Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA USA.
Hubert Department of Global Health Rollins School of Public Health Emory University Atlanta GA USA.
J Am Heart Assoc. 2024 Apr 16;13(8):e032019. doi: 10.1161/JAHA.123.032019. Epub 2024 Apr 2.
Historical redlining, a discriminatory lending practice, is an understudied component of the patient risk environment following hospital discharge. We investigated associations between redlining, patient race, and outcomes following heart failure hospitalization.
We followed a hospital-based cohort of Black and White patients using electronic medical records for acute heart failure hospitalizations between 2010 and 2018 (n=6800). Patient residential census tracts were geocoded according to the 1930s Home Owners' Loan Corporation map grades (A/B: best/still desirable, C: declining, D: redlined). We used Poisson regression to analyze associations between Home Owners' Loan Corporation grade and 30-day outcomes (readmissions, mortality, and their composite). One-third of patients resided in historically redlined tracts (n=2034). In race-stratified analyses, there was a positive association between historically declining neighborhoods and composite readmissions and mortality for Black patients (risk ratio [RR], 1.24 [95% CI, 1.003-1.54]) and an inverse association between redlined neighborhoods and 30-day readmissions among White patients (RR, 0.58 [95% CI, 0.39-0.86]). Examining racial disparities across Home Owners' Loan Corporation grades, Black patients had higher 30-day readmissions (RR, 1.86 [95% CI, 1.31-2.65]) and composite readmissions and mortality (RR, 1.32 [95% CI, 1.04-1.65]) only in historically redlined neighborhoods.
Historical redlining had potentially mixed impacts on outcomes by race, such that residing in less desirable neighborhoods was associated with an elevated risk of an adverse outcome following heart failure hospitalization in Black patients and a reduced risk in White patients. Moreover, racial disparities in patient outcomes were present only in historically redlined neighborhoods. Additional research is needed to explore observed heterogeneity in outcomes.
历史上的“红线划定”（redlining）是一种歧视性贷款做法，这是医院出院后患者风险环境中一个研究不足的组成部分。我们研究了“红线划定”、患者种族与心力衰竭住院后结局之间的关联。
我们对 2010 年至 2018 年间因急性心力衰竭住院的黑人和白人患者进行了一项基于医院的队列研究，这些患者的电子病历中有他们的住址。患者居住的普查地段按照 20 世纪 30 年代房主贷款公司（Home Owners' Loan Corporation）的评级（A/B：最佳/仍然理想，C：下降，D：红线划定）进行地理编码。我们使用泊松回归分析 Home Owners' Loan Corporation 评级与 30 天结局（再入院、死亡及其复合结局）之间的关系。三分之一的患者居住在历史上被划定为红线的地段（n=2034）。在种族分层分析中，对于黑人患者，历史上下降的社区与复合再入院和死亡率呈正相关（风险比[RR]，1.24[95%CI，1.003-1.54]），而对于白人患者，历史上被划定为红线的社区与 30 天再入院呈负相关（RR，0.58[95%CI，0.39-0.86]）。在 Home Owners' Loan Corporation 评级方面，检查种族差异，黑人患者仅在历史上被划定为红线的社区中，30 天再入院率（RR，1.86[95%CI，1.31-2.65]）和复合再入院率及死亡率（RR，1.32[95%CI，1.04-1.65]）更高。
历史上的“红线划定”对不同种族的结局可能产生了混合影响，例如，居住在条件较差的社区与黑人患者心力衰竭住院后不良结局风险增加相关，与白人患者风险降低相关。此外，只有在历史上被划定为红线的社区中才存在患者结局的种族差异。需要进一步研究以探索观察到的结局异质性。
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