1940 年个人层面的住宅红线风险与死亡率风险。

IF 22.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Sebastian Linde, Leonard E Egede
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引用次数: 0

摘要

重要性:历史上的 "红线"(Home Owners' Loan Corporation,HOLC)系统性地拒绝向主要由非洲裔美国人居住的社区的借款人提供信贷的做法)与社区的不良后果有关,但与个人死亡风险的关系尚不明确:目的:研究 1940 年 HOLC 住宅红线做法是否与日后死亡风险增加有关:该研究将 1940 年居住在 HOLC 评级社区(定义为人口普查辖区)内的个人与行政死亡记录数据联系起来。该研究估算了HOLC分级暴露的危险比以及特定年龄的预期寿命差距(55、65和75岁)。采用的方法是对标准参数生存分析进行调整,使其适用于死亡率覆盖窗口有限和幸存者观察不完整的数据。分析样本包括美国 23 个州 30 个最大城市(基于 1940 年人口统计)中 13 912 个辖区内的 961 719 个个人水平观测值。数据分析时间为 2023 年 12 月 1 日至 2024 年 9 月 4 日:主要结果和衡量标准:根据历史上的 HOLC 地图,曝光度为 HOLC 等级,其中 A 代表 "最佳 "或信用良好的地区;B 代表 "仍然理想";C 代表 "肯定会下降";D 代表不值得信用的 "危险 "地区(即红线),主要结果为社会保障 Numident 文件中的死亡年龄:961 719 人的个人样本在 1940 年的平均(标清)年龄为 19.26(9.26)岁,死亡时的平均(标清)年龄为 76.83(9.22)岁。在调整了性别(52.48% 为女性;47.52% 为男性)、种族和民族(7.36% 为非裔美国人;92.64% 为白人)以及潜在地点效应的模型中,HOLC 等级每降低 1 个单位,死亡风险就会增加 8%(危险比为 1.08 [95% CI, 1.07-1.09])。在 65 岁时,HOLC 等级每降低 1 个单位,这些危险比值差距估计为-0.49(95% CI,-0.56 至-0.43)岁:本研究发现,1940 年居住在红线社区的人比居住在其他 HOLC 等级地区的人晚年预期寿命更短。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Individual-Level Exposure to Residential Redlining in 1940 and Mortality Risk.

Importance: Historic redlining, the practice by the Home Owners' Loan Corporation (HOLC) of systematically denying credit to borrowers in neighborhoods that were inhabited by primarily African American individuals, has been associated with poor community outcomes, but the association with individual risk of death is not clear.

Objective: To examine if exposure to residential redlining practices by HOLC in 1940 is associated with increased risk of death later in life.

Design, setting, and participants: The study linked individuals who resided within HOLC-graded neighborhoods (defined as Census Enumeration Districts) in 1940 with administrative death records data. The study estimated hazard ratios as well as age-specific life expectancy gaps (at age 55, 65, and 75 years) for HOLC grading exposure. This was done using methods that adapted standard parametric survival analysis to data with limited mortality coverage windows and incomplete observations of survivors. The analysis sample consisted of 961 719 individual-level observations across 13 912 enumeration districts within 30 of the largest US cities (based on 1940 population counts) across 23 states. Data were analyzed between December 1, 2023, and September 4, 2024.

Main outcome and measures: The exposure was HOLC grade based on historic HOLC maps, with A representing "best" or creditworthy areas; B, "still desirable"; C, "definitely declining"; and D, "hazardous" areas not worthy of credit (ie, redlined), and the main outcome was age at death from the Social Security Numident file.

Results: The 961 719-person individual sample had a mean (SD) age of 19.26 (9.26) years in 1940 and a mean (SD) age at death of 76.83 (9.22) years. In a model adjusted for sex (52.48% female; 47.52% male), race and ethnicity (7.36% African American; 92.64% White), and latent place effects, a 1-unit lower HOLC grade was associated with an 8% (hazard ratio, 1.08 [95% CI, 1.07-1.09]) increased risk of death. At age 65 years, these hazard differentials translated into an estimated life expectancy gap of -0.49 (95% CI, -0.56 to -0.43) years for each 1-unit decrease of the HOLC grade.

Conclusion: This study found that individuals who resided within redlined neighborhoods in 1940 had lower life expectancy later in life than individuals who resided within other HOLC-graded areas.

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来源期刊
JAMA Internal Medicine
JAMA Internal Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
43.50
自引率
1.30%
发文量
371
期刊介绍: JAMA Internal Medicine is an international, peer-reviewed journal committed to advancing the field of internal medicine worldwide. With a focus on four core priorities—clinical relevance, clinical practice change, credibility, and effective communication—the journal aims to provide indispensable and trustworthy peer-reviewed evidence. Catering to academics, clinicians, educators, researchers, and trainees across the entire spectrum of internal medicine, including general internal medicine and subspecialties, JAMA Internal Medicine publishes innovative and clinically relevant research. The journal strives to deliver stimulating articles that educate and inform readers with the latest research findings, driving positive change in healthcare systems and patient care delivery. As a member of the JAMA Network, a consortium of peer-reviewed medical publications, JAMA Internal Medicine plays a pivotal role in shaping the discourse and advancing patient care in internal medicine.
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