B102-16 Impact of Historic Residential Redlining on Chronic Lower Respiratory Disease Prevalence in the US

Abstract Rationale Historically redlined neighborhoods affected by structural racism continue to face widespread poverty, discriminatory mortgage lending, economic disparities, and persistent segregation. The negative impacts of these socioeconomic trajectories persist, contributing to present-day health disparities. However, the association between historic residential redlining and the prevalence of chronic lower respiratory disease (CLRD) remains unclear. Methods We combined census tract-level data, including adult asthma and COPD prevalence from the CDC PLACES 2024 database, historical redlining Home Owners’ Loan Corporation (HOLC) neighborhood grades from the Mapping Inequality project, and social determinants of health data from the CDC’s Social Vulnerability Index and PLACES database. Each census tract was assigned an HOLC grade based on its overlap with historically HOLC-graded areas using a weighted score (1-4, corresponding to historical grades A-D), which was then transformed back into the new categories: A (best, 1.0-1.5), B (1.5-2.5), C (2.5-3.5), and D (redlined, 3.5-4.0). Mediation analysis was performed to estimate potential pathways through which redlining may contribute to disparities in adult asthma and COPD via tract-level mediators, including smoking, lack of insurance, housing insecurity, food insecurity, poverty, unemployment, and education. Results A total of 15,540 US census tracts were included in the analysis. In mediation analyses, residing in redlined census tracts (HOLC Grade C or D) was indirectly associated with higher asthma and COPD prevalence compared with residing in HOLC Grade A/B tracts through multiple neighborhood-level mediators. For asthma, significant mediation effects were observed through smoking prevalence (absolute change in disease prevalence: 0.77% for Grade C and 1.12% for Grade D; % mediated: 120-130%), housing insecurity (0.74% and 1.14%; 88-103%), food insecurity (0.72% and 1.15%; 86-103%), and poverty (0.71% and 1.18%; 98-101%). For COPD, the changes in disease prevalence were larger in magnitude, particularly through smoking prevalence (1.45% and 2.09%; 143-145%), housing insecurity (1.18% and 1.83%; 84-89%), food insecurity (1.29% and 2.04%; 92-100%), and poverty (1.20% and 2.00%; 95-101%). Conclusions Historic residential redlining is significantly associated with higher CLRD prevalence through multiple neighborhood-level mediators. Targeted public health policies and interventions aiming to mitigate the impact of structural racism on CLRD should be prioritized to address health disparities in disadvantaged neighborhoods. This abstract is funded by: None