Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013-2017.
Nancy Krieger, Gretchen Van Wye, Mary Huynh, Pamela D Waterman, Gil Maduro, Wenhui Li, R Charon Gwynn, Oxiris Barbot, Mary T Bassett
Abstract
To assess if historical redlining, the US government's 1930s racially discriminatory grading of neighborhoods' mortgage credit-worthiness, implemented via the federally sponsored Home Owners' Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth (< 37 weeks gestation). We analyzed 2013-2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time of birth to (1) HOLC grade and (2) current census tract social characteristics. The proportion of preterm births ranged from 5.0% in grade A ("best"-green) to 7.3% in grade D ("hazardous"-red). The odds ratio for HOLC grade D versus A equaled 1.6 and remained significant (1.2; < .05) in multilevel models adjusted for maternal sociodemographic characteristics and current census tract poverty, but was 1.07 (95% confidence interval = 0.92, 1.20) after adjustment for current census tract racialized economic segregation. Historical redlining may be a structural determinant of present-day risk of preterm birth. Policies for fair housing, economic development, and health equity should consider historical redlining's impacts on present-day residential segregation and health outcomes.
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Community Reviews
kayo
12/12/2025
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- worse home owners' loan corporation (HOLC) grades = higher prevalence of adverse maternal & census tract characteristics w/ worst tercile for racialized economic segregation - preterm birth sig associated w/ HOLC grade & both maternal and census tract characteristics - structural racism, past & present, can affect current adverse health outcomes, net maternal sociodemographic characteristics, and diverse current census tract characteristics