Structural Racism, Historical Redlining, and Incidence of Kidney Failure in US Cities, 2012–2019

Abstract

Background Historical redlining was a 1930s federally sponsored housing policy that permitted the Home Owners' Loan Corporation (HOLC) to develop color-coded maps and grade neighborhoods' mortgage lending risk on the basis of characteristics that included racial makeup. This practice has been associated with present-day health disparities. Racial inequities in kidney disease—particularly for Black individuals—have been linked to residential segregation and other structural inequities. Methods Using a registry of people with incident kidney failure and digitized HOLC maps, we examined the association between residence in a historically redlined US census tract (CT) with a historical HOLC grade of D or hazardous) and present-day annual CT-level incidence of kidney failure incidence among adults in 141 US metropolitan areas, in 2012 through 2019. Results Age-adjusted and sex-adjusted kidney failure incidence rates were significantly higher in CTs with a historical HOLC grade D compared with CTs with a historical HOLC grade of A or best (mean, 740.7 per million versus 326.5 per million, respectively, a difference of 414.1 per million). Compared with national averages of all adults in our sample, rates of kidney failure incidence were higher for Black adults in our study sample, irrespective of CT HOLC grade. Age-adjusted and sex-adjusted incidence rates for Black persons in CTs with a HOLC grade D were significantly higher than for Black persons residing in HOLC grade A CTs (mean, 1227.1 per million versus 1030.5 per million, respectively [a difference of 196.6 per million]). Conclusions Historical redlining is associated with present-day disparities in kidney failure incidence, demonstrating the legacy of historical racist policies on contemporary racial inequities in kidney health.

The Complex Patchwork of Transportation for In-Center Hemodialysis

“…25 Discriminatory housing practices, socioeconomic displacement, and federal interstate highway construction have created racially, economically, and geographically segregated communities in many parts of the United States. [26][27][28] Historically marginalized groups, including those with low-income, minoritized racial-ethnic groups, and dwelling in remote rural areas, often have disproportionately high rates of ESKD and face greater barriers to optimal treatment for kidney failure. 5,29,30 While evidence is limited, it follows that NEMT benefits and state-level and local-level eligibility for transportation services may disproportionately affect access and quality of care for members of these marginalized groups receiving dialysis.…”

Historic redlining and health outcomes: A systematic review

“…Data for different variables were collected during different time frames. Overall, data ranged from 2010 to 2018. increased preterm birth rates (Hollenbach et al, 2021;Krieger, Van Wye et al, 2020;Nardone, Casey et al, 2020), increased late-stage cancer diagnoses (Krieger, Wright et al, 2020), poorer breast cancer outcomes (Bikomeye et al, 2023), increased prevalence of cardiovascular disease or events (Al-Kindi et al, 2023;Deo et al, 2023;Jadow et al, 2023;Motairek et al, 2022;White et al, 2021;Wing et al, 2022), increased COVID-19 infection and death rates (Li & Yuan, 2022), poorer diabetes outcomes (Linde et al, 2022;White et al, 2021), increased gunshot wounds rates (Benns et al, 2020;Jacoby et al, 2018;Mehranbod et al, 2022;Spitzer et al, 2023), increased heat-related illness rates (Li et al, 2021), increased infant mortality (Huang & Sehgal, 2022;Lynch et al, 2021), increased kidney failure rates (Nguyen et al, 2023), more childhood obesity (Kowalski et al, 2023), increased pedestrian fatalities (Taylor et al, 2023), increase in fatal encounters with police (Mitchell & Chihaya, 2022), worse postoperative outcomes (Diaz et al, 2021), increased maternal mortality (Gao et al, 2022), overall worse self-rated physical health (Lynch et al, 2021;McClure et al, 2019), poorer mental health (Lynch et al, 2021), and increased prevalence of visual impairment and blindness (Hicks et al, 2023).…”

Separate and Unequal: Residential Segregation by Race and Incidence of Kidney Failure

“…Living in segregated neighborhoods is associated with detrimental social determinants of health and also associated with poor health outcomes, including White-Black survival gap. 3 In this issue of JASN, Nguyen et al 4 conducted a study examining differences in kidney failure incidence rates on the basis of residence in historically redlined neighborhoods in 141 metropolitan areas. They found that among adults with incident kidney failure between 2012 and 2019, residence in a historically redlined neighborhood was associated with significantly higher rates of kidney failure, and this association was evident not only for Black residents but also for nearly every demographic subgroup.…”

“…3,4 In the study by Lok et al, for example, when survival rates were determined for all AVFs and AVGs, including those evincing primary failure, AVFs and AVGs have comparable cumulative patency after 10 years of follow-up, 4 with the AVG, indeed, evincing marginally increased patency within the first 2 years. 3,4 It is only when analyses exclude AVFs and AVGs with primary failure that 5 and 2 years of median cumulative patency for AVFs and AVGs, respectively, emerge 3,4 ; this well-publicized statistic, often used in defense of the primacy of AVFs, thus fails to reflect the burden of AVF primary failure and the accompanying CVC dependency such failure necessitates. However, there are other germane issues, including the number of vascular procedures needed to assist AVF maturation and costs in achieving functional AVFs and AVGs.…”