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Historic Residential Redlining and Present-Day Social Determinants of Health, Home Evictions, and Food Insecurity within US Neighborhoods

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Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Objective

Examine the association between historic residential redlining and present-day racial/ethnic composition of neighborhoods, racial/ethnic differences in social determinant of health domains, and risk of home evictions and food insecurity.

Research Design and Methods

We examined data on 12,334 (for eviction sample), and 8996 (for food insecurity sample), census tracts in 213 counties across 37 states in the USA with data on exposure to historic redlining. First, we examined relationships between Home Owners’ Loan Corporation (HOLC) redlining grades (A=”Best”, B=”Still Desirable”, C=”Definitely Declining”, D=”Hazardous”) and present-day racial/ethnic composition and racial/ethnic differences in social determinant of health domains of neighborhoods. Second, we examined whether historic redlining is associated with present-day home eviction rates (measured across eviction filings rates, and eviction judgment rates for 12,334 census tracts in 2018) and food insecurity (measured across low supermarket access, low supermarket access and income, low supermarket access and low car ownership for 8996 census tracts in 2019). Multivariable regression models were adjusted for census tract population, urban/rural designation, and county level fixed effects.

Results

Relative to areas with a historic HOLC grading of “A (Best)”, areas with a “D (Hazardous)” grading had a 2.59 (95%CI=1.99–3.19; p-value<0.01) higher rate of eviction filings, and a 1.03 (95%CI=0.80–1.27; p-value<0.01) higher rate of eviction judgments. Compared to areas with a historic HOLC grading of “A (Best)”, areas rated with a “D (Hazardous)” had a 16.20 (95%CI=15.02–17.79; p-value<0.01) higher rate of food insecurity based on supermarket access and income, and a 6.15 (95%CI =5.53–6.76; p-value<0.01) higher rate of food insecurity based on supermarket access and car ownership.

Conclusions

Historic residential redlining is significantly associated with present-day home evictions and food insecurity, highlighting persistent associations between structural racism and present-day social determinants of health.

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Funding

Effort for this study was partially supported by the National Institute of Diabetes and Digestive Kidney Disease (K01DK131319, PI: Campbell), National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede), the National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker), and the American Diabetes Association (1-19-JDF-075, PI: Walker).

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Authors and Affiliations

  1. Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA

    Sebastian Linde PhD, Rebekah J. Walker PhD, Jennifer A. Campbell PhD, MPH & Leonard E. Egede MD, MS

  2. Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Sebastian Linde PhD, Rebekah J. Walker PhD, Jennifer A. Campbell PhD, MPH & Leonard E. Egede MD, MS

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  1. Sebastian Linde PhD
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Contributions

SL and LEE conceptualized the study; SL performed the statistical analyses; SL, JAC, RJW, and LEE drafted the manuscript. All authors were involved in critical revision of this manuscript content. The final manuscript was approved by all the authors. SL and LEE are the guarantors of this work.

Corresponding author

Correspondence to Leonard E. Egede MD, MS.

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The authors declare that they do not have a conflict of interest.

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Linde, S., Walker, R.J., Campbell, J.A. et al. Historic Residential Redlining and Present-Day Social Determinants of Health, Home Evictions, and Food Insecurity within US Neighborhoods. J GEN INTERN MED 38, 3321–3328 (2023). https://doi.org/10.1007/s11606-023-08258-5

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