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

Objectives. To determine whether historical redlining practices were associated with emergency department (ED) presence and capabilities in 2001 and 2022. Methods. Using a repeated, cross-sectional design, we linked census tract-level Home Owners' Loan Corporation classifications to ED locations and characteristics from the National ED Inventory-USA survey in 2001 and 2022. We modeled odds of ED presence and ED capabilities with Home Owners' Loan Corporation classification as the primary predictor variable. We adjusted the models for 2022 using contemporary demographics. Results. Neighborhoods with a Home Owners' Loan Corporation classification of best, compared with hazardous, had higher odds of an ED being present in 2001 (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.04, 1.90), which persisted in 2022 (OR = 1.73; 95% CI = 1.26, 2.37) after adjusting for contemporary demographics. Nonredlined neighborhoods had higher odds of ED presence than did redlined neighborhoods, driven by nonacademic EDs. The odds of having advanced ED capabilities did not differ across Home Owners' Loan Corporation classifications; however, nonredlined neighborhoods had significantly lower odds of ED capabilities. Conclusions. Although historical redlining classifications were associated with ED presence over time, redlining classification was not associated with current ED capabilities. (Am J Public Health. Published online ahead of print July 23, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308568).