历史上的红线政策与当前的非自杀性枪支致死事件

Historical Redlining and Present-Day Nonsuicide Firearm Fatalities.

机构信息

Department of Pediatrics, Boston Children's Hospital, and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts (A.D., K.J.B.).

Harvard T.H. Chan School of Public Health, Boston, Massachusetts (C.K.).

出版信息

Ann Intern Med. 2024 May;177(5):592-597. doi: 10.7326/M23-2496. Epub 2024 Apr 23.

DOI:10.7326/M23-2496

PMID:38648643

Abstract

BACKGROUND

Redlining began in the 1930s with the Home Owners' Loan Corporation (HOLC); this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. It is important to understand the potential health implications of this federally sanctioned segregation.

OBJECTIVE

To examine the relationship between historical redlining policies and present-day nonsuicide firearm fatalities.

DESIGN

Maps from the HOLC were overlaid with incidence of nonsuicide firearm fatalities from 2014 to 2022. A multilevel negative binomial regression model tested the association between modern-day firearm fatalities and HOLC historical grading (A ["best"] to D ["hazardous"]), controlling for year, HOLC area-level demographics, and state-level factors as fixed effects and a random intercept for city. Incidence rates (IRs) per 100 000 persons, incidence rate ratios (IRRs), and adjusted IRRs (aIRRs) for each HOLC grade were estimated using A-rated areas as the reference.

SETTING

202 cities with areas graded by the HOLC in the 1930s.

PARTICIPANTS

Population of the 8597 areas assessed by the HOLC.

MEASUREMENTS

Nonsuicide firearm fatalities.

RESULTS

From 2014 to 2022, a total of 41 428 nonsuicide firearm fatalities occurred in HOLC-graded areas. The firearm fatality rate increased as the HOLC grade progressed from A to D. In A-graded areas, the IR was 3.78 (95% CI, 3.52 to 4.05) per 100 000 persons per year. In B-graded areas, the IR, IRR, and aIRR relative to A areas were 7.43 (CI, 7.24 to 7.62) per 100 000 persons per year, 2.12 (CI, 1.94 to 2.32), and 1.42 (CI, 1.30 to 1.54), respectively. In C-graded areas, these values were 11.24 (CI, 11.08 to 11.40) per 100 000 persons per year, 3.78 (CI, 3.47 to 4.12), and 1.90 (CI, 1.75 to 2.07), respectively. In D-graded areas, these values were 16.26 (CI, 16.01 to 16.52) per 100 000 persons per year, 5.51 (CI, 5.05 to 6.02), and 2.07 (CI, 1.90 to 2.25), respectively.

LIMITATION

The Gun Violence Archive relies on media coverage and police reports.

CONCLUSION

Discriminatory redlining policies from 80 years ago are associated with nonsuicide firearm fatalities today.

PRIMARY FUNDING SOURCE

Fred Lovejoy Housestaff Research and Education Fund.

摘要

背景

“红线”政策始于 20 世纪 30 年代的房主贷款公司（HOLC），这种歧视性做法限制了抵押贷款的可用性，并加剧了至今仍存在的集中贫困。了解这种联邦批准的种族隔离政策可能对健康产生的潜在影响很重要。

目的

研究历史上的“红线”政策与当今非自杀性枪支死亡之间的关系。

设计

将 HOLC 的地图与 2014 年至 2022 年非自杀性枪支死亡的发生率叠加。使用多水平负二项回归模型检验现代枪支死亡率与 HOLC 历史评分（A[“最佳”]至 D[“危险”]）之间的关系，控制年份、HOLC 区域人口统计学因素以及州级因素作为固定效应，并为城市设置随机截距。使用 A 级地区作为参考，估计每个 HOLC 等级的每 10 万人的发病率（IR）、发病率比（IRR）和调整后的发病率比（aIRR）。

地点

202 个由 HOLC 在 20 世纪 30 年代进行评级的城市。

参与者

HOLC 评估的 8597 个地区的人口。

测量

非自杀性枪支死亡。

结果

2014 年至 2022 年期间，HOLC 评级地区共发生 41428 例非自杀性枪支死亡事件。枪支死亡率随着 HOLC 等级从 A 级上升到 D 级而增加。在 A 级地区，每年每 10 万人的发病率为 3.78（95%CI，3.52 至 4.05）。在 B 级地区，每年每 10 万人的发病率、IRR 和与 A 地区的 aIRR 分别为 7.43（CI，7.24 至 7.62）、2.12（CI，1.94 至 2.32）和 1.42（CI，1.30 至 1.54）。在 C 级地区，这些值分别为每年每 10 万人 11.24（CI，11.08 至 11.40）、3.78（CI，3.47 至 4.12）和 1.90（CI，1.75 至 2.07）。在 D 级地区，这些值分别为每年每 10 万人 16.26（CI，16.01 至 16.52）、5.51（CI，5.05 至 6.02）和 2.07（CI，1.90 至 2.25）。