American Diabetes Association
Supplementary_Appendix_File.pdf (319.87 kB)

Historic Residential Redlining and Present-Day Diabetes Mortality and Years of Life Lost: The Persistence of Structural Racism

Download (319.87 kB)
posted on 2022-05-31, 14:18 authored by Sebastian Linde, Rebekah J. Walker, Jennifer A. Campbell, Leonard E. Egede


Background: The association between structural racism, as captured by historic residential redlining practices under the Home Owners’ Loan Corporation (HOLC), and present-day diabetes mortality, and years of life lost, remains unknown. 

Methods: Age standardized mortality and years of life lost were combined with historic HOLC redlining data for the city of Seattle, Washington (109 census-tract level sample of observations) for each of the years 1990 through 2014 (25 years). Spatial autoregressive regression analyses to assess the association between an areas’ historic HOLC redlining score and diabetes (and all cause) mortality, and years of life lost were used. 

Results: Spatial autoregressive model estimates indicate that an area’s HOLC redlining score explains 45 to 56% of the variation in the census tract level diabetes mortality rate; and 51 to 60% of the variation in the census tract diabetes years of life lost rate, between the years of 1990 and 2014. For 2014, estimates indicate that areas with a unit higher HOLC grade are associated with a 53.7% (95% CI: 43.3-64.9%; p<0.01) higher diabetes mortality rates; and a 66.5% (95% CI: 53.7-80.4%; p<0.01) higher diabetes years of life lost rate. Magnitudes of marginal effects were consistently larger for diabetes than for all-cause outcomes.  

Conclusions:  Results indicate sizable, and statistically significant, associations between historic redlining practices and present-day diabetes mortality and years of life lost rates. In addition, the persistence of these associations across the 1990 – 2014 period, highlight a need for targeted action to undo the impact of historical redlining on current health.  


Effort for this study was partially supported by the National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede; K01DK131319, PI: Campbell) and the National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker).


Usage metrics

    Diabetes Care


    Ref. manager