Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
J Am Soc Nephrol. 2023 Sep 1;34(9):1493-1503. doi: 10.1681/ASN.0000000000000165. Epub 2023 Jun 12.
Residing in neighborhoods designated as grade D (hazardous) by the Home Owners' Loan Corporation (HOLC) under historical redlining-a discriminatory housing policy beginning in the 1930s-has been associated with present-day adverse health outcomes such as diabetes mortality. Historical redlining might underlie conditions in present-day neighborhoods that contribute to inequitable rates of kidney failure incidence, particularly for Black individuals, but its association with kidney disease is unknown. The authors found that among adults with incident kidney failure living in 141 metropolitan areas, residence in a historically redlined neighborhood rated grade D was associated with significantly higher kidney failure incidence rates compared with residence in a redlined grade A (best) neighborhood. These findings suggest that historical racist policies continue to affect current-day racial inequities in kidney health.
Historical redlining was a 1930s federally sponsored housing policy that permitted the Home Owners' Loan Corporation (HOLC) to develop color-coded maps and grade neighborhoods' mortgage lending risk on the basis of characteristics that included racial makeup. This practice has been associated with present-day health disparities. Racial inequities in kidney disease-particularly for Black individuals-have been linked to residential segregation and other structural inequities.
Using a registry of people with incident kidney failure and digitized HOLC maps, we examined the association between residence in a historically redlined US census tract (CT) with a historical HOLC grade of D or hazardous) and present-day annual CT-level incidence of kidney failure incidence among adults in 141 US metropolitan areas, in 2012 through 2019.
Age-adjusted and sex-adjusted kidney failure incidence rates were significantly higher in CTs with a historical HOLC grade D compared with CTs with a historical HOLC grade of A or best (mean, 740.7 per million versus 326.5 per million, respectively, a difference of 414.1 per million). Compared with national averages of all adults in our sample, rates of kidney failure incidence were higher for Black adults in our study sample, irrespective of CT HOLC grade. Age-adjusted and sex-adjusted incidence rates for Black persons in CTs with a HOLC grade D were significantly higher than for Black persons residing in HOLC grade A CTs (mean, 1227.1 per million versus 1030.5 per million, respectively [a difference of 196.6 per million]).
Historical redlining is associated with present-day disparities in kidney failure incidence, demonstrating the legacy of historical racist policies on contemporary racial inequities in kidney health.
This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2023_08_24_JASN0000000000000165.mp3.
根据住房业主贷款公司（HOLC）在历史上的红线划定（始于 20 世纪 30 年代的歧视性住房政策）将居民安置在被划分为 D 级（危险）的社区，与当今的不良健康结果有关，如糖尿病死亡率。历史上的红线划定可能是造成当今社区条件不平等的原因之一，这些条件导致了肾衰竭发病率的不平等，尤其是对黑人个体，但目前尚不清楚其与肾脏疾病的关联。作者发现，在居住于 141 个大都市区、患有新发肾衰竭的成年人中，与居住在 HOLC 评级 A（最佳）的红线划定社区相比，居住在历史上被划分为 D 级（危险）的红线划定社区与更高的肾衰竭发病率显著相关。这些发现表明，历史上的种族主义政策继续影响当前肾脏健康方面的种族不平等。
历史上的红线划定是 20 世纪 30 年代联邦政府赞助的住房政策，允许住房业主贷款公司（HOLC）根据包括种族构成在内的特征，对抵押贷款风险进行彩色编码地图和社区评级。这种做法与当今的健康差距有关。肾脏疾病的种族不平等——尤其是对黑人个体——与居住隔离和其他结构性不平等有关。
利用新发肾衰竭患者的登记处和数字化 HOLC 地图，我们研究了美国 141 个大都市区中，居住在历史上 HOLC 评级为 D 级（危险）的美国人口普查区（CT）与 2012 年至 2019 年期间成年人 CT 级别的现患肾衰竭年发病率之间的关系。
经年龄和性别调整的肾衰竭发病率在历史 HOLC 评级 D 的 CT 中明显高于历史 HOLC 评级 A 或最佳的 CT（分别为每百万 740.7 与每百万 326.5，差异为 414.1 每百万）。与我们样本中所有成年人的全国平均水平相比，我们研究样本中黑人成年人的肾衰竭发病率更高，无论 CT 的 HOLC 等级如何。HOLC 等级 D 的 CT 中黑人成年人的经年龄和性别调整的发病率明显高于 HOLC 等级 A 的 CT 中的黑人成年人（分别为每百万 1227.1 与每百万 1030.5，差异为 196.6 每百万）。
历史上的红线划定与当今肾衰竭发病率的差异有关，这表明历史上的种族主义政策对当代肾脏健康方面的种族不平等的影响。
本文包含一个播客，网址为 https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2023_08_24_JASN0000000000000165.mp3。
Zotero 插件