More than 50 years after the practice of redlining was banned, veterans living in neighborhoods where previous residents had been denied home loans or other benefits have a higher incidence of heart disease and other chronic conditions, according to research published last week in JAMA Network Open.
Examining the medical records of nearly 80,000 cardiovascular patients in the Veterans Health Administration against the backdrop of historic Home Owners' Loan Corporation maps and census data, the researchers found that veterans living in neighborhoods once redlined by the federal government had a nearly 13% higher risk of death from any cause and a 15% higher risk of a major heart attack than veterans who lived in the most desirable areas as deemed by the HOLC.
"Even nearly a century after its elimination, redlining is still adversely associated with cardiovascular events nationally," they wrote.
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The veterans living in formerly redlined neighborhoods also had a higher incidence of smoking, obesity, diabetes, chronic kidney disease and chronic obstructive pulmonary disease.
Previous studies also have shown that those living in formerly redlined areas have worse outcomes. The researchers, led by Dr. Salil Deo, a surgeon at the Louis Stokes Veterans Affairs Hospital in Cleveland, sought to determine whether there was any link between neighborhood redlining and cardiovascular health in a large population -- in this case, veterans who live in neighborhoods once deemed undesirable by the federal government.
The Home Owners' Loan Corporation was created in the 1930s by Congress to provide Americans a pathway to homeownership amid the Depression. The HOLC ranked neighborhoods in 200 cities from least to most risky, with the "A" neighborhoods, color-coded as green, considered to be the most likely to go up in value, and "D" neighborhoods, outlined in red, as most at risk for declining property values.
The "D" neighborhoods often were areas with mostly Black residents who subsequently were denied home loans backed by federal insurance programs. The designation denied residents any opportunity for upward mobility, led to disinvestment by companies, and increased segregation.
The practice of redlining was banned by the Fair Housing Act of 1968, which prohibited housing discrimination. But previous studies have shown that the neighborhoods, which are still primarily made up of Black and Hispanic residents, continue to have worse health outcomes. Researchers set out to determine how these conditions affect veterans living in these neighborhoods today.
They found that, of the veterans studied, nearly 82% lived in neighborhoods formerly categorized by the HOLC. Veterans living in "A" neighborhoods were more likely to be white and had lower rates of smoking, obesity, high cholesterol and high blood pressure, while their counterparts in the "D" neighborhoods had worse outcomes.
The authors said the reasons behind the differences "remain speculative and likely multifactorial," but added that contributing factors could include the dearth of green space or recreational areas in formerly redlined neighborhoods; a lack of access to healthy food; and higher levels of pollution -- not only in the air, soil and water but also noise and light pollution, which can cause stress and negatively impact health.
They also noted that the effects of racial discrimination and segregation over time may be "transgenerational" as the result of genetic factors that could contribute to overall health, cardiovascular strength and resilience.
The study had several limitations, according to researchers, including that it did not account for veterans who relocated to the studied neighborhoods from elsewhere. It also looked only at veterans in the Department of Veterans Affairs health care system who have access to treatment and services and not the entire veteran population of a neighborhood, which they said may actually have diminished the results of redlining.
"Nevertheless, these findings in a veterans' population that represents a large geographically and racially diverse contemporary cohort with atherosclerotic vascular disease ... shed light on racist residential policies and environmental disinvestment in a high-risk population," they wrote.
The researchers said the study has implications for physicians and public health policy, noting that it highlights the need to consider a patient's neighborhood characteristics when exploring their cardiovascular risk and appraise the role of structural racism in patient care.
They also said that steps should be taken to improve formerly redlined neighborhoods, such as increasing green space, reducing access to tobacco by increasing taxes and limiting sales, increasing access to healthy food, and reaching patients through non-standard methods of care, such as mobile health clinics.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter and Threads @patriciakime.
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