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...

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Bibliographic Details
Published in:American journal of public health (1971) Vol. 110; no. 7; pp. 1046 - 1053
Main Authors: Krieger, Nancy, Van Wye, Gretchen, Huynh, Mary, Waterman, Pamela D., Maduro, Gil, Li, Wenhui, Gwynn, R. Charon, Barbot, Oxiris, Bassett, Mary T.
Format: Journal Article
Language:English
Published: United States American Public Health Association 01.07.2020
Subjects:
AJPH Open-Themed Research
Birth
Birth certificates
Birth Outcomes
Census
Censuses
Confidence intervals
Economic development
Economics
Elementary school students
Epidemiology
Fairness
Female
Geography
Gestation
Health disparities
Health status
Home ownership
Housing
Housing - statistics & numerical data
Housing authorities
Housing policy
Humans
Income distribution
Infant, Newborn
Mothers
Neighborhoods
New York City - epidemiology
Other Maternal and Infant Health
Other Race/Ethnicity
Owners
Poverty
Pregnancy
Premature birth
Premature Birth - epidemiology
Public health
Racial discrimination
Racism
Redlining
Residence Characteristics - classification
Residential segregation
Risk
Segregation
Social Segregation
Sociodemographics
Systemic racism
Variables
Worthiness
New York City
United States > US
New York City New York
ISSN:0090-0036, 1541-0048, 1541-0048
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Summary: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.
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N. Krieger led writing of the article, contributed to conceptualizing the study, designed the analyses, oversaw generation of the area-based measures (Home Owners’ Loan Corporation [HOLC] and census-derived), and contributed to interpreting the results. G. Van Wye and M. Huynh co-led acquisition of the NYC DOHMH data and contributed to conceptualizing the study, overseeing conduct of the analyses, interpreting the results, and preparing the article. P. D. Waterman acquired the area-based measures (HOLC and census-derived) and prepared them for analysis; contributed to conceptualizing the study, interpreting the results, and preparing the article; and created the maps. G. Maduro and W. Li co-conducted the analyses and contributed to interpreting the results and preparing the article. R. C. Gwynn contributed to conceptualizing the study, interpreting results, and preparing the article. O. Barbot, as commissioner of the NYC DOHMH, approved acquisition of the NYC DOHMH data and contributed to article preparation. M. T. Bassett, as previous commissioner of NYC DOHMH, provided initial impetus for the analyses and contributed to conceptualizing the study, interpreting the results, and preparing the article. All authors approved submission of the version to be published and agree to be accountable for all aspects of the work.
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ISSN:0090-0036
1541-0048
1541-0048
DOI:10.2105/AJPH.2020.305656