Historical redlining linked with stroke prevalence in NYC

Story at a glance

• First introduced in the 1930s, redlining refers to a discriminatory housing practice that took a disproportionate toll on Black communities.

• It officially ended in 1968 thanks to the passage of the Fair Housing Act.

• But numerous studies have found a link between the practice and poor modern day health outcomes. 

Structural racism in the form of housing discrimination is associated with modern-day stroke risk for some communities in New York City.

That’s according to new research published Wednesday in JAMA Network Open.

Previous studies have found a similar association between redlining and current heart disease risks and exposure to polluted air.  

The latest research found the link between stroke and redlining remained even after adjusting for contemporary social determinants of health like median household income, race and ethnicity, low educational attainment and common cardiovascular risk factors. 

Redlining refers to discriminatory housing policies in effect from 1934 to 1968 that segregated areas in cities based on housing conditions and racial or ethnic composition.

The policies “disproportionately flagged many inner-city Black communities as hazardous, effectively divesting in their housing and economic development and excluding Black residents from home ownership,” researchers wrote. 

The Home Owners’ Loan Corporation created color-coded maps to differentiate lending risks in each area. Green areas were considered the “most desirable,” red areas were “hazardous” and the lowest rated areas were considered “redlined.” 

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To this day, formerly redlined areas have less access to quality housing stock, transportation, schools, green space and sanitation services. 

In the study, researchers determined weighted scores for historical redlining using the average proportion of original redlined territory overlapped with 2010 census tract boundaries in New York City. They then assessed how redlining compared with other social determinants of health when it came to modern-day stroke prevalence. 

More than 2000 census tracts were included in the analysis. Stroke prevalence was measured using Centers for Disease Control and Prevention data, collected between 2014 and 2018.

“After adjusting for [social determinants of health] and other relevant covariates, the historical redlining score was independently associated with a higher community-level stroke prevalence,” authors wrote. Educational attainment, language barrier, poverty and a shortage of healthcare professionals were all also associated with increased stroke prevalence. 

Although more research is needed on the topic, researchers note the association could be a result of the “constant adverse circumstances associated with living in a historically disinvested community.” These could lead to a lifetime of physical, psychological and financial stress, a burden that is difficult to measure, but could be passed from generation to generation, they said.

Notably, after adjusting for redlining score and other social determinants of health, data showed a higher community prevalence of Black race and/or Hispanic ethnicity was negatively linked with neighborhood stroke prevalence. 

This finding “is consistent with our understanding of the role of race and ethnicity as an identifier of social position rather than a biological risk factor,” researchers said.