| Title: | Historical Redlining Impacts Contemporary Environmental and Asthma-related Outcomes in Black Adults |
| Address: | "University of Pittsburgh Asthma and Environmental Lung Health Institute@UPMC and. Department of Environmental & Occupational Health, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania" |
| Journal Title: | Am J Respir Crit Care Med |
| DOI: | 10.1164/rccm.202112-2707OC |
| ISSN/ISBN: | 1535-4970 (Electronic) 1073-449X (Print) 1073-449X (Linking) |
| Abstract: | "Rationale: Environmental threats and poorly controlled asthma disproportionately burden Black people. Some have attributed this to socioeconomic or biologic factors; however, racism, specifically historical redlining, a U.S. discriminatory mortgage lending practice in existence between the 1930s and the 1970s, may have actuated and then perpetuated poor asthma-related outcomes. Objectives: To link historical redlining (institutional racism) to contemporary environmental quality- and lung health-related racial inequity. Methods: Leveraging a broadly recruited asthma registry, we geocoded 1,034 registry participants from Pittsburgh/Allegheny County, Pennsylvania, to neighborhoods subjected to historical redlining, as defined by a 1930s Home Owners' Loan Corporation (HOLC) map. Individual-level clinical/physiologic data, residential air pollution, demographics, and socioeconomic factors provided detailed characterization. We determined the prevalence of uncontrolled and/or severe asthma and other asthma-related outcomes by HOLC (neighborhood) grade (A-D). We performed a stratified analysis by self-identified race to assess the distribution of environmental and asthma risk within each HOLC grade. Measurements and Main Results: The registry sampling overall reflected Allegheny County neighborhood populations. The emissions of carbon monoxide, filterable particulate matter <2.5 mum, sulfur dioxide, and volatile organic compounds increased across HOLC grades (all P ??? 0.004), with grade D neighborhoods encumbered by the highest levels. The persistent, dispersive socioenvironmental burden peripherally extending from grade D neighborhoods, including racialized access to healthy environments (structural racism), supported a long-term impact of historical/HOLC redlining. The worst asthma-related outcomes, including uncontrolled and/or severe asthma (P < 0.001; Z = 3.81), and evidence for delivery of suboptimal asthma care occurred among registry participants from grade D neighborhoods. Furthermore, elevated exposure to filterable particulate matter <2.5 mum, sulfur dioxide, and volatile organic compound emissions (all P < 0.050) and risk of uncontrolled and/or severe asthma (relative risk [95% confidence interval], 2.30 [1.19, 4.43]; P = 0.009) demonstrated inequitable distributions within grade D neighborhood boundaries, disproportionately burdening Black registry participants. Conclusions: The racist practice of historical/HOLC redlining profoundly contributes to long-term environmental and asthma-related inequities in Black adults. Acknowledging the role racism has in these outcomes should empower more specific and novel interventions targeted at reversing these structural issues" |
| Keywords: | Adult *Asthma/epidemiology Biological Factors Carbon Monoxide Humans Particulate Matter/adverse effects Residence Characteristics Sulfur Dioxide *Volatile Organic Compounds asthma environment pollution racism redlining; |
| Notes: | "MedlineSchuyler, Alexander J Wenzel, Sally E eng F30 ES033557/ES/NIEHS NIH HHS/ R01 AI145406/AI/NIAID NIH HHS/ F30 ES033557-01/ES/NIEHS NIH HHS/ R01 AI145406-02/National Institute of Allergy and Infectious Diseases/ Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't 2022/05/26 Am J Respir Crit Care Med. 2022 Oct 1; 206(7):824-837. doi: 10.1164/rccm.202112-2707OC" |
