Freifeld Charlotte, Camarero Ava, Oh Joanne, Fairchok Alexandra, Yang Karen, Siegel Michael
Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
J Racial Ethn Health Disparities. 2024 Oct 28. doi: 10.1007/s40615-024-02220-9.
Previous research has documented a strong relationship between currently living in the redlined zones of the 1930s and suffering from a higher prevalence of disease. However, little is known about the relationship between historical redlining, modern-day redlining, and current resident health outcomes. This paper aimed to simultaneously model the associations between both historical redlining and modern-day redlining on current health outcomes.
In this paper, we used structural equation modeling to uncover relationships between current and historical redlining practices and modern-day life expectancy, exploring two levels of potential mediating factors: (1) racial segregation and structural racism; and (2) mediating health outcomes. We analyzed data from 11,661 census tracts throughout the United States using historical redlining data from 1940, modern redlining data from 2010 to 2017, racial segregation and structural racism indices from 2010 to 2019, health outcome data from 2021 to 2022, and life expectancy data from 2010 to 2015. Historical redlining was measured using Home Owners' Loan Corporation (HOLC) ratings, which ranged from 1.0 for favorable neighborhoods ("greenlined") to 4.0 for unfavorable ("redlined") neighborhoods. Modern-day redlining was measured using Home Mortgage Disclosure Act (HMDA) data, which were transformed into four quartiles, ranging from level 1 (low mortgage rejection rates) to level 4 (high mortgage rejection rates).
We found a significant relationship between historic redlining and current life expectancy, with average life expectancy decreasing steadily from 80.7 years in HOLC 1 tracts to 75.7 years in HOLC 4 tracts, a differential of 5.0 years between the greenlined and redlined tracts. We also found a significant relationship between modern-day redlining and current life expectancy, with average life expectancy decreasing steadily from 79.9 years in HMDA 1 tracts to 73.5 years in HMDA 4 tracts, a differential of 6.4 years. In the structural equation model, historical redlining had a total effect of decreasing life expectancy by 1.18 years for each increase of one in the HOLC rating. Modern-day redlining had a total effect of decreasing life expectancy by 1.89 years for each increase of one in the HMDA quartile.
This paper provides new evidence that the legacy of redlining is not relegated to the history books but rather is a present and pressing public health issue today.
先前的研究表明，当前居住在20世纪30年代划定的红线区域与疾病患病率较高之间存在密切关系。然而，对于历史上的红线划定、现代的红线划定与当前居民健康结果之间的关系，我们知之甚少。本文旨在同时建立历史红线划定和现代红线划定与当前健康结果之间的关联模型。
在本文中，我们使用结构方程模型来揭示当前和历史红线划定做法与现代预期寿命之间的关系，探索两个层面的潜在中介因素：（1）种族隔离和结构性种族主义；（2）中介健康结果。我们分析了来自美国11661个人口普查区的数据，使用了1940年的历史红线划定数据、2010年至2017年的现代红线划定数据、2010年至2019年的种族隔离和结构性种族主义指数、2021年至2022年的健康结果数据以及2010年至2015年的预期寿命数据。历史红线划定使用房主贷款公司（HOLC）评级来衡量，评级范围从适宜社区（“绿线”）的1.0到不适宜社区（“红线”）的4.0。现代红线划定使用《住房抵押贷款披露法案》（HMDA）数据来衡量，这些数据被转换为四个四分位数，范围从第1级（低抵押贷款拒绝率）到第4级（高抵押贷款拒绝率）。
我们发现历史红线划定与当前预期寿命之间存在显著关系，HOLC 1区的平均预期寿命从80.7岁稳步下降到HOLC 4区的75.7岁，绿线区和红线区之间相差5.0岁。我们还发现现代红线划定与当前预期寿命之间存在显著关系，HMDA 1区的平均预期寿命从79.9岁稳步下降到HMDA 4区的73.5岁，相差6.4岁。在结构方程模型中，HOLC评级每增加一级，历史红线划定对预期寿命的总影响为降低1.18岁。HMDA四分位数每增加一级，现代红线划定对预期寿命的总影响为降低1.89岁。
本文提供了新的证据，表明红线划定的遗留问题并非只存在于历史书中，而是当今一个现实且紧迫的公共卫生问题。
