UH study links poor health outcomes to past ‘red lines’


CLEVELAND — The new study from the Harrington Heart & Vascular Institute of University Hospitals further proves that those who experienced housing discrimination decades ago suffer higher rates or poor health outcomes.

The results were published in the Journal of the American College of Cardiology.

What do you want to know

  • New study continues to prove that housing discrimination seen decades ago continues to have an effect on health
  • Poor health outcomes include heart disease, kidney failure and diabetes
  • In the 1930s, the federal government created the Home Owners’ Loan Corporation, in part to stabilize the housing market during the Great Depression and to provide mortgage refinancing services to some homeowners.
  • HOLC has created maps of nearly 200 US cities that code neighborhoods into four categories, from “best” to “unsafe”: green, blue, yellow, and red

Poor health outcomes include heart disease, kidney failure, and diabetes.

The federal government created the Home Owners’ Loan Corporation in the 1930s to stabilize the housing market during the Great Depression. The HOLC also offered mortgage refinancing services to some homeowners in default and to expand home buying options for some citizens.

There were nearly 200 U.S. cities mapped by the HOLC to denote potential lending risk: A (“best” or green), B (“still desirable” or blue), C (“definitely in decline” or yellow), and D (“dangerous” or red), the latter being considered a “redlined” district.

Black-majority neighborhoods were more often “scarred,” meaning people who lived there were more likely to be denied loans to buy or renovate homes. The practice was not banned until the 1960s.

“Previous studies have shown that black adults living in previously demarcated areas had a lower cardiovascular health score than black adults living in neighborhoods rated A,” said cardiologist Dr. Sadeer Al-Kindi. at UH Harrington Heart & Vascular Institute and co. – author of the study. “Our study is the first to examine the nationwide relationship between red-light districts and cardiovascular disease. It supports findings from previous related studies while showing that historical redlining is associated with increased risk of comorbidities and lack of access to appropriate medical care today.

The study linked redlining maps from the 1930s to current neighborhood maps to examine the prevalence of cardiovascular risk factors and diseases obtained through data from the Centers for Disease Control and Prevention. They were classified by neighborhood category (from A to D, A meaning “lowest risk” and D meaning “highest risk”).

More than 11,000 HOLC-classified census leads and 38.5 million people across the country were included in the study.

Maps compare health issues to former HOLC neighborhoods (photo courtesy of University Hospitals)

The results show an overall increase in rates of obesity, diabetes, high blood pressure and smoking across the A to D grading spectrum.

Nearly double the number of adults ages 18-64 lacked health insurance in D-rated areas compared to those in A-rated areas. Neighborhoods with higher ratings had more routine health visits and better cholesterol screening compared to neighborhoods with a lower score.

“Our group at UH Harrington Heart & Vascular Institute wanted to study redlining in this way to better understand the socio-environmental underpinnings of health inequalities. Such an understanding can provide unprecedented new information with which to attempt to solve the current epidemic of chronic non-communicable diseases,” said Dr. Sanjay Rajagopalan, Division Chief of Cardiovascular Medicine and Academic and Scientific Director of the UH Harrington Heart & Vascular. Institute.

Rajagopalan also holds the Herman K. Hellerstein, MD Chair in Cardiovascular Research.

“UH is committed to improving the health of all people in Northeast Ohio by advancing science and human health and this study provides a foundation for programs like ACHIEVE Greater,” Rajagopalan said.

ACHIEVE Greater, announced last year, is an initiative funded by a transformative $18.2 million grant from the National Institutes of Health. Through this initiative, University Hospitals will provide care for people living in the Cuyahoga Metropolitan Housing Authority. More than half of Metropolitan Housing Authority units fall into a previously highlighted category.

“ACHIEVE Greater has the ultimate goal of reducing cardiovascular complications and hospitalizations by improving blood pressure, lipid and glucose targets for black patients at risk for heart health issues,” said Dr. Rajagopalan, who is also the principal investigator of the ACHIEVE Greater Cleveland team.

Health workers will visit communities to provide personalized health advice, such as diet and exercise, and services including blood pressure, cholesterol and average blood sugar screenings.

“The mission of the University Hospitals is to treat, teach and discover. With our redlining study, we have confirmed a problem that needs to be fixed. Now, armed with this crucial information, we have the opportunity to heal and the duty to act,” said Dr. Mehdi Shishehbor, president of the UH Harrington Heart & Vascular Institute and Angela and James Hambrick Chair in Innovation.


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