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• Posted July 6, 2023

Historic 'Redlining' of Neighborhoods Linked to Black Americans' Rate of Kidney Failure

Decades of “redlining” — discriminatory policies that led to disinvestment in minority communities within the United States — may be connected with current cases of kidney failure in Black adults.

A new study from researchers at Boston University School of Public Health (BUSPH) shows that long-term disinvestment of wealth and resources in historically redlined neighborhoods likely contributes to the disproportionate rate of kidney failure among Black adults today.

“Kidney failure disproportionately affects racial and ethnic minoritized populations, particularly Black individuals, and there is robust evidence linking neighborhood conditions to disparities in kidney disease,” said study lead author Dr. Kevin Nguyen, an assistant professor of health law, policy & management.

“It is therefore possible that in present-day neighborhoods, historical redlining could create conditions such as exposure to pollution, food insecurity and worse health care, which have been shown to contribute to inequitable rates of kidney failure incidence,” Nguyen said in a BUSPH news release.

To study this, the researchers used a national registry of nearly all U.S. adults who received treatment for new kidney failure between 2012 and 2019 in 141 cities.

The investigators also examined digitized maps from the Home Owners' Loan Corporation (HOLC), the government-sponsored corporation that designed color-coded maps beginning in the 1930s to show which residential neighborhoods were safe to insure mortgages. The practice discouraged mortgage lending in predominantly Black neighborhoods.

These neighborhoods were assigned letter grades from A to D for best to hazardous, or "redlined."

Black adults had higher rates of kidney failure regardless of the neighborhood HOLC grade, the study found. However, compared to Black adults in grade A neighborhoods, Black adults living in grade C and D neighborhoods had significantly higher rates of new cases of kidney failure.

New kidney failure was also higher among white, Hispanic and Asian American adults living in areas with HOLC grades from B to D, compared to adults living in grade A neighborhoods, the findings showed.

The study found that all adults living in these redlined areas were more likely to have chronic health conditions, and much less likely to receive pre-dialysis nephrology care or pursue home dialysis.

“Our findings underscore the role of historical racist policies on contemporary neighborhood conditions,” Nguyen said. “Advancing kidney health equity requires understanding that racial disparities in kidney disease are largely the product of structural causes that have systematically disadvantaged Black individuals compared with others and are rooted in historical racist policies such as redlining.”

The study results were published recently in the Journal of the American Society of Nephrology.

More information

The National Kidney Foundation has more on kidney failure.

SOURCE: Boston University School of Public Health, news release, June 29, 2023