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. 2020 Jul;110(7):1046-1053.
doi: 10.2105/AJPH.2020.305656. Epub 2020 May 21.

Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013-2017

Nancy Krieger  1 , Gretchen Van Wye  1 , Mary Huynh  1 , Pamela D Waterman  1 , Gil Maduro  1 , Wenhui Li  1 , R Charon Gwynn  1 , Oxiris Barbot  1 , Mary T Bassett  1
Affiliations

Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013-2017

Nancy Krieger et al. Am J Public Health. 2020 Jul.

Abstract

Objectives. To assess if historical redlining, the US government's 1930s racially discriminatory grading of neighborhoods' mortgage credit-worthiness, implemented via the federally sponsored Home Owners' Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth (< 37 weeks gestation).Methods. We analyzed 2013-2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time of birth to (1) HOLC grade and (2) current census tract social characteristics.Results. The proportion of preterm births ranged from 5.0% in grade A ("best"-green) to 7.3% in grade D ("hazardous"-red). The odds ratio for HOLC grade D versus A equaled 1.6 and remained significant (1.2; P < .05) in multilevel models adjusted for maternal sociodemographic characteristics and current census tract poverty, but was 1.07 (95% confidence interval = 0.92, 1.20) after adjustment for current census tract racialized economic segregation.Conclusions. Historical redlining may be a structural determinant of present-day risk of preterm birth.Public Health Implications. Policies for fair housing, economic development, and health equity should consider historical redlining's impacts on present-day residential segregation and health outcomes.

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Figures

FIGURE 1—
FIGURE 1—
Conceptual Model: Hypothesized Pathways Among Historical Redlining, Neighborhood Trajectories, and Preterm Birth Inequities aRedlining is a racially discriminatory practice in which Home Owners’ Loan Corporation maps rated areas in relation to how credit-worthy they were deemed for mortgages. The grades ranged from A (“best”—green) to B (“still desirable”—blue) to C (“definitely declining”—yellow) to D (“hazardous”—red, giving rise to the term “redlining”). A and B areas were predominantly White and affluent; C and D areas had residents of color, especially African Americans.
FIGURE 2—
FIGURE 2—
Census Tracts (n = 2166) by 1938 Home Owners’ Loan Corporation (HOLC) Grade: New York City Note. NYC = New York City.
See this image and copyright information in PMC

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