"Differences in stroke rates, whether we are studying ischemic or hemorrhagic stroke, are usually attributed to biological differences or differences in underlying conditions," said lead study author Jeffrey J. Wing, Ph.D., M.P.H., an assistant professor of epidemiology in the College of Public Health at The Ohio State University in Columbus, Ohio. "Yet, our findings suggest the difference we found in the Columbus area may actually be the result of structural racism."
Beginning in 1936, the Home Owners' Loan Corporation began restricting the sale of homes in certain neighborhoods across the country by redlining or marking neighborhoods by "risk for investment," which equated to race. As a result, residents who lived within these redlined areas were denied home loans, which lowered tax revenues in these communities, thereby reducing investment in schools and services, and creating numerous inequities for residents for multiple generations.
"Even though redlining was abolished in 1968, redlining is a form of structural racism that perpetuated segregation and racial inequities. Accumulating evidence shows this divisive and exclusionary housing practice continues to have long-term effects on the health of many people, even today - more than 80 years later," said study co-author Helen Meier, Ph.D., M.P.H., assistant research scientist at University of Michigan's Institute for Social Research. "Our study is one of the first to link historic redlining in a U.S. city to frequency of stroke."
Researchers examined the association between the discriminatory housing policies of redlining and stroke rates in Columbus, Ohio neighborhoods in 2017. They calculated historic redlining scores for neighborhoods within the boundaries of Columbus based on the degree of redlining. Thus, the greater the redlining, the higher the redlining score.
Researchers then matched the redlining scores with stroke rates measured in the same neighborhoods from the 500 Cities Project. The 500 Cities Project is from the U.S. Centers for Disease Control and Prevention and reports on 27 chronic disease measures for the 500 largest American cities in all 50 states, quantified by city and census tract-level data. They assessed the association between historic redlining scores and stroke rates across neighborhoods in Columbus in 2017.
Researchers found:
Higher historic redlining scores were associated with greater rates of stroke, when comparing the highest to the lowest quartile of historic redlining scores. Neighborhoods in the highest group of historic redlining scores had a 1.48% higher stroke rate, compared to those with the lowest redlining scores. "As different cities across the country declare racism as a public health crisis, it's important to have more research that shows the link between racism and health disparities," Wing said. "Our research has the potential to help change how we treat and care for all individuals and promote equitable access to care that can lead to improved health outcomes."
"Health disparities in stroke are going to persist until we address the legacy of structural racism, of which historical redlining is one form," Meier said. "It's important to document the significant, negative impacts of structural racism on health."
Study limitations include people who had a history of stroke may not have always resided in the same census tract, leading to unmeasured variability in redlining exposure. In addition, this is an ecologic-designed study, where redlining exposure was combined with stroke rate to a neighborhood level, which limits the assessment of individual associations, Wing added.
The American Heart Association recently published a presidential advisory that names structural racism as a cause of poor health and premature death from heart disease and stroke. The advisory, titled "Call to Action: Structural Racism as a Fundamental Driver of Health Disparities," reviews the historical context, current state and potential solutions to address structural racism in the U.S. and outlines steps the Association is taking to address and mitigate the root causes of health care disparities.
INFORMATION:
Co-authors of the study are Emily E. Lynch, M.P.H.; Sarah E. Laurent, Ph.D. candidate; Bruce C. Mitchell, Ph.D.; and Jason Richardson, M.A. The authors' disclosures are listed in the abstract.
Meier's work was funded in part by the Shaw Scientist Award from the Greater Milwaukee Foundation. Wing reports no study funding.
Additional Resources:
Multimedia is available on the right column of release link https://newsroom.heart.org/news/structural-racism-communities-with-higher-redlining-scores-had-higher-rates-of-stroke?preview=cda802f68a8cb4086b88134ed14788de
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Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.
The American Stroke Association's International Stroke Conference (ISC) is the world's premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 will be held virtually, March 17-19, 2021. The 3-day conference features more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.
About the American Stroke Association
The American Stroke Association is devoted to saving people from stroke -- the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.
