Historic Redlining and Impact of Structural Racism on Diabetes Prevalence in a Nationally Representative Sample of U.S. Adults
Authors' conclusion
Redlining has significant direct and indirect relationships with diabetes prevalence. Incarceration, poverty, discrimination, substance use, housing, education, unemployment, and food access may be possible targets for interventions aiming to mitigate the impact of structural racism on diabetes.
Study context
- Population
- U.S. census tracts with historic Home Owners' Loan Corporation (HOLC) grading; diabetes prevalence from CDC PLACES 2019, HOLC maps from Mapping Inequality, census data from Opportunity Insights
- Participants
- 11,375 census tracts
- Exposure
- Historic redlining and diabetes prevalence
- Outcome
- Crude prevalence of diabetes within a census tract (direct and indirect relationships with redlining)
Methodological detailscensus tract-level, structural equation modeling, nationally representative
- Census tract-level
- Structural equation modeling
- Nationally representative
Main finding
As reported in the abstract
Direct association of redlining with crude diabetes prevalence
Redlining directly associated with higher crude diabetes prevalence (P = 0.008)
r = 0.01
Observational data: associations, not effects.
Further findings
Indirect associations of redlining with diabetes prevalence via mediators
- Via incarceration (P < 0.001)
- r = 0.06
- Via poverty (P < 0.001)
- r = −0.10
- Via discrimination (P < 0.001)
- r = 0.14
- Via substance use: binge drinking (P < 0.001)
- r = −0.65
- Via substance use: smoking (P < 0.001)
- r = 0.35
- Via housing (P < 0.001)
- r = 0.06
- Via education (P < 0.001)
- r = −0.17
- Via unemployment (P < 0.001)
- r = −0.17
- Via food access (P < 0.001)
- r = 0.14
- Adjusted for 2010 population
Original publication
Historic Redlining and Impact of Structural Racism on Diabetes Prevalence in a Nationally Representative Sample of U.S. Adults. Diabetes Care. Published 22 February 2024. doi:10.
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