Relationship between redlining and heart failure risk strongest in most socioeconomically disadvantaged communities.
Among Black Medicare beneficiaries, historical redlining, a marker of structural racism, is associated with heart failure risk, according to a study published online July 17 in Circulation.
Amgad Mentias, M.D., from the Cleveland Clinic, and colleagues examined the association of redlining with the risk for heart failure among White and Black Medicare beneficiaries. The Mapping Inequality Project was used within each ZIP code to determine ZIP code-level redlining by the proportion of historically redlined areas. The association between higher ZIP code redlining proportion and heart failure risk was assessed separately among White and Black Medicare beneficiaries.
Data were included for 2,388,955 Medicare beneficiaries: 801,452 Black individuals and 1,587,503 White individuals. The researchers found that after adjustment for age, sex, and comorbidities, living in ZIP codes with a higher redlining proportion (quartile 4 versus 1 to 3) was associated with an increased risk for heart failure among Black beneficiaries (risk ratio, 1.08). After further adjustment for area-level Social Deprivation Index, the association remained significant (risk ratio, 1.04). The interaction between redlining proportion and Social Deprivation Index was significant such that there was a significant association for higher redlining proportion with heart failure risk only among socioeconomically distressed regions. Redlining was associated with a lower risk for heart failure after adjustment for age, sex, and comorbidities among White beneficiaries (risk ratio, 0.94).
“Historical redlining policies differentially affect heart failure risk by race in the United States, with redlining conferring a significantly higher risk of heart failure among Black individuals,” the authors write.
Several authors disclosed ties to the pharmaceutical and medical device industries.