制度性种族主义与妊娠健康：利用住房抵押贷款披露法案数据，在社区层面制定抵押贷款歧视指数。
Institutional racism and pregnancy health: using Home Mortgage Disclosure act data to develop an index for Mortgage discrimination at the community level.
机构信息
University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Maternal and Child Health, Chapel Hill, NC, USA.
出版信息
Public Health Rep. 2011 Sep-Oct;126 Suppl 3(Suppl 3):102-14. doi: 10.1177/00333549111260S315.
OBJECTIVES
We used Home Mortgage Disclosure Act (HMDA) data to demonstrate a method for constructing a residential redlining index to measure institutional racism at the community level. We examined the application of the index to understand the social context of health inequities by applying the residential redlining index among a cohort of pregnant women in Philadelphia.
METHODS
We used HMDA data from 1999-2004 to create residential redlining indices for each census tract in Philadelphia County, Pennsylvania. We linked the redlining indices to data from a pregnancy cohort study and the 2000 Census. We spatially mapped the levels of redlining for each census tract for this pregnancy cohort and tested the association between residential redlining and other community-level measures of segregation and individual health.
RESULTS
From 1999-2004, loan applicants in Philadelphia County, Pennsylvania, of black race/ethnicity were almost two times as likely to be denied a mortgage loan compared with applicants who were white (e.g., 1999 odds ratio [OR] = 2.00, 95% confidence interval [CI] 1.63, 2.28; and 2004 OR=2.26, 95% CI 1.98, 2.58). The majority (77.5%) of the pregnancy cohort resided in redlined neighborhoods, and there were significant differences in residence in redlined areas by race/ethnicity (p<0.001). Among the pregnancy cohort, redlining was associated with residential segregation as measured by the percentage of black population (r=0.155), dissimilarity (r=0.250), exposure (r=-0.115), and isolation (r=0.174) indices.
CONCLUSIONS
The evidence of institutional racism may contribute to our understanding of health disparities. Residential redlining and mortgage discrimination against communities may be a major factor influencing neighborhood structure, composition, development, and wealth attainment. This residential redlining index as a measure for institutional racism can be applied in health research to understand the unique social and neighborhood contexts that contribute to health inequities.
目的
我们使用住房抵押贷款披露法案（HMDA）的数据，展示了一种构建住宅红线指数的方法，以衡量社区层面的制度性种族主义。我们通过在费城的一个孕妇队列中应用住宅红线指数，研究了该指数在理解健康不平等的社会背景方面的应用。
方法
我们使用 1999 年至 2004 年的 HMDA 数据，为宾夕法尼亚州费城县的每个普查区创建住宅红线指数。我们将红线指数与妊娠队列研究和 2000 年人口普查的数据相关联。我们对该妊娠队列的每个普查区的红线级别进行了空间映射，并测试了住宅红线与其他社区层面的隔离和个人健康措施之间的关联。
结果
在 1999 年至 2004 年期间，宾夕法尼亚州费城县的黑人种族/族裔的贷款申请人被拒绝抵押贷款的可能性几乎是白人申请人的两倍（例如，1999 年的优势比[OR]为 2.00，95%置信区间[CI]为 1.63，2.28；2004 年的 OR=2.26，95%CI 为 1.98，2.58）。大多数（77.5%）的孕妇队列居住在红线社区，并且种族/族裔之间在红线地区的居住存在显著差异（p<0.001）。在孕妇队列中，红线与以黑人人口比例（r=0.155）、不相似性（r=0.250）、暴露度（r=-0.115）和隔离度（r=0.174）指数衡量的居住隔离相关。
结论
制度性种族主义的证据可能有助于我们理解健康差异。针对社区的住宅红线和抵押贷款歧视可能是影响邻里结构、组成、发展和财富获取的主要因素。作为衡量制度性种族主义的指标，住宅红线指数可以应用于健康研究，以了解导致健康不平等的独特社会和邻里背景。
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