Redlining and Prevalent Obesity, Hypertension, and Diabetes in GuLF Study Participants

The Home Owners' Loan Corporation (HOLC) created color-coded maps of more than 200 U.S. cities in the 1930s to facilitate mortgage lending, with redlined neighborhoods marked in red and assigned the "worst" grade (D). Historic redlining has persistent present-day consequences, although few studies have explored redlining in relation to cardiovascular disease risk factors. Cross-sectional associations between living in an area of historic redlining and prevalent obesity, hypertension, and diabetes were evaluated.

At enrollment, participants reported physician-diagnosed diabetes and hypertension, height, weight, and residential address. Redlining was based on available HOLC neighborhood grades (A/B/C/D) linked to participant addresses (N = 1653) at the census-tract level. Modified Poisson regression was used to determine prevalence ratios (PRs) and 95% confidence intervals (CIs) for HOLC grade and obesity, hypertension, and diabetes. Effect measure modification was evaluated by race (Black/White) and oil spill cleanup worker status (yes/no).

Historic redlining (D vs. A/B) was associated with a higher prevalence of obesity (PR = 1.42, 95% CI: 1.09-1.87), hypertension (PR = 1.19, 95% CI: 1.09-1.87), and diabetes (PR = 1.58, 95% CI: 0.71-3.48). In stratified analyses, associations of redlining (D vs. A/B/C) with hypertension (PR = 1.19, 95% CI: 0.91-1.55) and diabetes (PR = 1.47, 95% CI: 0.66-3.66) were suggested only among Black participants. Redlining was associated with obesity among workers (PR = 1.49, 95% CI: 1.23-1.82) but not among non-workers.

Legacy consequences of historic redlining may negatively impact the cardiovascular health of present-day residents.