Mediating Pathways between Neighborhood Structural Investment and Cardiometabolic Health Across U.S. Cities.

Background: Epidemiologic studies have linked neighborhood socioeconomic conditions to health. However, few have examined neighborhood structural investment (NSI) influences on cardiometabolic risk markers across urban environments. This study investigated whether NSI varies by historic redlining, associations between NSI and the prevalence of obesity, diabetes, and coronary heart disease (CHD) and whether redlining's effect on obesity, diabetes, and CHD prevalence are mediated by neighborhood structural investment.

Methods: NSI was measured using a composite score based on census tract data from MapUSA, which included home value, rent, vacant houses, and structures older than 30 years (higher scores representing greater investment). Obesity, diabetes, and CHD prevalence estimates were from the 2024 CDC's 500 Cities 2024 data. Redlining data from the Home Owners' Loan Corporation (HOLC) scores from the University of Richmond's Mapping Inequality Project were analyzed for seventeen U.S. cities. NSI was tested as a mediator of these associations. Models were adjusted for % Black, % of people 60 and older, % of families in poverty, % of people with a college degree, % unemployed, median household income, and length of residency.

Results: Living in a formerly redlined neighborhood was associated with lower NSI longitudinally. NSI was associated with decreased obesity, diabetes, and CHD prevalence, but these associations varied by city. NSI mediated associations between redlining and health outcomes varying by city.

Conclusions: This study suggests that historic redlining is associated with contemporary health outcomes via neighborhood structural investment. Such findings could be used to inform cardiometabolic health intervention designs.