Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013 2017.
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. (Am J Public Health. Published online ahead of print May 21, 2020: e1 e8. doi:10.2105/AJPH.2020.305656)
American journal of public health