study highlights that redlining is a factor in premature birth | Health news from the healthiest communities

Now a new study focused on Rochester, New York, points to redness – a government-backed New Deal-era practice that effectively segregated neighborhoods and discouraged investment in minority communities – helping fuel preterm birth rates that are significantly higher for black mothers than for black mothers. their white peers.

Published in the JAMA Network Open, the study suggests that the influence of long-term systemic racism and structural inequalities potentially “spills over into time, with impacts that extend beyond measurable socio-economic inequalities.”

Two co-authors of the study – Elaine hill, economist in the Department of Public Health Sciences at the University of Rochester Medical Center, and Dr Stefanie Hollenbach, an assistant professor in the Department of Obstetrics and Gynecology at URMC – told US News in a joint email interview that the results “were striking but, unfortunately, not surprising.”

Neighborhoods that were primarily deemed undesirable for investment and mortgage lending decades ago “were associated with a persistent and increased risk” of women delivering before their babies were full, according to Hill and Hollenbach. The findings come amid what the study calls “particularly large racial and ethnic disparities in the United States, with non-Hispanic black women having a preterm birth rate at least 50% higher than non-Hispanic white women.”

Using birth certificate information gleaned from a database of nine counties in the Finger Lakes region in new York State, the study compared obstetric outcomes from 2005 to 2018 with a loan company of historical owners Rochester map. The HOLC was a government-backed agency that used refinancing to deal with foreclosures during the Great Depression, and its color-coded maps ranked urban neighborhoods by perceived risk for the investment. Neighborhoods with more people of color or immigrant groups were often classified as risky and colored red, which many believe fueled a system of segregation in which people were unable to access typical home loans and poor communities, mostly in the minority, suffered lack of significant investment.

The study covered more than 64,000 births within 15 postal codes corresponding to one or more HOLC classifications: “A contemporary postal code overlapping the historical designation D ‘Dangerous’ and (a) contemporary postal code overlapping characterized historic regions. as A “Best” or B “Always desirable”, according to the study.

The researchers found that the prevalence of preterm births was lowest at 7.55% in the postal code historically defined as “Best” or “Still desirable” and was highest – at 12.38% – in the postal code. historically defined as “Dangerous”. In the classifications between the two extremes, the share of premature births varied from 11.14% in the “still desirable” or “sharply declining” areas, to 9.68% in the “sharply declining” areas and 11.91 % in “dangerous” or “sharply declining” areas.

An association between preterm births and redlining was present even when researchers adjusted poverty at the community level, educational level, and maternal and paternal race. Researchers also found higher odds of severe maternal depression, substance use disorders, pregnancy-associated hypertension, and neonatal complications in women and births in the “dangerous” zone compared to those in the “Best” or “Still desirable” zone.

“These associations highlight echoes of the past – conferring higher morbidity on members of communities affected by a legacy of divestment,” the study said.

In the study, the researchers recognized that their work is limited by the fact that only 1 zip code each falls into the extreme positive and negative ends of the HOLC designation. However, given that the study’s data range begins in 2005 – almost 40 years after the Federal Fair Housing Act Redlining banned – it presents more evidence that historical and negative designations of some neighborhoods appear to have “a lingering impact on health inequalities that is influenced by race, but also extends beyond this social construct” Hill and Hollenbach told US News.

Babies born early usually have a greater degree of health problems than babies born after 37 weeks gestation, which can include serious problems with major organs such as the brain and lungs. Premature infants often have to spend time in hospital intensive care units after birth, are at a higher risk of hospital readmission or death upon return home, and may have chronic health problems over the course of their life. their life.

Hill and Hollenbach say they recognized it as an opportunity to explore “how this historical basis of institutionalized racism might impact modern outcomes.” They say their research underscores the need to examine the legacy of systemic racial discrimination to “find out” why black women and their newborns are at higher risk of complications than whites, “as well as a variety of problems. ‘other health problems’.

Redlining cards, they say, can be a key to unlocking ways to eliminate health disparities.

“If we hope to reduce and eventually eliminate health inequalities, including racial disparities in outcomes, a broader understanding of the contributions to these disparities is essential to inform interventions to dismantle them,” they say. “Redlining maps are now available for over 200 cities across the United States and could be used to target these interventions. “

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