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Associations Between Historically Redlined Districts and Racial Disparities in Current Obstetric Outcomes
Stefanie J Hollenbach1,2, Loralei L Thornburg1, J Christopher Glantz1
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York.
JAMA Network Open
|September 30, 2021
Summary
Historic redlining, a discriminatory housing practice, is linked to higher rates of preterm birth in modern obstetric outcomes. This study highlights the lasting impact of structural racism on maternal health disparities.
Area of Science:
- Public Health
- Sociology
- Obstetrics
Background:
- Racial and ethnic disparities in obstetric outcomes persist in the U.S. despite high healthcare spending.
- Structural racism, including historical discriminatory practices, is a significant factor influencing these disparities.
Purpose of the Study:
- To investigate the association between historical redlining and contemporary obstetric outcomes.
- To understand how past discriminatory housing policies contribute to current racial inequities in maternal health.
Main Methods:
- Retrospective cohort study using birth certificate data (2005-2018) from a 9-county region in New York.
- Matched modern obstetric outcomes with geographic areas based on 1940 Home Owners' Loan Corporation (HOLC) redline maps.
- Used logistic regression to analyze preterm birth rates, controlling for socioeconomic factors and parental race.
Main Results:
- Preterm birth rates increased in areas historically designated as "Hazardous" by redlining compared to "Best" or "Still Desirable" areas.
- These associations remained statistically significant after adjusting for poverty, education, and parental race.
- An adjusted odds ratio of 1.46 for preterm birth was observed in relation to HOLC categories, controlling for socioeconomic factors.
Conclusions:
- The study demonstrates a persistent link between historical redlining and modern obstetric disparities, specifically preterm birth.
- Findings suggest that the legacy of structural inequity, beyond current socioeconomic factors, significantly impacts maternal health.
- Addressing historical injustices is crucial for improving obstetric outcomes and reducing racial disparities in healthcare.
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