Poor health outcomes—including early deaths—linger for decades for those who lived in ‘redlined’ neighborhoods

Redlining—a mid-20th-century federal government practice of denying home loans in African American and other minority neighborhoods—has long been associated with poor health outcomes, including disparate overall mortality rates among racial and ethnic groups.

The term gets its name from the practice by the Home Owners’ Loan Corporation (HOLC, operational from 1933 to 1954) of color-coding maps based on each neighborhood’s level of mortgage creditworthiness, with A being the most creditworthy and D—noted with a red line—the least.

Now, a new study led by a researcher with the Texas A&M University School of Public Health has, for the first time, also identified an association between redlining and an increased risk of death later in life among individuals who experienced the now-defunct practice in 1940.

“Other studies have associated redlining with aggregate mortality rates, but our study has the advantage of using a very large sample size from across the entire country, which allowed us to determine if there was an association with individual risk of death,” said Sebastian Linde, PhD, an associate professor in the Department of Health Policy and Management, who led the study.

For their research, published in JAMA Internal Medicine, Linde and a colleague at the University at Buffalo linked the age of death of 961,719 individuals who lived in redlined neighborhoods in 1940 with their age of death as listed in Social Security Numident data. The neighborhoods were in 30 of the nation’s largest cities.

“We found that these individuals, on average, were 19.2 years old in 1940 and, on average, died at 76.8 years old,” Linde said. “When the statistical model was adjusted for sex, race and ethnicity and any effects that could occur long after exposure to redlined neighborhoods, we found that each one-unit lower HOLC ranking—such as from an A to a B—was associated with an 8 percent likelihood of increased risk of death.”

In addition, at age 65, individuals residing within D (redlined) neighborhoods on average died about 1.44 years sooner than those who lived within the highest-graded areas.

Linde said that although redlining was made illegal with the passage of the Fair Housing Act of 1968, the historic HOLC maps continue to be associated with health and mortality outcomes because the results of investment decisions that supported racial segregation at the time still linger today.

In addition, the practice was one of several that reinforced racial segregation, such as zoning laws that prevented the construction of affordable housing in suburban neighborhoods and the reluctance of the Federal Housing Administration to provide mortgage insurance within majority racial and ethnic minority communities.

“The forces behind housing development and access are complex and multilayered, so we cannot claim that HOLC redlining alone led to the associations we found,” Linde said. “Instead, the results might more accurately be seen as the product of larger public and private forces that were effectively encoded in the HOLC maps.”

In addition, Linde noted that the results should be interpreted as associations rather than causes and effects because he and his colleague used an observational study design and thus did not carry out any interventions to alter an outcome.

Still, Linde said the results underscore the lingering effects of systemic discrimination, and policymakers might want to target the mechanisms through which now-illegal structural inequalities continue to affect human health and well-being today.

By Ann Kellett, Texas A&M University School of Public Health