Redlining, a historical housing discrimination practice, continues to be linked to worse cardiovascular health among U.S. veterans, according to research published in JAMA Network Open.
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Researchers used historic HOLC and census data, along with medical data from Veterans Affairs patients, to look at the cardiovascular health of 79,997 veterans with atherosclerotic diseases such as coronary artery disease. They also looked at median household income and education levels and other information to assess the current prosperity of neighborhoods.
The analysis included patients from 81.5 percent of the tracts graded by HOLC. Patients living in areas once given HOLC’s highest grade were likelier to be White, and they had lower rates of cardiovascular risk factors such as smoking, chronic kidney disease, high blood pressure and obesity. Those risk factors were more common in once-redlined neighborhoods. For example, 31.1 percent of veterans living in neighborhoods graded riskiest by HOLC smoked, compared with 27.
Patients living in formerly redlined neighborhoods were likelier to be diagnosed with chronic kidney disease, heart failure, diabetes and chronic obstructive pulmonary disease. They also had a nearly 13 percent higher mortality risk and a 14 percent higher risk of having a major cardiovascular event, such as a stroke or heart attack, than their counterparts in other neighborhoods.The risk is probably the result of a variety of factors, the researchers write.
“This further underscores the idea that one’s surrounding environment is a powerful estimator of health,” the researchers write — even though it has been nearly a century since HOLC introduced redlining. They call for public health experts to consider neighborhood when assessing cardiovascular risk, and suggest that further research be conducted to inform policies around everything from food access to tobacco sales.
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