Historical Neighborhood Redlining and Contemporary Cardiometabolic Risk

Motairek, Issam; Lee, Eun Kyung; Janus, Scott E.; Farkouh, Michael E.; Freedman, Darcy A.; Wright, Jackson T.; Nasir, Khurram; Rajagopalan, Sanjay; Al‐Kindi, Sadeer G.

doi:10.1016/j.jacc.2022.05.010

Cited by 53 publications

(43 citation statements)

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“…A similar interplay among social standing, race, and stroke has previously been documented and is well established in other chronic diseases with disparate outcomes related to race and ethnicity . The present study adds to the literature by solidifying the association of historical redlining and modern stroke prevalence and is in line with other recent studies showing associations between HRS and community burden of cardiovascular disease …”

Section: Discussionsupporting

confidence: 89%

“…Weighted HRS based on the 4 original Homeowner’s Loan Corporation residential security grades (best, desirable, declining, and hazardous for investment) overlapped on the 2010 census tract boundaries of New York City were obtained from the Inter-University Consortium for Political and Social Research at the University of Michigan . Census tract HRS were computed using the mean proportion of original redlined territory contained within each census tract, similar to methods used in prior studies . Stroke prevalence, including both ischemic and hemorrhagic, and relevant covariates including median age and prevalence of diabetes, hypertension, smoking, and hyperlipidemia were collected for adults 18 years or older at the census tract level from the Centers for Disease Control and Prevention 500 Cities Project (Figure).…”

Section: Methodsmentioning

confidence: 99%

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Historical Redlining, Social Determinants of Health, and Stroke Prevalence in Communities in New York City

et al. 2023

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ImportanceHistorical redlining was a discriminatory housing policy that placed financial services beyond the reach of residents in inner-city communities. The extent of the impact of this discriminatory policy on contemporary health outcomes remains to be elucidated.ObjectiveTo evaluate the associations among historical redlining, social determinants of health (SDOH), and contemporary community-level stroke prevalence in New York City.Design, Setting, and ParticipantsAn ecological, retrospective, cross-sectional study was conducted using New York City data from January 1, 2014, to December 31, 2018. Data from the population-based sample were aggregated on the census tract level. Quantile regression analysis and a quantile regression forests machine learning model were used to determine the significance and overall weight of redlining in relation to other SDOH on stroke prevalence. Data were analyzed from November 5, 2021, to January 31, 2022.ExposuresSocial determinants of health included race and ethnicity, median household income, poverty, low educational attainment, language barrier, uninsurance rate, social cohesion, and residence in an area with a shortage of health care professionals. Other covariates included median age and prevalence of diabetes, hypertension, smoking, and hyperlipidemia. Weighted scores for historical redlining (ie, the discriminatory housing policy in effect from 1934 to 1968) were computed using the mean proportion of original redlined territories overlapped on 2010 census tract boundaries in New York City.Main Outcomes and MeasuresStroke prevalence was collected from the Centers for Disease Control and Prevention 500 Cities Project for adults 18 years and older from 2014 to 2018.ResultsA total of 2117 census tracts were included in the analysis. After adjusting for SDOH and other relevant covariates, the historical redlining score was independently associated with a higher community-level stroke prevalence (odds ratio [OR], 1.02 [95% CI, 1.02-1.05]; P &lt; .001). Social determinants of health that were positively associated with stroke prevalence included educational attainment (OR, 1.01 [95% CI, 1.01-1.01]; P &lt; .001), poverty (OR, 1.01 [95% CI, 1.01-1.01]; P &lt; .001), language barrier (OR, 1.00 [95% CI, 1.00-1.00]; P &lt; .001), and health care professionals shortage (OR, 1.02 [95% CI, 1.00-1.04]; P = .03).Conclusions and RelevanceThis cross-sectional study found that historical redlining was associated with modern-day stroke prevalence in New York City independently of contemporary SDOH and community prevalence of some relevant cardiovascular risk factors.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Historical Redlining, Social Determinants of Health, and Stroke Prevalence in Communities in New York City

et al. 2023

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“…Policies such as community redlining may also be adversely associated with BP and cardiovascular health status. Among adults, this process has been associated with higher rates of CVD and hypertension and poorer cardiometabolic health outcomes …”

Section: Discussionmentioning

confidence: 99%

Association of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware

et al. 2023

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ImportanceThe association between degree of neighborhood deprivation and primary hypertension diagnosis in youth remains understudied.ObjectiveTo assess the association between neighborhood measures of deprivation and primary hypertension diagnosis in youth.Design, Setting, and ParticipantsThis cross-sectional study included 65 452 Delaware Medicaid-insured youths aged 8 to 18 years between January 1, 2014, and December 31, 2019. Residence was geocoded by national area deprivation index (ADI).ExposuresHigher area deprivation.Main Outcomes and MeasuresThe main outcome was primary hypertension diagnosis based on International Classification of Diseases, Ninth Revision and Tenth Revision codes. Data were analyzed between September 1, 2021, and December 31, 2022.ResultsA total of 65 452 youths were included in the analysis, including 64 307 (98.3%) without a hypertension diagnosis (30 491 [47%] female and 33 813 [53%] male; mean [SD] age, 12.5 (3.1) years; 12 500 [19%] Hispanic, 25 473 [40%] non-Hispanic Black, 24 565 [38%] non-Hispanic White, and 1769 [3%] other race or ethnicity; 13 029 [20%] with obesity; and 31 548 [49%] with an ADI ≥50) and 1145 (1.7%) with a diagnosis of primary hypertension (mean [SD] age, 13.3 [2.8] years; 464 [41%] female and 681 [59%] male; 271 [24%] Hispanic, 460 [40%] non-Hispanic Black, 396 [35%] non-Hispanic White, and 18 [2%] of other race or ethnicity; 705 [62%] with obesity; and 614 [54%] with an ADI ≥50). The mean (SD) duration of full Medicaid benefit coverage was 61 (16) months for those with a diagnosis of primary hypertension and 46.0 (24.3) months for those without. By multivariable logistic regression, residence within communities with ADI greater than or equal to 50 was associated with 60% greater odds of a hypertension diagnosis (odds ratio [OR], 1.61; 95% CI 1.04-2.51). Older age (OR per year, 1.16; 95%, CI, 1.14-1.18), an obesity diagnosis (OR, 5.16; 95% CI, 4.54-5.85), and longer duration of full Medicaid benefit coverage (OR, 1.03; 95% CI, 1.03-1.04) were associated with greater odds of primary hypertension diagnosis, whereas female sex was associated with lower odds (OR, 0.68; 95%, 0.61-0.77). Model fit including a Medicaid-by-ADI interaction term was significant for the interaction and revealed slightly greater odds of hypertension diagnosis for youths with ADI less than 50 (OR, 1.03; 95% CI, 1.03-1.04) vs ADI ≥50 (OR, 1.02; 95% CI, 1.02-1.03). Race and ethnicity were not associated with primary hypertension diagnosis.Conclusions and RelevanceIn this cross-sectional study, higher childhood neighborhood ADI, obesity, age, sex, and duration of Medicaid benefit coverage were associated with a primary hypertension diagnosis in youth. Screening algorithms and national guidelines may consider the importance of ADI when assessing for the presence and prevalence of primary hypertension in youth.

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“…It has been shown that an adverse environment for a community in the past can have a long-term negative health consequence in the present [31]. Exposure of a population to just one famine is known to increase the risk of diabetes and ASCVD via multigenerational epigenetic effects [32].…”

Section: How Does Famine Affect Cardiometabolic Risk In Future Genera...mentioning

confidence: 99%

The Susceptibility of South Asians to Cardiometabolic Disease as a Result of Starvation Adaptation Exacerbated During the Colonial Famines

2022

Endocrinol Diabetes Metab J

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South Asians, representing one quarter of the world's population, have disproportionally high rates of obesity and cardiometabolic disease thus resulting an epidemic health crisis. This crisis could be the consequence of epigenetic effects exacerbated during the colonial-era famines resulting in a unique starvation-adapted physiology. Due to evolutionary mismatch in circumstances of abundance, this starvation-adapted physiology can become harmful. Evidence for this starvation adaptation in South Asians includes high body fat and unfavorable adipokines; low lean body mass; lower resting energy expenditure (compounded by lack of brown adipose tissue); greater insulin resistance and insulin response; exaggerated lipemic response to fat and sugar intake; less capacity to handle an overabundance of food; lower fat burning (oxidative capacity) and VO2max during aerobic exercise; and energyconserving response to resistance exercise, as well as increased lipoprotein (a) levels. The Roma people, also of South Asian ancestry, may represent an interesting pre-colonial historical control. Physician and patient knowledge of this unique physiology in South Asians will promote a stronger physicianpatient relationship and foster compliance with treatment.

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Historical Neighborhood Redlining and Contemporary Cardiometabolic Risk

Cited by 53 publications

References 5 publications

Historical Redlining, Social Determinants of Health, and Stroke Prevalence in Communities in New York City

Historical Redlining, Social Determinants of Health, and Stroke Prevalence in Communities in New York City

Association of Area Deprivation With Primary Hypertension Diagnosis Among Youth Medicaid Recipients in Delaware

The Susceptibility of South Asians to Cardiometabolic Disease as a Result of Starvation Adaptation Exacerbated During the Colonial Famines

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