One of the legacies of the “red line” may be the higher morbidity and mortality rate from COVID-19, which mainly affects minorities and the poor in these neighborhoods, according to a study published at the ATS 2022. Redlining is a federal policy of the Great Depression. in which quarter with large ethnic / racial minority groups federal resources were denied.

“Our research shows that where you live matters,” said presentation author Ernesto Casillas, MD, a researcher at the University of California, San Francisco (UCSF). “Previous studies have shown that the red line is associated with worse outcomes of asthma, fertility and cancer.”

He added: “When the pandemic began, early epidemiological data showed that the most vulnerable groups in our society were affected by COVID-19 disproportionately. As far as we know, no previous study has attempted to assess the role of the red line on COVID-19 health outcomes. Our study has attempted to close this important gap. ”

The sale of housing was a racist mortgage policy imposed by the Federal Homeowners’ Loan Corporation (HOLC), which refused financial assistance to homeowners at risk of losing their homes due to the Great Depression. HOLC literally drew red lines around the neighborhoods and found them less desirable because of the racial and ethnic composition of those neighborhoods. These communities are now vulnerable to poverty, crime and disease. Examples of areas of California with a red line include South and East Los Angeles and areas surrounding San Francisco, Tenderloin County, and Mission.

In this study, Dr. Casillas and his colleagues at UCSF examined census data on cases and deaths from COVID-19 reported to the California Department of Public Health from January 2020 to August 2021. San Francisco, Auckland, Los Angeles, San Jose, Sacramento, Stockton, Fresno and San Diego were included in the study. The researchers then used digital versions of HOLC maps to assign each census area a risk class defined by HOLC (AD, with “D” denoting census tracts in areas with a historic red line). They then conducted a statistical analysis to assess the relationship between HOLC risk and the number of cases and deaths from COVID-19 adjusted for the percentage of women, age, comorbidities and overpopulation. The Healthy Places Index (HPI), the Combined Society Welfare Index, and the Extreme Concentration Index (ICE), a measure of the social division of economically deprived and privileged social groups, were used in separate analyzes to adjust for a set of measures of social conditions.

If the results were not adjusted by any of the methods described above, they showed that as the HOLC class deteriorated, the number of COVID-19 cases and deaths increased. For sites with the worst HOLC score, D (with a red line), the incidence rate (RR) was 3.34 (i.e., 3.34 times higher), compared to the best scores. RR to death was 2.27. In the adjusted models, the RR for COVID-19 cases was 1.28 and the RR for death was 1.62. When adjusted for HPI, the frequency of RR was 1.21 and RR for death was 1.56. Similarly, when adjusted for ICE, the RR for COVID-19 cases was 1.14 and the RR for deaths was 1.38.

“The legacy of red-line housing is still present in almost every major city in America,” said Dr. Casillas. “While generalizing red-line areas outside of California is beyond our current study, other red-line states have similar problems, such as racial segregation, poor access to healthy food, higher poverty, and poor housing quality. These are just some of the factors that make the red line communities vulnerable to serious health outbreaks such as COVID-19. However, more research is needed to better address this issue. ”