Historical Redlining and Change in Blood Pressure: The Multi-Ethnic Study of Atherosclerosis (MESA)

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Abstract
BACKGROUND: Historical redlining may contribute to racial inequities in cardiovascular health. Longitudinal studies are needed to investigate the influence of historical redlining on blood pressure (BP) and its changes over time, and to understand the role contemporary residential segregation plays in this relationship. METHODS: Using the MESA (Multi-Ethnic Study of Atherosclerosis), this study examined associations between redlining, measured using 1930s Home Owners’ Loan Corporation grades, and repeated BP measures. We used race/ethnicity-stratified 3-level mixed-effects models to assess associations between redlining and average BP, as well as changes in BP, across 6 follow-up examinations from 2000 to 2018, accounting for time-varying sociodemographic and health factors. RESULTS: The sample included 4774 adults with a mean baseline age of 61.9 years; the racial/ethnic composition was 26.7% Black, 23.9% Hispanic, 13.3% Chinese, and 36.1% White. Independent of sociodemographic factors, Black participants in redlined neighborhoods graded D had 7.26 mm Hg higher average systolic BP (95% CI, 0.99–13.54) and 3.62 mm Hg higher average diastolic BP (95% CI, 0.64–6.60), compared with those in non-redlined tracts graded A . Contemporary residential segregation modified this association such that the increase was larger in currently segregated Black neighborhoods. When assessing BP changes, we found that the difference in systolic BP for participants in D -graded neighborhoods decreased among Black participants over follow-up. There was no statistically significant association with average BP or BP changes in other racial/ethnic groups. CONCLUSIONS: These findings demonstrated that historical discriminatory policies may have a harmful impact on BP outcomes among Black adults in the United States.

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