LAUSR

Background: Coronary heart disease (CHD) is the leading cause of death in the United States (US). Evidence supports adverse neighborhood conditions as a contributor to CHD. However, the impact of discriminatory housing practices, including historic redlining, on CHD across US cities remains understudied. Methods: Data on CHD for US cities were downloaded from the 500 Cities Project. We merged this data with census tract historic redlining data from the Mapping Inequality Project and census tract level demographic data from the American Community Survey. We used linear regressions to examine relationships between historic redlining scores and CHD adjusting for census tract level covariates. Results: 12 cities from the US were included in the analyses. After controlling for covariates, these relationships' strength and significance varied by city and region. In the Northeast/Mid-Atlantic region (Boston, Baltimore, and New York), increases in redlining scores were associated with increases in the proportion of people with CHD (Table). In the Midwest, increases in redlining scores were associated with increases in the proportion of people with CHD in Detroit and Cleveland; this relationship was significant in Detroit and marginally significant in Cleveland. There were no significant associations in Chicago. In the South, census tracts with higher redlining scores were associated with higher CHD prevalence in Miami. Paradoxical relationships were seen in Atlanta where higher redlining scores were associated with a lower proportion of people with CHD; there were no significant associations in Dallas. In the West, increases in redlining scores were associated with increases in the proportion of people with CHD in Los Angeles; relationships were not statistically significant in San Francisco or Seattle. Discussion: This is one of the first studies to suggest differential impact of historic redlining on CHD across US cities. Additional research is needed to examine potential mechanisms that explain these associations.