Associations between historical redlining, neighbourhood deprivation and chronic health in a cohort of people with a history of injection drug use
Celeste Zinmon-Htet, Jacqueline Erin Rudolph, Amii M Kress, Lauren Zalla, Becky L Genberg, Shruti Mehta, Gregory KirkBackground
Historical redlining, carried out by the Home Owners’ Loan Corporation (HOLC), assigned US neighbourhoods grades A (‘best’) to D (‘hazardous’), institutionalising residential segregation and leaving lasting effects on neighbourhood development and health outcomes. There is limited research examining the association between residence in historically redlined areas, present-day neighbourhood socioeconomic status and chronic disease in Baltimore, Maryland.
Methods
We used 2015–2019 data from the AIDS Linked to the IntraVenous Experience (ALIVE) cohort, an observational study of adults with a history of injection drug use living in or near Baltimore. We included 1335 participants (6568 visits), whose addresses could be assigned an HOLC grade and a 2015 Area Deprivation Index (ADI) percentile. Outcomes included eight chronic health outcomes for which we ran three logistic regression models: HOLC alone, ADI alone and both exposures with an interaction term.
Results
ALIVE participants were predominantly older (median age: 53.5), black (80%) and male (67%). Relative to grade D, prevalence of hypertension was 14% and 6% higher in grades A and B and prevalence of liver disease was 5–6% higher in grades B and C. Overall, ADI was not associated with any outcome. Within grade D, we saw increases of 3%–5% in prevalence of hypertension, HIV, renal disease, lung disease and multimorbidity per 25-percentile increase in ADI.
Conclusions
HOLC grade, ADI and chronic conditions had at most modest relationships. Select chronic diseases had lower prevalence in grade D than in areas with higher grades, which may reflect changes in community resources since the 1930s.