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. 2024 Nov 15;210(10):1201-1209.
doi: 10.1164/rccm.202309-1702OC.

The Legacy of Redlining: Increasing Childhood Asthma Disparities through Neighborhood Poverty

Patrick H Ryan  1   2 , Antonella Zanobetti  3 , Brent A Coull  3   4 , Howard Andrews  5 , Leonard B Bacharier  6 , Dakota Bailey  7 , Paloma I Beamer  8   9 , Jeff Blossom  7 , Cole Brokamp  1   2 , Soma Datta  10 , Tina Hartert  11 , Gurjit K Khurana Hershey  1   12 , Daniel J Jackson  13 , Christine C Johnson  14 , Christine Joseph  14 , Jorja Kahn  10 , Nathan Lothrop  8   9 , Margee Louisias  15 , Heike Luttmann-Gibson  3 , Fernando D Martinez  8   16 , Eneida A Mendonça  1   17 , Rachel L Miller  18 , Dennis Ownby  19 , Sima Ramratnam  13 , Christine M Seroogy  13 , Cynthia M Visness  20 , Anne L Wright  8   16 , Edward M Zoratti  14 , James E Gern  13 , Diane R Gold  3   10
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The Legacy of Redlining: Increasing Childhood Asthma Disparities through Neighborhood Poverty

Patrick H Ryan et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Identifying the root causes of racial disparities in childhood asthma is critical for health equity. Objectives: To determine whether the racist policy of redlining in the 1930s led to present-day disparities in childhood asthma by increasing community-level poverty and decreasing neighborhood socioeconomic position (SEP). Methods: We categorized census tracts at the birth address of participants from the Children's Respiratory and Environmental Workgroup birth cohort consortium into categories A, B, C, and D as defined by the Home Owners Loan Corporation, with D being the highest perceived risk. Surrogates of present-day neighborhood-level SEP were determined for each tract, including the percentage of low-income households, the CDC's Social Vulnerability Index, and other tract-level variables. We performed causal mediation analysis, which, under the assumption of no unmeasured confounding, estimates the direct and mediated pathways by which redlining may cause asthma disparities through tract-level mediators adjusting for individual-level covariates. Measurements and Main Results: Of 4,849 children, the cumulative incidence of asthma through age 11 was 26.6%, and 13.2% resided in census tracts with a Home Owners Loan Corporation grade of D. In mediation analyses, residing in Grade-D tracts (adjusted odds ratio = 1.03 [95% confidence interval = 1.01, 1.05]) was significantly associated with childhood asthma, with 79% of this increased risk mediated by percentage of low-income households; results were similar for the Social Vulnerability Index and other tract-level variables. Conclusions: The historical structural racist policy of redlining led to present-day asthma disparities in part through decreased neighborhood SEP. Policies aimed at reversing the effects of structural racism should be considered to create more just, equitable, and healthy communities.

Keywords: asthma; mediation analysis; racism; redlining.

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References

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