Bauer S J, Spoer B R, Ehrman R, Nnodim Opara I, Wei H, Ellendula R S, Haidar A H, Hardeman M, Levy P D, Korzeniewski S J
Integrative Biosciences Center, Wayne State University, 6135 Woodward Avenue, Detroit, MI, 48202, USA; Department of Family Medicine and Public Health Sciences, Wayne State University, 3939 Woodward Avenue, Detroit, MI, 48201, USA.
Department of Population Health, Division of Epidemiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
Public Health. 2025 Jan;238:181-187. doi: 10.1016/j.puhe.2024.10.022. Epub 2024 Dec 13.
Historic redlining grades that were assigned to US neighborhoods based largely on minority race or ethnicity by the Home Owners Loan Corporation (HOLC) during the 1930s have been linked with adverse health outcomes among neighborhood residents. This review aimed to summarize the quantitative evidence, so we could determine if any findings are replicated and otherwise identify research gaps.
Systematic review.
We conducted a systematic review by searching the PubMed® MEDLINE database for observational studies that reported on health outcomes among people who resided in neighborhoods that were assigned HOLC grades. We assessed quality by allocating points based on whether studies reported the sample size or count of people affected by outcomes (yes = 1 point, no = 2 points), and whether unadjusted magnitudes of association were reported alongside adjusted estimates (yes = 1 point, no = 2 points). The sum score was used to classify each study as high (2 points), average (3 points) or low quality (4 points).
Among the 89 articles identified, 32 met inclusion criteria; 15 were deemed high-quality. The most frequently studied health conditions in order of descending frequency were: i) injury or violence (n = 8), ii) cancer (n = 7), iii) cardiometabolic (n = 6), iv) perinatal (n = 5), v) asthma (n = 2).
People who lived in areas with less desirable HOLC grades tended to suffer higher than expected rates of injury or violence, asthma, adverse pregnancy outcomes, and some cardiometabolic disorders; associations with cancer were mostly null. Methodological differences limited opportunities for direct comparison across studies, and there was significant heterogeneity among the few estimates that were generally comparable. While robust data are lacking, the limited existing evidence supports a possible association between historically redlined areas and heightened risk of adverse health outcomes. Why this association may exist remains unknown.
20世纪30年代，美国房主贷款公司（HOLC）主要根据少数族裔种族或族裔对美国社区划定的历史红线等级，已与社区居民的不良健康结果相关联。本综述旨在总结定量证据，以便我们确定是否有任何研究结果得到重复，并识别其他研究空白。
系统综述。
我们通过检索PubMed® MEDLINE数据库进行系统综述，以查找关于居住在被划定HOLC等级社区的人群健康结果的观察性研究。我们根据研究是否报告受结果影响人群的样本量或数量（是 = 1分，否 = 2分）以及是否在调整估计值的同时报告未调整的关联强度（是 = 1分，否 = 2分）来分配分数，以此评估质量。总分用于将每项研究分类为高质量（2分）、中等质量（3分）或低质量（4分）。
在识别出的89篇文章中，32篇符合纳入标准；15篇被认为是高质量的。按频率从高到低排列，最常研究的健康状况依次为：i）伤害或暴力（n = 8），ii）癌症（n = 7），iii）心脏代谢疾病（n = 6），iv）围产期疾病（n = 5），v）哮喘（n = 2）。
居住在HOLC等级较差地区的人群往往遭受高于预期的伤害或暴力、哮喘、不良妊娠结局以及某些心脏代谢疾病发生率；与癌症的关联大多为无关联。方法学差异限制了跨研究直接比较的机会，并且在少数通常具有可比性的估计值之间存在显著异质性。虽然缺乏有力数据，但现有有限证据支持历史上被划定红线的地区与不良健康结果风险增加之间可能存在关联。这种关联为何存在尚不清楚。
