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Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018
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.
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“Beginning in the 1930s, the Federal Homeowners Loan Corporation (HOLC) created 'residential security maps' of U.S. Cities, color-coding neighborhoods to indicate their perceived mortgage lending risk.20,21”
From Environmental roots of neonatal health: how social and structural exposures shape early-life outcomes (2026) · cites this paper as [21]
In the citing paper
“Neighborhoods with a high proportion of Black, Immigrant, and working-class residents were outlined in red and deemed 'hazardous,' effectively choking off investment.20,21”
From Environmental roots of neonatal health: how social and structural exposures shape early-life outcomes (2026) · cites this paper as [21]
In the citing paper
“Historically redlined neighborhoods that are currently experiencing gentrification or displacement had higher odds of severe maternal morbidity than non-redlined, non-gentrifying neighborhoods.21”
From Environmental roots of neonatal health: how social and structural exposures shape early-life outcomes (2026) · cites this paper as [21]
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How Structural Racism Works — Racist Policies as a Root Cause of U.S. Racial Health Inequities
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Race for Profit: How Banks and the Real Estate Industry Undermined Black Homeownership
Taylor, K.-Y. (2019) · doi:10.5149/northcarolina/9781469653662.001.0001 · Cited by 854
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Jones, C. P. (2001) · American Journal of Epidemiology · doi:10.1093/aje/154.4.299 · Cited by 532
Racial discrimination, John Henryism, and depression among African Americans
Hudson, D. L., Neighbors, H. W., Geronimus, A. T., & Jackson, J. S. (2016) · Journal of Black Psychology · doi:10.1177/0095798414567757 · Cited by 345
Historical redlining and cardiovascular health: The Multi-Ethnic Study of Atherosclerosis
Mujahid, M. S., Gao, X., Tabb, L. P., Morris, C., & Lewis, T. T. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2110986118 · Cited by 161
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Cited by
Nawaz, K., Babata, K., Scheid, L., Bitar, L., Ortiz, N. V., Kota, S., & Chalak, L. F. (2026) · Pediatric Research · doi:10.1038/s41390-026-05139-5 · Cited by 1
Metadata
- Authors
- Gao, X., Morello-Frosch, R., Nuru-Jeter, A. M., Snowden, J. M., Carmichael, S. L., & Mujahid, M. S.
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2024-09-23
- Volume
- 7
- Issue
- 9
- Pages
- e2429428
- ISSN
- 2574-3805
- Cited by
- 17
- References
- 5
- Language
- en
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