates and cancer,” Ernesto Casillas, MD, pulmonary and critical care medicine fellow at the University of California, San Francisco, said in a press release. “When the pandemic started, early epidemiologic data showed that our society’s most vulnerable groups were being disproportionately affected by COVID-19.”
This ecological study examined census tract data on COVID-19 cases and deaths reported to the California Department of Public Health from San Francisco, Oakland, Los Angeles, San Jose, Sacramento, Stockton, Fresno and San Diego from January 2020 to August 2021. Using digital HOLC maps, researchers assigned each of the 1,100 census tracts a designated risk grade and evaluated the association between the risk grade and COVID-19 cases and death rates.
In a separate analysis, to adjust for aggregate measures of social conditions, researchers utilized the Healthy Places Index (HPI), which is an aggregate measure of community well-being, and the Index of Concentration at the Extremes (ICE), which is a measure of spatial social separation of deprived and privileged social groups.
As the HOLC risk grade worsened, COVID-19 cases and death rates increased. Census tracts with the worse risk grade of D who were redlined had a higher incident rate for COVID-19 cases (RR = 2.27; 95% CI, 1.61-3.17) and deaths (RR = 3.34; 95% CI, 2.76-4.01) compared with best-graded census tracts in unadjusted models. These associations remained in the adjusted models for both COVID-19 cases (RR = 1.28; 95% CI, 1.14-1.43) and death (RR = 1.62; 95% CI, 1.18-2.21).
In addition, these associations remained after adjusting for HPI score for COVID-19 cases (RR = 1.21; 95% CI, 1.08-1.34) and deaths (RR = 1.56; 95% CI, 1.14-2.12). Researchers observed similar associations when adjusting for ICE for COVID-19 cases (RR = 1.14; 95% CI, 1.02-1.28) and deaths (RR = 1.38; 95% CI, 1.01-1.89).
“Although generalizing to redlined neighborhoods outside of California goes beyond the scope of our present study, redlined neighborhoods in other states experience similar issues such as racial segregation, poor access to health foods, higher rates of poverty and lower-quality housing,” Casillas said. “These are just some of the factors that make redlined communities vulnerable to major health outbreaks such as COVID-19. However, additional research is needed to address this question more explicitly.”