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

CLEVELAND — New research from University Hospitals’ Harrington Heart & Vascular Institute further provides evidence that those who faced housing discrimination decades ago suffer a higher rate or poorer health outcomes.

The findings are published in the Journal of the American College of Cardiology.


what you should Know

  • New study continues to show that housing discrimination we faced 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 offer home mortgage refinancing services to some homeowners
  • HOLC created maps of nearly 200 U.S. cities that color-code neighborhoods into four categories from “best” to “dangerous”: 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. HOLC also offered home mortgage refinancing services to some defaulting homeowners and to expand home buying opportunities for some citizens.

There were nearly 200 U.S. cities mapped by HOLC to indicate potential credit risk: A (“best” or green), B (“still desirable” or blue), C (“definitely declining” or yellow), and D (“dangerous” or red), the latter being considered a “red line” neighborhood.

Majority-black neighborhoods were more often “redlined,” meaning people living there were more likely to be denied a loan to buy or repair homes. The practice was not outlawed until the 1960s.

“Earlier studies have shown that black adults living in previously red-lined neighborhoods had lower cardiovascular health outcomes than black adults living in A-rated neighborhoods,” said Dr- Dr. Sadeer Al-Kindi, a cardiologist at the UH Harrington Heart & Vascular Institute and co-author of the study. “Our study is the first to examine the national association between red-lined neighborhoods and cardiovascular disease. It supports the results of previous related studies, further showing that historical flushing is associated with increased risk of comorbidities and lack of access to appropriate medical care today.

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

More than 11,000 HOLC-classified census tracts and 38.5 million people nationwide were included in the study.

Maps compare health issues to past HOLC neighborhoods (Photo courtesy of University Hospitals)

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

Nearly twice as many adults between the ages of 18 and 64 had no health insurance in Class D areas compared to those in Class A areas. Better-scoring neighborhoods had more routine health visits and better screening for cholesterol compared to worse-rated neighborhoods.

“Our group at the UH Harrington Heart & Vascular Institute wanted to study the red line in this way to better understand the socio-ecological basis of health disparities. Such understanding may provide unprecedented new information with which to try to solve the current epidemic of chronic noncommunicable diseases,” said Dr. Sanjay Rajagopalan, chief of the Division of Cardiovascular Medicine and Chief Academic and Scientific Officer of UH Harrington Heart & Vascular Institute.

Rajagopalan is also the Herman K. Hellerstein, MD, Chair of Cardiovascular Research.

“UH is committed to improving the health of all people in Northeast Ohio through advances in science and human health, and this research provides a foundation for programs like ACHIEVE GreatER,” Rajagopalan said.

ACHIEVE GreatER, announced last year, is an initiative funded by an $18.2 million grant from the National Institutes of Health. Through the initiative, University Hospitals will provide care for residents of the Cuyahoga Metropolitan Housing Authority. More than half of the Metropolitan Housing Authority’s units fall into a category that was previously red.

“ACHIEVE GreatER has the ultimate goal of reducing cardiovascular complications and hospitalizations by improving blood pressure, lipids, and glucose in black patients at risk for cardiovascular disease,” said Dr. Rajagopalan, who is also the team’s principal investigator. ACHIEVE Greater Cleveland.

Health workers will go into 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 university hospitals is to treat, educate and discover. With our research on the red line, we have confirmed a problem that needs to be addressed. Now, armed with this important information, we have an opportunity to heal and we have a duty to act,” said Dr. Mehdi Shishehbor, president of the UH Harrington Heart & Vascular Institute and Angela and James Hambrick Chair of Innovation.

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