The Legacy of Redlining: Increasing Childhood Asthma Disparities Through Neighborhood Poverty
Year: 2025
Type: article
Abstract: Historically redlined neighborhoods continue to experience elevated poverty mortgage lending bias, economic inequity, and segregation. Such neighborhoods have less tree canopy and green space and higher temperatures and air pollution. The objective of this analysis is to examine redlining as a root cause of childhood asthma disparities, with the hypothesis that the link between historical redlining and current-day asthma risk is mediated by downstream consequences, including community-level poverty, household income, unemployment, education, and other characteristics.A total of 4839 children who were enrolled in 7 of 12 cohorts participating in the Children’s Respiratory and Environmental Workgroup (CREW) consortium, representing 7 metropolitan regions in the United States.Health and covariate data for each CREW cohort were harmonized. The primary outcome for this analysis was parental report of a physician’s diagnosis of asthma during a cohort study visit before age 12. Information collected at enrollment included participants’ sex, race, ethnicity, parental history of asthma, maternal education, and smoking during pregnancy. Birth record addresses of participants were geocoded on the basis of birth year and merged with tract-level data including the percentage of low-income houses, median household income, percentage without a high school diploma, and percentage unemployed. The authors also linked an area-level socioeconomic deprivation index to the census tract at birth. Original HOLC (Home Owners’ Loan Corporation) maps were digitized and used to calculate the percentage of each census tract area into 1 of 4 HOLC grades, mixed, or “No Grade Assigned.”There were no direct effects between redlining and asthma, but there were significant indirect effects on increased risk for childhood asthma through census tract–level variables, including percentage of low-income households, median household income, percentage of population without a high school diploma, and the socioeconomic deprivation index, compared with children living in more favorably designated tracts.The authors’ analyses suggest that a large proportion (∼80%) of the increased risk in asthma among children living in redlined neighborhoods operates through the mediating pathways represented by neighborhood-level poverty and indices of vulnerability. The downstream consequences of these historically racist policies continue to manifest with present-day health disparities.This study builds on the existing literature concerning the impact of social determinants of health on the incidence and morbidity of childhood asthma but potentially identifies a unique mediator pathway using neighborhoods and, thus, identifies that so-called “redlined neighborhoods,” with their poor housing and lack of historical investment, continue to have effects on health disparities today; it also identifies potential solutions such as improved employment and educational opportunities directed toward such neighborhoods.
Source: PEDIATRICS
Author: Paul V. Williams
Language: English
Subfield: Sociology and Political Science
Field: Social Sciences
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W4416832744
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