The following are six recently-published academic studies of the redlining aspects of housing segregation and the authors' summaries. If available, their section snippets, full-text, other summaries, and publishers are available online via the links.
This study aimed to examine the association of county-level racial and economic residential segregation with mortality rates in the U.S. between 2018 and 2022. Residential segregation was measured by the Index of Concentration at the Extremes and categorized into quintiles. Outcomes included 2018–2022 county-level age-adjusted mortality rates from all causes and the top 10 causes. Multilevel linear mixed modeling was clustered at the state level and adjusted for county's poverty, metropolitan status, and racial composition.
A total of 3,129 counties were included. County-level age-adjusted mortality rates decreased as the segregation level decreased for all causes (from 1,078.8 deaths in the most segregated counties to 734.92 deaths in the least segregated counties per 100,000 persons per year) and for 10 leading causes. Adjusted rate ratios showed dose-response associations between segregation and mortality from all causes and 9 out of 10 leading causes. Using the least segregated counties as the reference group, the adjusted rate ratios (aRR) for all-cause mortality was 1.25 (95% CI=1.22, 1.28), 1.20 (1.17, 1.22), 1.13 (1.11, 1.15), and 1.09 (1.08, 1.10) for the first (most segregated) through the fourth quintile of segregation, respectively.
Racial and economic residential segregation was positively associated with mortality rates at the county level in the contemporary U.S. Future studies should elucidate the mechanisms underlying associations to inform evidence-based interventions and improve the health of the entire population.
We determined if living in historically redlined neighborhoods was associated with level and change in cognitive functioning and if this association differed for Black and White older adults. We linked the Health and Retirement Study 1998–2018 data to redlining scores from the Historic Redlining Indicator data. Our sample included adults aged 50 years and older (24,230 respondents, 129,618 person-period observations). Using three-level linear mixed models, we estimated the relationship between living in historically redlined neighborhoods on level and change in cognitive functioning for pooled and race-stratified samples.
Residents of historically redlined “Declining” and “Hazardous” neighborhoods had lower cognitive functioning scores compared to residents of “Best/Desirable” neighborhoods. Among Black adults, living in “Hazardous” neighborhoods was associated with slower declines in cognitive functioning compared to living in “Best/Desirable” neighborhoods.
Historical redlining is associated with older adults’ cognitive functioning, underscoring the importance of sociohistorical context for the neighborhood–cognition relationship.
Historical redlining, a 1930s-era form of residential segregation and proxy of structural racism, has been associated with breast cancer risk, stage, and survival, but research is lacking on how known present-day breast cancer risk factors are related to historical redlining. We aimed to describe the clustering of present-day neighborhood-level breast cancer risk factors with historical redlining and evaluate geographic patterning across the U.S.
As contemporary neighborhood profiles differ according to historical redlining grade, historical redlining may contribute to current breast cancer disparities. We evaluated whether historical redlining grade is associated with overall 5-year survival in a cohort of breast cancer cases in New York State (NYS). We hypothesize worse redlining grade is associated with lower survival. Methods: This NYS Cancer Registry-based cohort included 60,773 breast cancer cases diagnosed 2008-2018 and in a census tract at diagnosis with a historical redlining grade. Cases were assigned a grade: A (“best”) to D (“hazardous”). Cox models estimated hazard ratios (HR) for 5-year mortality associated with historical redlining grade. We stratified models by case factors and neighborhood characteristics. Results: Five-year survival displayed a significant gradient with historical redlining (P<0.001). Compared to A-grade, residence in B-grade, C-grade, and D-grade neighborhood was associated with a 29%, 37%, and 64% increase in mortality, respectively (P<0.001). Associations persisted after adjustment for health insurance and treatments. Elevated risk associated with D-grade was specifically observed among non-Hispanic White cases, local and regional stage, hormone receptor-positive tumors, non-triple negative cases, and across neighborhood characteristics.
We found significant interaction with redlining grade for race/ethnicity and neighborhood characteristics. Conclusions: Historical redlining was associated with progressively lower survival for each grade among breast cancer cases. Associations are not fully explained by healthcare factors or contemporary neighborhood characteristics. Impact: Historical redlining has lasting effects on contemporary breast cancer survival.
We investigated the association between historic redlining and risk of gestational diabetes mellitus (GDM), and whether this relationship is mediated by maternal obesity and area-level deprivation. This retrospective study included 86,834 singleton pregnancies from Kaiser Permanente Southern California’s health records (2008–2018). Redlining was assessed using digitized Home Owners’ Loan Corporation (HOLC) maps, with patients’ residential addresses geocoded and assigned HOLC grades (A, B, C, or D) based on their geographic location within HOLC-graded zones. For GDM case patients, exposure was assigned based on address at diagnosis date; for non-case patients, it was assigned based on address during the 24th to 28th gestational week. Health records were combined with area deprivation index (ADI) from 2011 to 2015 census data. Mixed-effect logistic regression models assessed associations between redlining and GDM, with mediation by BMI and ADI evaluated using inverse odds ratio weighting. Models were adjusted for maternal age, education, race and ethnicity, neighborhood-level income, and smoking status.
Among the 10,134 (11.67%) GDM case patients, we found increased risk of GDM in B (“still desirable,” adjusted odds ratio [aOR] 1.20, 95% CI 0.99–1.44), C-graded (“definitely declining,” aOR 1.22, 95% CI 1.02–1.47), and D-graded (“hazardous,” i.e., redlined, aOR 1.30, 95% CI 1.08–1.57) neighborhoods compared with the “best”-graded zone. Pre-pregnancy BMI and ADI mediated 44.2% and 64.5% of the increased GDM risk among mothers in redlined areas.
Historic redlining is associated with an increased risk of GDM, mediated by maternal obesity and neighborhood deprivation. Future research is needed to explore the complex pathways linking redlining to pregnancy outcomes.
Although housing discrimination was outlawed in the United States in 1968, historic redlining remains a driver of racialized inequities in environmental health. However, there are many aspects of environmental health that are not yet well-understood in relation to redlining. We investigated the legacy of redlining on social and environmental determinants of health and the spatial distribution of these relationships across Baltimore and Philadelphia. We use publicly available spatial data sources on socio-demographics, built environment, housing, mobility, and arrests to understand the distribution of determinants of health given historic redlining. Multiscale geographically weighted regression was implemented to measure the relationship between these dimensions and redlining grades.
While we identified strong, spatially heterogenous relationships between redlining and social and environmental determinants of health, for nearly all determinants of health, we observed the most adverse characteristics in “C” tracts, indicating a yellow-lining effect. Meanwhile, redlined tracts in both cities exhibited a mix of built environment characteristics, including higher levels of walkability, housing density, renter-occupied housing, and vacancies.
Our findings suggest that while redlining has played a role in shaping neighborhood conditions, other factors, such as ongoing disinvestment and neighborhood transformation processes are likely influential in determining current social and environmental determinants of health.
"Impact of Contemporary Redlining on Healthcare Disparities Among Patients with Gastrointestinal Cancer: A Mediation Analysis." Chatzipanagiotou, O.P., Woldesenbet, S., Munir, M.M. et. al. Annals of Surgical Oncology 32, 1199–1209 (2025). https://doi.org/10.1245/s10434-024-16373-8.
Historically, housing policies have perpetuated the marginalization and economic disinvestment of redlined neighborhoods. Residential segregation persists nowadays in the form of contemporary redlining, promoting healthcare disparities. The current study sought to assess the effect of redlining on oncological outcomes of patients with gastrointestinal cancer and identify mediators of the association.
Patients with colorectal or hepatobiliary cancer were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2007-2019). The contemporary redlining index, a measure of mortgage lending bias, was assessed relative to disease stage at diagnosis, receipt of appropriate treatment, textbook outcome, and mortality. Mediation analysis was used to identify socioeconomic, structural, and clinical mediating factors.
Among 94,988 patients, 32.2% resided in high (n = 23,872) and highest (n = 6,791) redlining census tracts compared with 46.2% in neutral and 21.6% in low redlining tracts. The proportion of Black, Hispanic, and White patients experiencing high and highest redlining was 65.9%, 41.6%, and 27.9%, respectively. Highest redlining was associated with 18.2% higher odds of advanced disease at diagnosis, greater odds of not undergoing surgery for localized disease (adjusted odds ratio [aOR] 1.363, 95% confidence interval [CI] 1.219-1.524) or not receiving chemotherapy for advanced disease (aOR 1.385, 95% CI 1.216-1.577), and 26.7% lower odds of textbook outcome achievement. Mediation analysis for appropriate treatment quantified the proportion of the association driven by socioeconomic status, racial/ethnic minority status, racial/economic segregation, primary care shortage, and housing/transportation.
"Persistent Effect of Redlining on Survival from Screenable Cancers in Washington State, 2000–2018," by Amiri, S., Petras, A. & Buchwald, D. Journal of Urban Health (2025). https://doi.org/10.1007/s11524-025-00973-0.
This study examined the extent to which the 1930s Home Owners’ Loan Corporation (HOLC) redlining grades are associated with contemporary survival from screenable cancers among residents of three largest cities in Washington State. Redling assigned a mortgage security metric to neighborhoods. We used 2000–2018 data from the Washington State Cancer Registry to examine differences in survival from all-cause and cancer-specific mortality for breast (n = 14,725), cervical (n = 656), colorectal (n = 7,089), and lung (n = 8,365). Survival was examined in HOLC areas graded as A (best); B (still desirable); C (declining); and D (redlined) using Kaplan–Meier and Cox proportional hazards regression techniques.
Among patients with breast cancer, the hazard ratio for all-cause mortality was highest for areas graded D followed by C and B. For colorectal and lung cancer, the hazard ratio for all-cause mortality was highest for areas graded C followed by D and B. The estimated marginal slopes for the log hazard of mortality decreased over time in HOLC areas graded A, B, and C for breast and lung cancers, and in areas graded D for colorectal and lung cancers. HOLC grade was not associated with survival among cervical cancer patients. These findings call for efforts to reduce screenable – but often unrecognized – health inequalities associated with residential location.
