Emergency Department Presence and Capabilities in Historically Redlined Areas: 2001 and 2022

Area of Science:

• Public Health
• Health Services Research
• Urban Planning

Background:

• Historical redlining, a discriminatory housing practice, may have lasting impacts on healthcare access.
• Understanding the long-term effects of redlining on healthcare infrastructure is crucial for addressing health disparities.

Purpose of the Study:

• To examine the association between historical redlining (Home Owners' Loan Corporation classifications) and the presence and capabilities of emergency departments (EDs).
• To assess if these associations changed between 2001 and 2022.

Main Methods:

• A repeated, cross-sectional design was used, linking census tract-level HOLC classifications to ED data from the National ED Inventory-USA.
• Statistical models were employed to assess the odds of ED presence and capabilities based on HOLC classification, with adjustments for contemporary demographics in 2022.

Main Results:

• Neighborhoods with "best" HOLC classifications had higher odds of ED presence in both 2001 and 2022 compared to "hazardous" classifications.
• Nonredlined neighborhoods showed higher odds of ED presence, particularly nonacademic EDs, than redlined neighborhoods.
• No significant difference in advanced ED capabilities was found across HOLC classifications, yet nonredlined neighborhoods had lower odds of ED capabilities.

Conclusions:

• Historical redlining is associated with the presence of emergency departments over time.
• Redlining classification was not found to be associated with current advanced ED capabilities.
• These findings highlight the persistent influence of historical housing policies on healthcare access and infrastructure.