{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:35:22Z","timestamp":1791434122236,"version":"4.3.3"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n In the 1930s, the government-sponsored Home Owners\u2019 Loan Corporation (HOLC) established maps of US neighborhoods that identified mortgage risk (grade A [green] characterizing lowest-risk neighborhoods in the US through mechanisms that transcend traditional risk factors to grade D [red] characterizing highest risk). This practice led to disinvestments and segregation in neighborhoods considered redlined. Very few studies have targeted whether there is an association between redlining and cardiovascular disease.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate whether redlining is associated with adverse cardiovascular outcomes in US veterans.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this longitudinal cohort study, US veterans were followed up (January 1, 2016, to December 31, 2019) for a median of 4 years. Data, including self-reported race and ethnicity, were obtained from Veterans Affairs medical centers across the US on individuals receiving care for established atherosclerotic disease (coronary artery disease, peripheral vascular disease, or stroke). Data analysis was performed in June 2022.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Home Owners\u2019 Loan Corporation grade of the census tracts of residence.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The first occurrence of major adverse cardiovascular events (MACE), comprising\u2009myocardial infarction, stroke, major adverse extremity events, and all-cause mortality. The adjusted association between HOLC grade and adverse outcomes was measured using Cox proportional hazards regression. Competing risks were used to model individual nonfatal components of MACE.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 79\u202f997 patients (mean [SD] age, 74.46 [10.16] years, female, 2.9%; White, 55.7%; Black, 37.3%; and Hispanic, 5.4%), a total of 7% of the individuals resided in HOLC grade A neighborhoods, 20% in B neighborhoods, 42% in C neighborhoods, and 31% in D neighborhoods. Compared with grade A neighborhoods, patients residing in HOLC grade D (redlined) neighborhoods were more likely to be Black or Hispanic with a higher prevalence of diabetes, heart failure, and chronic kidney disease. There were no associations between HOLC and MACE in unadjusted models. After adjustment for demographic factors, compared with grade A neighborhoods, those residing in redlined neighborhoods had an increased risk of MACE (hazard ratio [HR], 1.139; 95% CI, 1.083-1.198;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and all-cause mortality (HR, 1.129; 95% CI, 1.072-1.190;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Similarly, veterans residing in redlined neighborhoods had a higher risk of myocardial infarction (HR, 1.148; 95% CI, 1.011-1.303;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) but not stroke (HR, 0.889; 95% CI, 0.584-1.353;\n P<\/jats:italic>\n \u2009=\u2009.58). Hazard ratios were smaller, but remained significant, after adjustment for risk factors and social vulnerability.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of US veterans, the findings suggest that those with atherosclerotic cardiovascular disease who reside in historically redlined neighborhoods continue to have a higher prevalence of traditional cardiovascular risk factors and higher cardiovascular risk. Even close to a century after this practice was discontinued, redlining appears to still be adversely associated with adverse cardiovascular events.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.22727","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T11:00:42Z","timestamp":1689073242000},"page":"e2322727","source":"Crossref","is-referenced-by-count":39,"title":["Association Between Historical Neighborhood Redlining and Cardiovascular Outcomes Among US Veterans With Atherosclerotic Cardiovascular Diseases"],"prefix":"10.1001","volume":"6","author":[{"given":"Salil V.","family":"Deo","sequence":"first","affiliation":[{"name":"Surgical Services, Louis Stokes Veteran Affairs Hospital, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issam","family":"Motairek","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khurram","family":"Nasir","sequence":"additional","affiliation":[{"name":"Houston Methodist Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amgad","family":"Mentias","sequence":"additional","affiliation":[{"name":"Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakov","family":"Elgudin","sequence":"additional","affiliation":[{"name":"Surgical Services, Louis Stokes Veteran Affairs Hospital, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim S.","family":"Virani","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Rajagopalan","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadeer","family":"Al-Kindi","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"issue":"6","key":"zoi230672r1","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1177\/0096144211435126","article-title":"The Federal Home Loan Bank Board, redlining, and the national proliferation of racial lending discrimination, 1921\u20131950.","volume":"38","author":"Woods","year":"2012","journal-title":"J Urban Hist"},{"key":"zoi230672r2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.114696","article-title":"Health outcomes in redlined versus non-redlined neighborhoods: A systematic review and meta-analysis.","volume":"294","author":"Lee","year":"2022","journal-title":"Soc Sci Med"},{"issue":"2","key":"zoi230672r3","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.jacc.2022.05.010","article-title":"Historical neighborhood redlining and contemporary cardiometabolic risk.","volume":"80","author":"Motairek","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"51","key":"zoi230672r4","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2110986118","article-title":"Historical redlining and cardiovascular health: the Multi-Ethnic Study of Atherosclerosis.","volume":"118","author":"Mujahid","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"8","key":"zoi230672r7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0237241","article-title":"Associations between historical redlining and birth outcomes from 2006 through 2015 in California.","volume":"15","author":"Nardone","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"zoi230672r8","doi-asserted-by":"publisher","first-page":"17006","DOI":"10.1289\/EHP7495","article-title":"Redlines and greenspace: the relationship between historical redlining and 2010 greenspace across the United States.","volume":"129","author":"Nardone","year":"2021","journal-title":"Environ Health Perspect"},{"key":"zoi230672r9","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.annepidem.2018.11.008","article-title":"Material community deprivation and hospital utilization during the first year of life: an urban population-based cohort study.","volume":"30","author":"Brokamp","year":"2019","journal-title":"Ann Epidemiol"},{"issue":"9","key":"zoi230672r10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.30853","article-title":"Association of social risk domains with poor cardiovascular risk factor control in US adults with diabetes, from 2006 to 2016.","volume":"5","author":"Corwin","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"4","key":"zoi230672r11","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1021\/acs.estlett.1c01012","article-title":"Historical redlining is associated with present-day air pollution disparities in US cities.","volume":"9","author":"Lane","year":"2022","journal-title":"Environ Sci Technol Lett"},{"issue":"1","key":"zoi230672r12","doi-asserted-by":"publisher","DOI":"10.3390\/cli8010012","article-title":"The effects of historical housing policies on resident exposure to intra-urban heat: a study of 108 US urban areas.","volume":"8","author":"Hoffman","year":"2020","journal-title":"Climate (Basel)"},{"issue":"6","key":"zoi230672r13","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1007\/s11524-022-00665-z","article-title":"The relationship of historical redlining with present-day neighborhood environmental and health outcomes: a scoping review and conceptual model.","volume":"99","author":"Swope","year":"2022","journal-title":"J Urban Health"},{"issue":"4","key":"zoi230672r14","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1080\/13549839.2022.2155942","article-title":"Historical neighbourhood redlining and contemporary environmental racism.","volume":"28","author":"Motairek","year":"2023","journal-title":"Local Environ"},{"issue":"8","key":"zoi230672r15","doi-asserted-by":"publisher","first-page":"e419","DOI":"10.1016\/S2468-2667(20)30162-6","article-title":"Using the right words to address racial disparities in COVID-19.","volume":"5","author":"Milner","year":"2020","journal-title":"Lancet Public Health"},{"key":"zoi230672r16","article-title":"The lingering legacy of redlining on school funding, diversity, and performance. Annenberg Institute for School Reform","author":"Lukes","year":"2021"},{"key":"zoi230672r17","doi-asserted-by":"publisher","DOI":"10.1016\/j.regsciurbeco.2020.103622","article-title":"The long-run effects of the 1930s HOLC \u201credlining\u201d maps on place-based measures of economic opportunity and socioeconomic success.","volume":"86","author":"Aaronson","year":"2021","journal-title":"Reg Sci Urban Econ"},{"key":"zoi230672r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2021.100793","article-title":"The legacy of structural racism: associations between historic redlining, current mortgage lending, and health.","volume":"14","author":"Lynch","year":"2021","journal-title":"SSM Popul Health"},{"issue":"2","key":"zoi230672r19","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1111\/ijur.2009.33.issue-2","article-title":"Redlining revisited: mortgage lending patterns in Sacramento 1930\u20132004.","volume":"33","author":"Hernandez","year":"2009","journal-title":"Int J Urban Reg Res"},{"issue":"10071","key":"zoi230672r20","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1016\/S0140-6736(16)31714-7","article-title":"Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study.","volume":"389","author":"Tawakol","year":"2017","journal-title":"Lancet"},{"issue":"2","key":"zoi230672r21","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1007\/s12350-022-03003-7","article-title":"The combined effect of air and transportation noise pollution on atherosclerotic inflammation and risk of cardiovascular disease events.","volume":"30","author":"Osborne","year":"2023","journal-title":"J Nucl Cardiol"},{"issue":"7","key":"zoi230672r22","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1093\/eurheartj\/ehaa982","article-title":"A leucopoietic-arterial axis underlying the link between ambient air pollution and cardiovascular disease in humans.","volume":"42","author":"Abohashem","year":"2021","journal-title":"Eur Heart J"},{"issue":"8","key":"zoi230672r23","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1111\/soc4.v7.8","article-title":"Transgenerational consequences of racial discrimination for African American health.","volume":"7","author":"Goosby","year":"2013","journal-title":"Sociol Compass"},{"issue":"2","key":"zoi230672r24","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s11524-018-00336-y","article-title":"Understanding embodiment in place-health research: approaches, limitations, and opportunities.","volume":"96","author":"Petteway","year":"2019","journal-title":"J Urban Health"},{"issue":"3","key":"zoi230672r25","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.gheart.2016.08.002","article-title":"The impact of neighborhoods on CV risk.","volume":"11","author":"Diez Roux","year":"2016","journal-title":"Glob Heart"},{"issue":"3","key":"zoi230672r26","doi-asserted-by":"publisher","first-page":"34004","DOI":"10.1289\/EHP9033","article-title":"Walking on a redline: did discriminatory US housing policies affect greenspace development?","volume":"129","author":"Lewis","year":"2021","journal-title":"Environ Health Perspect"},{"issue":"7","key":"zoi230672r27","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.22987","article-title":"Evaluation of restrictions on tobacco sales to youth younger than 21 years in Cleveland, Ohio, area.","volume":"5","author":"Trapl","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi230672r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2022.102775","article-title":"Historical redlining and food environments: a study of 102 urban areas in the United States.","volume":"75","author":"Li","year":"2022","journal-title":"Health Place"},{"issue":"6","key":"zoi230672r29","doi-asserted-by":"publisher","first-page":"e106","DOI":"10.1161\/HYPERTENSIONAHA.122.19088","article-title":"Utilizing mobile health units for mass hypertension screening in socially vulnerable communities across Detroit.","volume":"79","author":"Brook","year":"2022","journal-title":"Hypertension"},{"key":"zoi230672r5","unstructured":"Mapping inequality. Accessed January 30, 2022. https:\/\/dsl.richmond.edu\/panorama\/redlining\/"},{"key":"zoi230672r6","unstructured":"Richardson? J, Mitchell? BC, Meier? HC, Lynch? E, Edlebi? J. Redlining and neighborhood health. 2020. Accessed June 5, 2023. https:\/\/ncrc.org\/holc-health\/#:~:text=As%20our%20results%20showed%2C%20neighborhoods,in%20cities%20across%20the%20country"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2807137\/deo_2023_oi_230672_1688156409.26829.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T11:00:45Z","timestamp":1689073245000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2807137"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,11]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.22727","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,11]]}}}