Sponsor
This research was supported by the National Institute of Nursing Research (grant Nos. R01 NR017020 and R01 NR020335) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (No. F31 HD106772).
Published In
Jama Network Open
Document Type
Article
Publication Date
9-23-2024
Subjects
Health Research -- Public Health
Abstract
Importance Historically redlined neighborhoods may experience disinvestment, influencing their likelihood of gentrification, a process of neighborhood (re-)development that unequally distributes harms and benefits by race and class. Understanding the combined outcomes of redlining and gentrification informs how the mutually constitutive systems of structural racism and racial capitalism affect pregnancy outcomes. Objective To examine if historical redlining and contemporary gentrification is associated with increased severe maternal morbidity (SMM) odds. Design, Setting, and Participants This cross-sectional study used data from a statewide population-based sample of all live hospital births at 20 weeks’ gestation or more between 2005 and 2018 in California. Analysis was conducted from March 2023 to January 2024. Exposure Redlining (as characterized by the federal Home Owners’ Loan Corporation mortgage security maps) and displacement (using present-day sociodemographic and housing market information). Main Outcomes and Measures Mixed-effects logistic regression models were used to assess the association of census tract–level exposure to historical redlining and contemporary gentrification with increased SMM odds, adjusting for sociodemographic and pregnancy related factors. Outcome classification was based on the Centers for Disease Control and Prevention SMM index, which defines SMM as having any of the 21 procedures and diagnoses based on the International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Results The study sample included 1 554 837 births (median [SD] maternal age, 29.0 [6.4] years; 3464 American Indian or Alaskan Native [0.2%], 224 774 Asian [14.5%], 132 240 Black [8.5%], 880 104 Hispanic [56.6%], 312 490 White [20.1%]), with 22 993 cases of SMM (1.4%). Residents in historically redlined neighborhoods that were undergoing gentrification or displacement were more likely to be Black, Hispanic, and American Indian or Alaskan Native. Independent of individual-level characteristics, SMM odds were greater for individuals living in redlined neighborhoods that experienced displacement (OR, 1.21; 95% CI, 1.14-1.28) and in redlined neighborhoods undergoing gentrification (OR, 1.21; 95% CI, 1.13-1.29) compared with those in continuously advantaged neighborhoods. Conclusions and Relevance Findings from this cross-sectional study demonstrate that the legacies of redlining, intertwined with current dynamics of displacement and gentrification, affect SMM. Place-based sociopolitical mechanisms that inequitably distribute resources may be important intervention points to address structural drivers of adverse pregnancy outcomes and their racial inequities.
Rights
Copyright (c) 2024 The Authors Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.
Locate the Document
DOI
10.1001/jamanetworkopen.2024.29428
Persistent Identifier
https://archives.pdx.edu/ds/psu/42630
Citation Details
Gao, X., Morello-Frosch, R., Nuru-Jeter, A. M., Snowden, J. M., Carmichael, S. L., & Mujahid, M. S. (2024). Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018. JAMA Network Open, 7(9), e2429428.