Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013-2017

Area of Science:

• Environmental Health
• Social Epidemiology
• Reproductive Health

Background:

• Historical redlining, a discriminatory US housing policy from the 1930s, assigned mortgage credit-worthiness based on race.
• This policy, implemented through Home Owners' Loan Corporation (HOLC) maps, created lasting residential segregation and disparities.
• Understanding the long-term health consequences of redlining is crucial for public health.

Purpose of the Study:

• To investigate the association between historical redlining (HOLC grades) and contemporary preterm birth risk.
• To determine if redlining's impact on preterm birth persists after accounting for socioeconomic factors.

Main Methods:

• Analysis of 2013-2017 New York City birth certificate data for singleton births (n=528,096).
• Linking maternal residence to historical HOLC grades and current census tract characteristics.
• Multilevel modeling to adjust for sociodemographic factors and socioeconomic segregation.

Main Results:

• Preterm birth proportions were higher in historically redlined areas (5.0% in Grade A vs. 7.3% in Grade D).
• HOLC Grade D was associated with increased preterm birth odds (OR=1.6), remaining significant after adjustments.
• The association persisted after controlling for maternal factors and poverty, but not fully after accounting for racialized economic segregation.

Conclusions:

• Historical redlining appears to be a significant structural determinant of present-day preterm birth risk.
• The findings underscore the enduring impact of discriminatory housing policies on current health outcomes.
• Addressing historical redlining's legacy is essential for achieving health equity.