Impact of 1940s exposure to redlining on mortality and self-rated health later in life among older adults.

Background Historical redlining policies enacted in the 1930s and 1940s that restricted investment in Black neighborhoods shaped neighborhood conditions that may contribute to inequities in health and mortality among older adults today. Areas "redlined" by the Home Owners' Loan Corporation (HOLC) in the 1930s against Black neighborhoods are associated with worse present-day area-level health outcomes. We examined whether early, personal exposure to redlining close to when the maps were drawn is associated with individual-level mortality hazard (survival time ratio) and self-rated health in older adults. Methods We used mapped 1940 census enumeration districts to assign 1930s HOLC redlining categories (green A ("best"), blue B ("still desirable"), yellow C ("definitely declining"), and red D ("hazardous")) to Health and Retirement Study participants based on 1940 census residence. We applied survey weights and ran a survival analysis with a parametric normal distribution maximum likelihood estimation to account for survivorship bias, and logistic regression on self-rated health, and included analyses stratified by race. Results 1940 HOLC-categorized yellow C (0.62 times the survival time, 95% CI: 0.41, 0.92) and red D (red: 0.59, 95% CI: 0.40, 0.87) exposures were significantly associated with reduced survival time compared to green A in both unadjusted and adjusted models. In stratified analyses, both Black and white residents of redlined areas had worse survival time ratios compared to green A, though the magnitude of effect was larger for Black residents than for white residents. Yellow C (Odds Ratio: 1.94, 95% CI: 1.16, 3.23) and red D (2.34, 95% CI: 1.37, 3.98) areas were also associated with increased odds of worse self-rated health compared to green A areas. Discussion Living in redlined areas in the 1940s is associated with worse mortality survival for both Black and white older adults and with decreased self-rated health in older adults between 1992 and 2018. These findings extend beyond broader prior research demonstrating present-day area-level associations of redlining with worse health and are consistent with prior research on individual-level exposure to redlining. Associations with worse mortality in both Black and white residents (with stronger effects in Black residents) are consistent with theory and research demonstrating that structural racism degrades health for all communities.