Historic Redlining Linked to Worse Cardiovascular Health for Veterans

Redlining, a historical housing discrimination practice, continues to be linked to worse cardiovascular health among U.S. veterans, according to research published in JAMA Network Open.

The analysis used data from the Home Owners’ Loan Corporation (HOLC), a New Deal program that was created by Congress in the 1930s in an attempt to make homeownership more accessible during the Great Depression. But HOLC ended up making it harder for many Americans to get mortgages, classifying areas with large numbers of racial, ethnic and religious minorities as high-risk and coding their neighborhood maps with the red color that gave the practice of redlining its name.

Though HOLC discontinued its mapping in the 1940s, racist housing policies persisted for decades. Redlining was prohibited by the 1968 Fair Housing Act, but it has long been associated with increased disease risk, reduced access to health care and other worse health outcomes.

Researchers used historic HOLC and census data, along with medical data from Veterans Affairs patients, to look at the cardiovascular health of 79,997 veterans with atherosclerotic diseases such as coronary artery disease. They also looked at median household income and education levels and other information to assess the current prosperity of neighborhoods.

The analysis included patients from 81.5 percent of the tracts graded by HOLC. Patients living in areas once given HOLC’s highest grade were likelier to be White, and they had lower rates of cardiovascular risk factors such as smoking, chronic kidney disease, high blood pressure and obesity. Those risk factors were more common in once-redlined neighborhoods. For example, 31.1 percent of veterans living in neighborhoods graded riskiest by HOLC smoked, compared with 27.2 percent of those living in neighborhoods graded as lowest risk.

Patients living in formerly redlined neighborhoods were likelier to be diagnosed with chronic kidney disease, heart failure, diabetes and chronic obstructive pulmonary disease. They also had a nearly 13 percent higher mortality risk and a 14 percent higher risk of having a major cardiovascular event, such as a stroke or heart attack, than their counterparts in other neighborhoods.

The risk is probably the result of a variety of factors, the researchers write. Formerly redlined neighborhoods have worse air quality, for example, and higher noise levels — both of which have been linked to adverse health outcomes. And those whose ancestors faced racism and discrimination may have inherited genetic factors that could affect cardiovascular health, they add.

“This further underscores the idea that one’s surrounding environment is a powerful estimator of health,” the researchers write — even though it has been nearly a century since HOLC introduced redlining. They call for public health experts to consider neighborhood when assessing cardiovascular risk, and suggest that further research be conducted to inform policies around everything from food access to tobacco sales.