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. 2025 Jun;4(6 Pt 2):101830.
doi: 10.1016/j.jacadv.2025.101830.

Historical Redlining and Cardio-Kidney-Metabolic Disease Risk Factors, Prevalence, and Outcomes: A Scoping Review

Ramzi Ibrahim  1 , Dwani Patel  2 , Hoang Nhat Pham  2 , Mahmoud Abdelnabi  3 , Girish Pathangey  3 , Issam Motairek  4 , Khurram Nasir  5 , Sadeer Al-Kindi  5
Affiliations

Historical Redlining and Cardio-Kidney-Metabolic Disease Risk Factors, Prevalence, and Outcomes: A Scoping Review

Ramzi Ibrahim et al. JACC Adv. 2025 Jun.

Abstract

Background: Cardio-kidney-metabolic (CKM) diseases impact a large portion of the U.S. population each year, particularly among racial minorities and socially disadvantaged groups. Social factors contribute to this disparity, including barriers to healthcare access, structural racism, and sociocultural influences.

Objectives: This scoping review aimed to assess the understanding of how historical redlining has affected the prevalence and outcomes of CKM diseases.

Methods: We conducted a scoping review of multiple databases to identify studies examining the relationship between historical redlining and the risk factors, prevalence, and outcomes associated with CKM diseases. Data extraction focused on the type of study, linked databases, research questions, primary outcomes, and study quality.

Results: From an initial pool of 176 studies identified, 13 were included. Among these, 6 studies explored the impact of historical redlining on cardiovascular disease risk factors, prevalence, and metabolic disorders; 2 studies examined historical redlining in relation to heart failure; 2 studies focused on kidney disease; and 3 studies investigated atherosclerotic disease. Our findings indicate an association between historically redlined regions and increased prevalence of cardiovascular disease risk factors, heart failure events, metabolic disease burden, and kidney failure incidence. The appraisal of these studies showed that the majority met 20 to 22 of the criteria outlined in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist.

Conclusions: This scoping review highlighted significant associations between historically redlined neighborhoods in the United States and the prevalence and outcomes of CKM diseases. These findings have revealed the potential impact of structural racism and discriminatory practices on healthcare inequities.

Keywords: cardio-kidney-metabolic disease; healthcare inequities; historical redlining; social determinants of health (SDoH).

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Conflict of interest statement

Funding support and author disclosures This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

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Graphical abstract
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PRISMA Diagram
Central Illustration
Central Illustration
Historical Redlining and its Association With Cardio-Kidney-Metabolic Disease Risk Factors, Prevalence, and Outcomes Created using Biorender.com.
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