Mediating Pathways Between Neighborhood Structural Investment and Cardiometabolic Health Across U.S. Cities

Epidemiologic studies have linked neighborhood socioeconomic conditions to health. However, few have examined neighborhood structural investment influences on cardiometabolic risk markers across urban environments. This study investigated whether neighborhood structural investment varies by historic redlining, associations between neighborhood structural investment and the prevalence of obesity, diabetes, and coronary heart disease and whether the effect of redlining on obesity, diabetes, and coronary heart disease prevalence is mediated by neighborhood structural investment.

Neighborhood structural investment was measured using a composite score based on census tract data from the MapUSA project, which included home value, rent, vacant houses, and structures older than 30 years (with higher scores representing greater investment). Obesity, diabetes, and coronary heart disease prevalence estimates were from the 2024 Centers for Disease Control and Prevention's 500 Cities Project 2024 data. Redlining data from the Home Owners' Loan Corporation scores from the University of Richmond's Mapping Inequality project were analyzed for 16 U.S. cities. Neighborhood structural investment was tested as a mediator of these associations. Models were adjusted for % Black individuals, % of people aged ≥60 years, % of families in poverty, % of people with a college degree, % unemployed, median household income, and length of residency.

Living in a formerly redlined neighborhood was associated with lower neighborhood structural investment longitudinally. Neighborhood structural investment was associated with decreased obesity, diabetes, and coronary heart disease prevalence, but these associations varied by city. Neighborhood structural investment mediated associations between redlining and health outcomes varying by city.

This study suggests that historic redlining is associated with contemporary health outcomes via neighborhood structural investment. These findings can be used to inform cardiometabolic health intervention designs.