Living in historically redlined, gentrified areas tied to severe maternal morbidity

Key takeaways:

• Odds for severe maternal morbidity were higher for mothers who lived in historically redlined and recently gentrified areas in California.
• Factoring in race and ethnicity did not change the findings.

Women who resided in historically redlined communities in California that experienced displacement or gentrification were at greater risk for severe maternal morbidity compared with women living in advantaged neighborhoods, data show.

“Individual-level factors have not sufficiently explained the increasing occurrence of severe maternal morbidity and its inequities, demonstrating the need to examine contextual factors,” Mahasin S. Mujahid, PhD, MS, FAHA, professor of epidemiology and the Lillian E. I. and Dudley J. Aldous Chair in the School of Public Health at the University of California, Berkeley, and colleagues wrote in JAMA Network Open. “Existing research has documented that residing in a previously redlined or a currently gentrifying neighborhood may be associated with increased risks of adverse pregnancy-related and infant outcomes, but the combined influence of redlining and gentrification on pregnancy-related mortality and morbidity remains unknown.”

For the cross-sectional study, researchers analyzed data from 1,554,837 live hospital births in California from 2005 to 2018. The median maternal age was 29 years. Birth files included the parent’s geocoded residential address at birth, which was assigned census tract identifiers to link to variable exposures, the researchers wrote.

Redlining was characterized by the federal Home Owners’ Loan Corporation (HOLC) mortgage security maps; the researchers reported that displacement was assessed using present-day sociodemographic and housing market information.

Researchers assessed the association between exposure to historical redlining and contemporary gentrification with increased odds for severe maternal morbidity, adjusting for pregnancy-related factors.

Within the cohort, 56.6% of mothers were Hispanic; 20.1% were white; 14.5% were Asian ; 8.5% were Black and 0.2% were American Indian or Alaska Native. There were 22,993 cases of severe maternal morbidity overall (1.4%).

Residents in historically redlined neighborhoods that were undergoing gentrification or displacement were more likely to be Black, Hispanic, and American Indian or Alaska Native, according to the researchers.

Independent of individual-level characteristics, mothers who lived in historically redlined neighborhoods that experienced displacement were more likely to experience severe maternal morbidity (OR = 1.21; 95% CI, 1.14-1.28), as were mothers who lived in redlined neighborhoods undergoing gentrification (OR = 1.21; 95% CI, 1.13-1.29) compared with women who lived in continuously advantaged neighborhoods. Mother who lived in tracts that experienced redlining but are now considered exclusive were also more likely to experience severe maternal morbidity (OR = 1.12; 95% CI, 1.06-1.19). Results persisted when adjusted for race and ethnicity (P = .18); however, American Indian, Alaska Native and Black mothers residing in tracts undergoing displacement or gentrification experienced the highest severe maternal morbidity prevalence, according to the researchers. They noted such findings highlight “the injustices of populations contending with historical marginalization and present-day struggles, such as the housing crisis, while coping with high rates of adverse pregnancy outcomes.”

“This study demonstrates the importance of understanding pregnancy outcomes within the context of historical processes that shape neighborhood conditions,” the researchers wrote. “Regardless of a neighborhood’s current gentrification status, living in redlined census tracts was associated with greater severe maternal morbidity odds compared with living in neighborhoods that experienced neither process. These findings align with prior studies documenting that the legacies of HOLC redlining remain connected with severe maternal morbidity, even after accounting for contemporary neighborhood deprivation, and also influence other related outcomes, including adverse birth outcomes.”