Bradford James M, Eldin Maya M, Golestani Simin, Cardenas Tatiana Cp, Trust Marc D, Mery Marissa, Teixeira Pedro G, DuBose Joseph, Brown Lawrence H, Bach Michelle, Robert Michelle, Ali Sadia, Salvo Deborah, Brown Carlos Vr
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX.
Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX.
J Trauma Acute Care Surg. 2024 May 21. doi: 10.1097/TA.0000000000004290.
As part of New Deal era federal housing policy, the Home Owners Loan Corporation (HOLC) developed maps grading US neighborhoods by perceived financial security. Neighborhoods with high concentrations of racial and ethnic minorities were deemed financially unstable and denied federal investment, a practice colloquially known as redlining. The aim of this study was to assess the association of historical redlining within Austin, Texas to spatial patterns of penetrating traumatic injury.
Retrospective cross sectional study utilizing data from violent penetrating trauma admissions between January 1, 2014 - December 31, 2021, at the single Level 1 trauma center in Austin, Texas. Using ArcGIS, addresses where the injury took place were geocoded and spatial joining was used to match them to their corresponding census tract, for which 1935 HOLC financial designations are classified as: "Hazardous", "Definitely Declining", "Still Desirable", "Best", or "Non HOLC Graded". Tracts with designations of "Hazardous" and "Definitely Declining" were categorized as Redlined. The adjusted incidence rate ratio comparing rates of penetrating trauma among historically Redlined vs. Not Redlined and Not Graded census tracts was calculated.
1,404 violent penetrating trauma admissions were identified for the study period, of which 920 occurred within the county of interest. Among these, 5% occurred in census tracts that were Not Redlined, 13% occurred in Redlined tracts, and 82% occurred in non HOLC graded tracts. When adjusting for differences in current census tract demographics and social vulnerability, historically Redlined areas experienced a higher rate of penetrating traumatic injury (Not Redlined IRR = 0.42, 95% CI 0.19-0.94, p = 0.03; Not Graded IRR = 0.15, 95% CI 0.07-0.29, p < 0.001).
Neighborhoods unfavorably classified by HOLC in 1935 continue to experience a higher incidence rate of violent penetrating trauma today. These results underscore the persistent impacts of structural racism and of historical residential segregation policies on exposure to trauma.
Level IV, Prognostic and Epidemiological.
作为新政时代联邦住房政策的一部分，房主贷款公司（HOLC）绘制了地图，根据感知到的金融安全状况对美国社区进行评级。种族和少数民族高度集中的社区被认为金融不稳定，被拒绝获得联邦投资，这种做法俗称“红线划定”。本研究的目的是评估德克萨斯州奥斯汀市历史上的红线划定与穿透性创伤的空间模式之间的关联。
采用回顾性横断面研究，利用2014年1月1日至2021年12月31日期间德克萨斯州奥斯汀市唯一的一级创伤中心暴力穿透性创伤入院数据。使用ArcGIS对受伤发生地点的地址进行地理编码，并使用空间连接将其与相应的人口普查区匹配，1935年HOLC的金融指定被分类为：“危险”、“肯定衰退”、“仍然理想”、“最佳”或“非HOLC分级”。指定为“危险”和“肯定衰退”的区域被归类为红线划定区域。计算了比较历史上红线划定区域与未红线划定和未分级人口普查区穿透性创伤发生率的调整发病率比值比。
在研究期间确定了1404例暴力穿透性创伤入院病例,其中920例发生在感兴趣的县内。其中，5%发生在未红线划定的人口普查区，13%发生在红线划定区域，82%发生在非HOLC分级区域。在调整当前人口普查区人口统计学和社会脆弱性差异后，历史上红线划定的地区穿透性创伤发生率较高（未红线划定区域发病率比值比=0.42，95%置信区间0.19 - 0.94，p = 0.03；未分级区域发病率比值比=0.15，95%置信区间0.07 - 0.29，p < 0.001）。
1935年被HOLC不利分类的社区如今暴力穿透性创伤的发病率仍然较高。这些结果强调了结构性种族主义和历史住宅隔离政策对创伤暴露的持续影响。
四级，预后和流行病学。
