Primary Submission Category: Structural factors
Understanding the Legacy of Redlining on Contemporary Inequities in Birth Outcomes: Strengthening Causal Evidence using a Sibling Comparison Approach
Authors: Samantha Gailey Theresa Osypuk
Presenting Author: Samantha Gailey*
In the US, birthing people racialized as Black remain more than twice as likely to experience adverse birth outcomes than other racial/ethnic groups. Scholars and policymakers have recently sought to understand how upstream discriminatory policies and practices, including historical redlining, adversely affect perinatal health. However, research on redlining—or the structural denial of mortgage financing based on neighborhood racial composition in the 1930s—has largely relied on ecological designs in geographically restricted areas, which limit causal understanding of whether redlining underlies contemporary population health inequities. This study improved upon past redlining/population health work by applying a rigorous identification strategy; we used a longitudinal sibling-linked dataset to test whether within-person changes in neighborhood HOLC grade due to moving affected risk of 6 birth outcomes, controlling for unobserved confounders and contemporary neighborhood disadvantage. Results show that moving to “riskier” neighborhoods, defined by historic HOLC grade, is deleterious for infant birthweight and risk of small-for-gestational age among Black, but not white or Hispanic, birthing people. For example, moving from a greenlined (“A” or “Best”) to a redlined (“D” or “Hazardous”) neighborhood corresponds with an average within-person decrease in birthweight of nearly 70 grams among Black birthing people between births. Findings are consistent with evidence that the federal practice of redlining systematically disadvantaged Black families so profoundly that racialized patterns of adverse health remain observable nearly a century later.